- Associated Press - Saturday, July 23, 2016

BALTIMORE (AP) - Helping children overcome feeding disorders is painstaking work. Sometimes the first step is just to touch the food.

Not eat it, not taste it, just touch it. It may not sound like much, but clinicians say it’s a crucial first step to helping children overcome their aversions to food.

That’s one of the goals of Mt. Washington Pediatric Hospital’s Feeding Clinic, which offers an intensive, six-week program to help address feeding disorders - conditions where a child can’t or won’t eat. The program’s team of psychologists, occupational therapists and speech therapists work one-on-one with the children, three meals a day, throughout the program.

Some children may be accustomed to feeding tubes and need help learning to chew and swallow; others may have stopped eating certain foods, or even all but one food - and it’s much more than just being a picky eater.

One former patient, for example, was autistic and would only eat McDonald’s French fries fresh from the fryer; his parents had a special arrangement with the restaurant so he could eat French fries for breakfast, said Dr. Richard M. Katz, the hospital’s chief medical officer, who specializes in pediatric gastroenterology.

The hospital’s feeding clinic was established in 1995, and the six-week Feeding Day Treatment Program launched in 2001. Children who don’t make enough progress with their regular therapy at the clinic move to the intensive program; less-intensive therapy continues when the six weeks are up.

Between 8 and 12 patients attend the Feeding Day program at a time, and between 75 and 80 children are treated each year.

“It’s a very slow process for many of them,” Katz said, explaining that each patient has different goals. Some may go from being exclusively tube-fed to less than 25 percent tube-fed; for others “all we want them to do is take a few bites of some new food,” he said.

Occupational and speech therapists help patients work on chewing and swallowing, while psychologists focus on reducing anxiety connected to food.

That may start with a step as small as touching the food a few times - then moving on to kissing it, licking it, and eventually taking a small bite, said Ellen Wingert, an occupational therapist and manager of the feeding day program.

Toys are frequently employed as rewards, or to reduce anxiety, for those little steps, Wingert said.

On July 18, seven-year-old David Avetisyan, whose diet usually consists of canned milk, was working with a psychologist to eat cereal - one Rice Krispie at a time. The feeding session was combined with a round of the card game Uno, and the boy couldn’t take a turn until he finally took a bite.

“This really is enormous for him,” Katz said. “His mother’s thrilled that he can do that.”

A key part of the therapy is that for the first few weeks, parents aren’t allowed in the room during meals - but they can watch on a closed-circuit TV down the hall. That’s an important part of disrupting the usual eating routine so a new one can be established, Wingert said.

“We totally change all the rules,” she said. “The parents aren’t there to save them . it’s a whole new place, new people, a whole new set of rules.”

During the last two weeks, the parents are brought back in the room during meals to help make sure the new habits stay in place when the child starts eating at home, Wingert said.

Sonali Wickrema’s 4-year-old daughter, Seren Brown, finished the six-week program on July 15. Seren was born three months prematurely and needed a breathing tube and tracheotomy as well as feeding tubes, Wickrema said.

Seren developed an aversion to any type of food because it interfered with breathing. She began her treatment at Mt. Washington with monthly oral therapy sessions, which continued until clinicians felt she was ready for the six-week program.

“It was about getting her to trust food,” Wickrema said. “Every day (Seren) would run to the clinic because she loved it so much.”

At the outset, she could eat infant purees and nibble on some dissolvable foods like graham crackers, but it might take 15 minutes for her to eat what another child her age could eat in two; by the end of the program, she was eating those items faster, as well as vegetable sticks, tomatoes, and blueberries, Wickrema said.

Seren still needs a feeding tube to make sure she gets enough nutrition and will continue with outpatient therapy. But she’s made great progress during the six weeks, Wingert said.

Wickrema said the benefits aren’t limited to her daughter.

“A year ago, I couldn’t feed her,” she said, explaining that the process filled her with stress and anxiety. “Now I love sitting down and having a meal with her.”

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Information from: The Daily Record of Baltimore, https://www.thedailyrecord.com

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