Telehealth offers benefits for the treatment of children with feeding disorders
Many neurotypical and most neurodivergent children suffer from feeding problems. This not only affects the child, but the entire family.
Focused Approach is a startup that helps children aged six months to 16 years with nutritional disorders. The Focused on Feeding program has helped families go from the hospital bed (with malnutrition) to the dinner table – entirely through telemedicine.
In addition to helping individual families virtually, Focused Approach also offers clinics the opportunity to add the Focused on Feeding program to their list of services.
Dena E. Kelly is a licensed professional advisor and founder and CEO of Focused Approach. We interviewed her for a deep dive into nutritional disorders and how telehealth can help.
Q: How did you come up with the idea for the startup to help children with nutritional disorders? And how did telemedicine come into the mix?
A. Nutritional disorders in children are a common problem nationwide. In fact, it is estimated that up to 45% of neurotypical and 80% of neurodivergent children struggle with nutritional problems – not eating the right variety and amount of food. When children have difficulty eating, this not only affects the child, but the entire family.
Over the past fifteen years of working with these children and their families, the biggest barrier has been accessibility to services, either from a physical location or through the waitlist for a program. When COVID hit, it forced everyone to get creative in innovating the way therapy was delivered. For me, that meant switching from hands-on, child-centered therapy to virtual, parent-centered treatment.
What was quickly discovered was that outcomes for most families remained the same, if not improved.
Therapy in the child's familiar home environment, with parents taking the lead in treatment, offers numerous benefits. Families can now access services directly from their own home, allowing the child to immediately generalize the skills they learn. This means that there is no transfer of skills from therapist to parent or from clinic to home environment. The child learns to eat where we want him to eat, with the people we want him to eat with.
Additionally, this approach helps parents avoid the inconvenience of another car trip to a therapy center. Often, families with children with special needs spend much of their day each week driving around to different therapies with no end in sight, as most therapies can require years of service.
By using a nutritional therapy telemedicine platform, families can have the session in their own kitchen while feeding their child a meal. And most families can graduate within six months.
Finally, in addition to significant benefits for patients and their families, there are also direct financial and operational benefits for clinics. Providing nutritional therapy in person in a clinic requires both set-up and clean-up time, which can reduce the number of clients seen daily by 25% or more.
With this form of therapy, therapists must also allow time for late arrivals or last-minute cancellations. This is common because families can be delayed if they need to get from one appointment to another, traffic changes, or a family member's illness. This can cause inconsistencies in therapy sessions and increase the time it takes to reach nutritional goals.
With telemedicine sessions, late arrivals and cancellations are much less common because the session takes place in their own home, so there is no travel involved, and even if a family member is not feeling well, a therapy session can often still take place, reducing the treatment improves. consistency between sessions and a shorter overall therapy time.
Despite the clear demand and need for this treatment, there was still a limited number of therapists trained in feeding disorders in any given area. As I continued to see how families struggled to access care in a timely manner, I knew more could be done.
One of my biggest motivations for opening Focused Approach was finding applied behavior analysis therapists who worked with children who were struggling with feeding issues and didn't know how to approach it, and trained them to move through the refusal more confidently to work. .
This would help more therapists understand feeding disorders and how to treat them, so more children could access the service.
Q. Your program called Focused on Feeding is designed to help families move from the hospital bed to the dinner table through virtual care. Explain how this works and where telemedicine plays a role.
A. Our Focused on Feeding program is designed to help families at many stages of the food refusal journey. We work with families who are able to identify refusal early, usually thanks to another therapist they work with, and they just need some guidance in developing mealtime structure or learning basic eating skills.
We also work with families who have a child who has been refusing for years, but who has recently become a greater concern, due to social, weight or medical issues. The most serious cases are families who were often unaware that help was available for feeding disorders and that the child's nutritional intake was so low that hospitalization and a feeding tube were required.
The therapy includes both direct involvement with the child and parent/caregiver training so that the family can learn how to modify interactions with the child to improve eating behavior. Each case is individual in terms of what the sessions look like from day to day, but usually requires a lot of preparation on the part of the parents to make the sessions successful.
The child will always look to the parent's response to learn how to behave – we see this outside of mealtime too.
Because the sessions are heavy on parent/guardian training, in most cases it is easier to conduct the sessions via telemedicine because they are the ones leading the sessions and we are there to provide support in implementing techniques that were discussed in the training.
The program thrives on the opportunity to collaborate with other disciplines the family may already be working with. Occupational therapists and speech therapists can be a great support in helping a child eat successfully. Medical professionals such as gastrointestinal physicians and registered dietitians are helpful advisors in ensuring that the child's physical body is growing appropriately and overcoming any medical barriers to successful feeding.
Feeding problems can be extremely complex and if a child has a team of healthcare providers who can bring together their areas of expertise, this gives the child the greatest chance of improving overall symptoms.
Q. Choose a case and discuss the results of using the program and how telemedicine helped.
A. A family called me from their daughter's hospital room, desperate for help. Their 12-year-old girl had become so malnourished that she had lost significant weight and had to have a feeding tube inserted to force intake.
The medical team wanted to enroll her in a hospital program to combat her food refusal, but the parents were against the idea. They wanted her to be treated from home. I agreed to take on the case.
The treatment was delivered entirely via telemedicine and was initially very tough during the parent training sessions as they had to address the environment they had created and figure out how they were going to make adjustments to make it a positive eating environment for their daughter.
During the first few weeks, each family member experienced a roller coaster of emotions. Treating them virtually gave me easier access to support them as needed between their regularly scheduled sessions. The kid started making profits almost immediately. As her oral food intake increased, her mood and energy levels improved and her parents became more confident in carrying out the protocol.
She became more internally motivated to eat and required less direct intervention. Within six weeks, she was able to remove the feeding tube and feed herself with oral food consumption. This was made possible through consultation with her GI doctor and registered dietitian.
Her parents have learned techniques to help her cope with challenges that arise and it has allowed them to eat out, both socially with friends and at restaurants as a family. This family went from a six-week daily intensive intervention to once-a-week check-in sessions and will continue to reduce the frequency of sessions over the coming months until they no longer require continued consultation.
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