Research and advocacy

The Feeding Program is driven by an evidence-based practice approach. This means that the Feeding team looks to validate their clinical approach and treatments with evidence that tracks our patients’ progress and confirms these treatments are effective. Below are a few recent published articles that showcase our team’s positive outcomes from our treatment approaches:

Retrospective study to evaluate the effectiveness of an inpatient feeding program to help children wean off a gastrostomy tube (g-tube). This study reviewed the data of 77 patients who were admitted into our inpatient feeding program. The results of this study showed significant improvement in oral calorie intake, mealtime environment and feeding behaviors for the patients. After two weeks of treatment, 51% of the patients were fully weaned from their tube. These patients also maintained nutritional stability and tube independence at their one year post treatment follow-up appointment. This study’s results confirmed that our inpatient interventions are a safe and effective approach in helping long-term tube feeding children transition to oral feeding. Article

Retrospective study to identify the adverse effects that occur when appetite manipulation is used for g-tube weaning. Appetite manipulation can be an effective approach for children weaning off of their g-tubebut can result in dehydration, low blood sugar and loss of appetite. At Children’s Wisconsin, we admit medically complex patients to the hospital to perform g-tube weaning in a safe environment. Our team performed a retrospective study of 143 patients who underwent appetite manipulation. Results showed that 78.2% of these patients experienced at least one adverse event, such as signs of dehydration or low blood sugar, which emphasizes the need for monitoring in an inpatient setting by a team with expertise in feeding disorders. Overall, the study found that appetite manipulation is the safest for the patient when done in the inpatient setting and that our inpatient program demonstrated positive outcomes for the patient as it relates to time to discharge and adverse events. Article

Study to evaluate the effectiveness of intensive outpatient feeding programs. While intensive outpatient feeding programs are often used to treat severe feeding disorders, there was little to no information available that described treatment protocols for an intensive outpatient program and little information on clinical effectiveness. The Feeding Program addressed this with a paper that described our treatment protocol and evaluated the clinical outcomes of the protocol. The findings of the study included improvement in caregiver/child interactions at mealtime and improved caregiver use of effective mealtime strategies. The data also showed decreases in caregiver distress, as well as caregiver perceptions of their child as “difficult”. The study confirmed the effectiveness of our intensive outpatient treatment program and its aim of supporting caregivers in learning effective strategies to help their child in feeding. Article 

Beyond the clinical and research work, our team understands the importance of advocating for children who struggle with a feeding or swallowing disorder. Below are a few examples of how our providers are working in the field to improve outcomes for our children:

Leadership in feeding advocacy groups: We are proud to have our specialists sit on the medical council for Feeding Matters, the first organization in the world dedicated to advancing the research, identification and collaborative care of pediatric feeding disorders.

Feeding Research Consortium: In 2017, the Feeding team was integral to the creation of the International Pediatric Feeding Research Consortium (IPFRC). The IFPRC is an alliance of some of the top academic interdisciplinary feeding teams in the country, with a mission to promote more consistent data collection and information sharing amongst the consortium partners.

Defining a code for medical reimbursement: In 2016, members of the feeding program met along with 18 other healthcare professionals to create a universally accepted definition of PFD. The consensus definition was published in January 2019. 

The Feeding team is exceptionally active in research on pediatric feeding disorders. Their findings have helped improve the standard of care for children nationwide. Through their research, the team has been recognized worldwide for their leadership in pediatric feeding disorders and has been invited to share their expertise across the globe.  

See below for a full listing of the Feeding team’s most recent accomplishments (2018 - 2023):

Publications

1. Begotka A, Long B, Goday PS, Silverman AH. Caregiver Impressions of Clinical Effectiveness of an Intensive Behavioral Feeding Program. Clin Pract Pediatr Psychol 2018. 6:248–258.
2. Feuling MB, Goday PS. Pediatric Nutrition. In Pediatric Swallowing and Feeding: Assessment and Management, 3rd edition. 2018.
3. Goh V, Goday PS. Assessment of Nutritional Adequacy. In Rudolph’s Pediatrics. 23rd Edition. 2018.
4. Larson-Nath C, Goday PS. Normal Nutritional Requirements. In Rudolph’s Pediatrics. 23rd Edition. 2018.
5. Larson-Nath C, Mavis A, Duesing L, Van Hoorn M, Walia CLS, Karls C, Goday PS. Defining pediatric failure to thrive in the developed world: validation of a subjective diagnosis tool. Clin Pediatr (Phila). 2018. doi: 10.1177/0009922818821891
6. Larson-Nath C, St. Clair N, Goday PS. Hospitalization for Failure to Thrive: A prospective descriptive report. Clin Pediatr (Phila). 2018;57:212-219. doi: 10. 1177/0009922817698803. PMID: 28952374 
7. Matta SK, Goday PS. Nutritional issues in the toddler to adolescent years. In Rudolph’s Pediatrics. 23rd Edition. 2018.
8. Pollow A, Karls C, Witzlib M, Noel R, Goday PS, Silverman A. Safety of Appetite Manipulation in Children with Feeding Disorders Admitted to an Inpatient Feeding Program. J Ped Gastr Nutr. 2018;66:e127-e130. doi: 10.1097/MPG.0000000000001849. PMID: 29210920.
9. Silverman, A. H. & Begotka, A. M. (2018). Psychological and Behavioral Disorders in Dysfunctional Feeding: Identification and Management. In Ongkasuwan & Chiou (Eds.), Pediatric Dysphagia: Challenges and Controversies, (pp. 281-302). Springer International Publishing.
10. TK Kaenkumchorn, Goday PS. Poor Weight Gain. Curr Treat Options Peds. 2022. 8:369–381. doi:10.1007/s40746-022-00253-y
11. Wall, M & Silverman, A. H. (Dec 2018). Psychological Aspects and Behavioral Issues in Pediatric Feeding. In Arvedson & Lefton-Greif (Eds.), Pediatric Swallowing and Feeding: Assessment and Management (3rd ed.). Plural Publishing. 

Invited Lectures/Workshops/Presentations/Site Visits:

International

1. Silverman, A. H. Assessment and Management of Pediatric Feeding Disorders: Making the Case for Interdisciplinary Management. Workshop Presentation to Ogolnopolski Zjazd Polskiego Towarzystwa Gastroenterologii, Hepatologii I Zywienia Dzieci (General Congress of the Polish Society of Gastroenterology, Hepatology and Nutrition of Children), Lublin, Poland. May 2018
2. Silverman, A. H. Feeding Therapy: Clinical Approaches & Challenges. Grand Rounds Presentation, Memorial Institute, Warsaw, Poland. May 2018
3. Silverman, A. H. Neurological Impairments in Pediatric Feeding Disorders: Special Considerations for Clinical Assessment & Treatment. Presentation to Ogolnopolski Zjazd Polskiego Towarzystwa Gastroenterologii, Hepatologii I Zywienia Dzieci (General Congress of the Polish Society of Gastroenterology, Hepatology and Nutrition of Children), Lublin, Poland. May 2018
   

National

1. Arvedson JA, Delaney A, Goday PS. Pediatric Feeding Disorder (PFD) Diagnosis & the New PFD ICD Code: A Panel Discussion.  The American Speech-Language-Hearing Association (ASHA) Convention. Washington, DC. April 2022
2. Begotka, A., & Kovacic, K., Medical and Behavioral Treatment of Choking Phobia. Poster presentation at the NASPGHAN Annual Meeting, Hollywood, FL. 10/2018.
3. Begotka, A., & Kopesky, J., Tackling Feeding Problems in Children with Metabolic Conditions. Invited lecture at the 2022 Genetic Metabolic Dietitians International conference, Henderson, NV, 5/6/2022. 
4. Burrell, L. Stubbs, K., Lukens, C. T., Silverman, A. H. & Dempster, R. Addressing the Unmet Need: Novel Treatments of Pediatric Feeding Disorders. Platform presentation to the 2018 Society of Pediatric Psychology Annual Conference, Orlando, FL. April 2018
5. Daniels, S., Martino, R., Silverman, A. & Suiter, D. Swallow Screening: Purposefully Different from an Assessment-Sensitivity Specificity Related to Clinical Yield, Interprofessional Roles, Patient Selection. Platform Presentation to the 2018 Charleston Swallowing Conference: Innovation to Implementation in Dysphagia Practice, Chicago, IL. July 2018
6. Dodrill, P & Silverman, A. Beyond Oropharyngeal Borders: Indications & Implementation of a Behavioral Treatment Approach in Children. Platform Presentation to the 2018 Charleston Swallowing Conference: Innovation to Implementation in Dysphagia Practice, Chicago, IL. July 2018
7. Gosa, M., Lefton-Greif, M. & Silverman, A. Facts & Fallacies of the Most Commonly Used Infant Feeding Practices Platform Presentation to the 2018 Charleston Swallowing Conference: Innovation to Implementation in Dysphagia Practice, Chicago, IL. July 2018
8. Miller, A. & Silverman, A. Maturing & Aging Brainstem Mechanisms – Which Aspects of Swallowing are Hard-Wired or Adaptive? Platform Presentation to the 2018 Charleston Swallowing Conference: Innovation to Implementation in Dysphagia Practice, Chicago, IL. July 2018 

Regional

1. Aldinger, M., Begotka, A., Feuling, M.B., & Goday, P. ASHA Voices: Teaming Up to Treat Pediatric Feeding Disorder, Podcast interview for American Speech Language Hearing Association (ASHA). 1/20/2022.
2. Aldinger, M., Begotka, A., Hilbrands, J., & Kovacic, K. Pediatric Feeding Disorder and the Feeding Team Clinic. Invited presentation to Birth to 3 providers, Milwaukee, WI, 3/31/2022.
3. Begotka, A., Feeding and Anxiety Disorders. Invited presentation at Children’s Wisconsin, Psychiatry Nurse Practitioner Didactic seminar. Milwaukee, WI, 1/6/2022.
4. Begotka, A. & Goday, P., A Multidisciplinary Protocol for Treating Choking Phobia. Pediatric Grand Rounds, Children’s Wisconsin, Milwaukee, WI, 3/18/2022.
5. Begotka, A., Interdisciplinary Approach to Phagophobia. Invited presentation at Children’s Wisconsin, Children’s Gastroenterology Division meeting. Milwaukee, WI, 1/12/2022.
6. Begotka, A., Multidisciplinary Care for Children with Phagophobia. Virtual Food Science and Nutrition Conference. 2/14/2022.
7. Begotka, A., Understanding Phagophobia and the Role of the Speech and Language Pathologist. Invited presentation at Children’s Wisconsin, Speech and Language pathologist “Feeding Frenzy” meeting. Milwaukee, WI, 10/14/21.
8. Bitong, J., Van Hoorn, M., Aldinger, M., & Wall, M.A., Pediatric Feeding Disorder and the Feeding Clinic Team. PowerPoint presentation at Pediatric Grand Rounds. Children’s Wisconsin and Medical College of Wisconsin. Milwaukee, WI, 12/2020
9. Goday, P., Clark, B., Crouse, J., Hettich, K., Silverman, A., Van Hoorn, M., & Zorek, K. Everything You Wanted to Know About Nutrition but Didn’t Know Where to Look. Platform Presentation to the Best Practices in Pediatrics and Pediatric Emergency Medicine, Wisconsin Dells, WI. March 2018