Feeding and Swallowing Center Day – Hospital Feeding Program

Learn about what you can expect at the Day Hospital Intensive Feeding Program at the Children's Hospital of Philadelphia, which helps children learn to eat a larger amount and variety of food and fluid.



Narrator : Your child has been recommended for the intensive Day Hospital Feeding Program at the Children's Hospital of Philadelphia located in the Children's Seashore House Building on the Philadelphia campus. This treatment program helps children learn to eat a larger amount and variety of food and fluid by teaching parents to manage mealtime refusal behaviors. We see a variety of children who resist eating for a number of different reasons, including medical problems, developmental issues and sensory issues. Most children stay in the program a total of four weeks, coming into the hospital every day Monday through Friday.

Families need to arrive as early as 8:00 am and typically leave by 4:00 pm. During that time children participate in three feeding therapy sessions a day. At first children eat in a one-on-one setting with a trained feeding therapist who uses a strict set of mealtime rules. You will initially be observing these therapy sessions from an observation room. By the end of the program you will be taught to use the same rules so that your child will continue to eat in this same way at home. Each day you and your child will check in at the day hospital room. There is a TV, an outside play area, tables, chairs and cubbies for personal belongings in this room. Think of it as your home base. In the day hospital room you will meet a nurse and other staff members. The day hospital staff is there to provide you with useful information about the hospital and general information about your admission.

One of the biggest challenges of the Day Hospital Program is the amount of unstructured time in between feeding therapy sessions. These feeding therapy sessions are scheduled three hours apart to make your child as hungry as possible. Your child may also participate in supportive therapies such as oral-motor therapy or occupational therapy. However, these sessions are typically scheduled no more than once to three times per week.

Between Feeding Therapy Sessions

Narrator : Outside of these therapy sessions we encourage you to take advantage of a number of resources available in the hospital. There is an indoor playroom with a variety of toys, puzzles and books. There is also an outdoor terrace where kids can run around safely. The Connelly Resource Center is another popular space. Families may use the computers there and check out items from their library. Some kids enjoy the activities in the atrium of the main hospital as well. Families are also encouraged to explore activities outside of the hospital. Many families take a short walk to a nearby fish pond. For young children who may need to nap we provide a small nap room where they can rest. We will also provide you with a list of various activities that may be going on in the hospital during your admission. These may include story time for kids and coffee hours for parents.

During the long days that you are here you will need to eat as well. There are several options for your own food during the day. We strongly recommend you pack your own lunch. There are microwaves available for use in the hospital. If you do not bring your lunch there are places where you can buy lunch including two cafeterias. These cafeterias offer soups, salads, deli counter, fresh entrees and boxed entrees daily. There is also an Au Bon Pain at the hospital. It offers a variety of coffee, soups, salads and sandwiches. Another option at the hospital is McDonalds. There is also a Java City which is a small convenience store located in the Children's Seashore House. Java City carries coffee, snacks and a limited assortment of boxed lunches. Lastly, there are a variety of street vendors and neighborhood restaurants within walking distance of the hospital.

Feeding Therapy Sessions

Narrator : When it is time for your child's feeding therapy session, our staff will watch your child while you make your way to the observation room. The goal of each feeding therapy session is to help your child successfully eat by having them follow a set of mealtime rules. At the beginning of each meal, your child will hear the same basic rules.

Therapist : Jake, if you take your bite, then we get to play. If you don't take your bite, I'm going to help you. And if you still don't take your bite, you won't get to play. Give me five.

Narrator : When your child follows the therapist's instructions to take a bite then they'll be rewarded with toys and cheering. After they have had a chance to play then we'll take the toys away and then instruct them again.

Therapist : Take your bite.

Narrator : If your child does not follow the instructions then their consequence will be very different. Rather than getting the toys and other rewards, all the toys will be placed out of their reach and the therapist will turn away from them. This is to teach them that they will not get any attention or anything fun when they refuse to eat. After being ignored for a short period, the therapist will offer another bite and instruct your child again, "Take a bite." The primary goal of these feeding sessions is to establish a consistent set of expectation for your child's behavior. The rules that your child is learning puts you in charge of the meal.

We use positive reinforcement to encourage your child to eat by providing praise and attention for good behaviors such as chewing, swallowing and accepting the bite. Ignoring refusal behaviors such as throwing food or crying will discourage your child from demonstrating those behaviors. Keep in mind these feeding therapy sessions will not look like a typical mealtime. For example, your child will only ever see one bite of food at a time and only very small bites. This will keep your child from feeling overwhelmed by seeing too much food in front of them. Our goal is to help your child be successful with following the mealtime rules and accepting their bites. The ultimate goal is to provide you a way of managing your child's behaviors at mealtimes effectively.

The first step in the training process is to observe your child's therapy sessions. You will learn about the feeding therapy strategies by watching the therapist and your child interact with one another. You will see how the therapist responds to any refusal behaviors managing them through the use of the structured mealtime protocol and having your child take their bites. The goal is for you to learn to use the same techniques as the feeding therapists to increase your child's acceptance at meals. Staff will speak with you about the sessions you are watching and will be able to answer questions that you may have. You are encouraged to ask questions to learn and understand as much as possible about the mealtime rules being used with your child. When you watch the meals, pay attention to both the therapist and your child. What is the therapist doing? What is your child doing? How does the therapist react to your child's behaviors? There are handouts in the observation room that contain helpful information about the feeding strategies that we use. Each meal will be recorded for review by staff and caregivers. When the therapy session is over, you will meet your child and your therapist again. Be happy and excited for your child when you see them again. They did a lot of hard work and are learning to follow the mealtime rules. Your time in the observation room is a good opportunity to start thinking about this new way you will eat with your child at home after you have been trained in the feeding therapy techniques.

Hands-on Caregiver Training

Narrator : Hands-on training usually begins by the fourth week of your child's admission. Your training will be a gradual process with the goal of passing the torch from the feeding therapist to you. Through this training you will have the skills to be your child's feeding therapist. Training will start with you, a therapist and your child in the meals. At first the therapist will start meals and feed most of the bites of food to your child. Gradually, the therapist will have you feed a few bites at each meal until you are feeding your child the whole meal. Once you have practiced doing the whole meal from telling your child the rules to giving them their last bite, you will feed your child with a therapist watching from the observation room. Once you are independently feeding meals at the hospital, we will provide you with specific instructions for practicing meals at home. Maintaining a consistent eating routine at home will help your child continue to eat everything they have learned to eat during their admission. After you have completed the training process, we want you to feel confident about feeding your child. Even if your child demonstrates some refusal behaviors at home, you will be able to manage these behaviors by using the techniques you learned during your child's admission. Once your child is officially discharged from the program, you will be fully trained to feed your child at home using the structured meal protocol.

After Discharge

Narrator : For the first two weeks after discharge, you and your child should do at least two structured meals per day. These meals should be done in a quiet one-on-one setting just as they were done in the hospital. Even siblings should be occupied in a separate room so that your child can focus on eating. During this time the amount of food and variety of food that they are eating will not change from when they were discharged. This is an important time for you and your child to adjust to this new way of eating at home. After approximately two weeks you will return for your first follow-up appointment with your child to review how your child is eating at home. We will continue to meet with you and your family every one to two months on an outpatient basis. During the several months following discharge you and your family will work on increasing the amount and variety of food your child eats at each meal. Over time we will help you fade out the structured mealtime protocol as well. The average length of time you will work with the team is at least six to 12 months after discharge but this is based on individual progress.

Parent Perspectives

Mom 1 : My experience has been great. From the time just even starting with the feeding team everyone's been very helpful and on top of James and trying to figure out his, you know, different health issues that he has. I was a little, you know, nervous coming in because I knew that it's an intense program. And I was, you know, a little, you know, nervous to find-- like what to expect from it, you know, and what to watch. But it worked out and, you know, I've had a very good experience from everything.

Mom 2 : It's been great. Bennett came in here not eating, pretty much not eating anything at all. And after just a week was pretty much not refusing his bites anymore, was taking really good bites for the therapists. And, of course, then by the third week we were feeding him and now the fourth week we're going home. So pretty exciting.

Mom 1 : I guess the hardest part was the free time. For me it's, you know, it's having a child like a one-and-a-half year old just trying to occupy their time and, you know, just finding something to do. And the hardest part--and then also not being able to, you know, eat in front of your child because you're not allowed to--

Unknown Person : Yeah.

Mom 1 : You know, have them have the food, you know, in between a session. So that was a little difficult because, you know, you're kind of like sneaking around and stuff. I knew that I had a lot of free time and to make sure, you know, that I had things to do with the free time with James. So it was helpful to know all that prior to coming in.

Mom 2 : Because I think one of the hardest things for me as his mom was wanting him to eat. And then when he picked up on taking the bites in here and he wanted to eat outside, I had to say, "No." And at first that feels a little uncomfortable because -- in your mind you're thinking the whole purpose is to get them to eat so we should feed them when they want to eat. But realizing that is not helpful and that would have not helped him feel hungry. And then the second thing is really just watching him with the struggles that he did make and being on the other side and not being able to rescue

Mom 1 : The day or two before they told me I was going to train, I was very nervous, you know, because, you know, you want to do the best for your child, you know. It's just a lot of steps to follow. So I was a little nervous with that. But I feel now that I've done it a couple times and I've actually done it. They assigned his meal for the first time and it went well so I'm feeling positive about it.

Mom 2 : The simplicity of the program really worked very well. Because I think when we first saw it, it seems almost so simple that you think, "Oh, I must have tried that at some point at home." Or you think that maybe you could even like, "Oh, we could do that." And what was interesting about it is that it worked so well for you guys and then when we came into the room, he went right back to the way he was. And we had to start that process and work with it and just seeing it work the whole way through which was amazing. I'm actually at this point finding it a little sad to be leaving because he has loved all of his therapists so much. And the experience has been so positive that just seeing him take bites and be happy about doing it has made a huge difference in both of our lives. So it's sort of going to be sad to leave.

Narrator : Our team is committed to assisting you and your family achieve your feeding goals. If you have more questions about our program please feel free to contact us. Thank you for your time.

Topics Covered: Intensive Day Hospital Feeding Program

Related Centers and Programs: Martha Escoll Lubeck Feeding and Swallowing Center