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Complex Feeding & Nutrition

We provide consultative services, including medical management, nutrition counseling and feeding therapy, to children with complex feeding and nutritional issues that are difficult to manage.
Your Visit

Our Goals

The Complex Feeding and Nutrition Service (CFNS) is a comprehensive interdisciplinary team that strives to anticipate and respond to the needs of infants and children whose complex feeding and nutritional issues cannot be addressed by their community. We are committed to enhancing the health and well-being of these infants and children, as well as their families, by providing excellent family-centered clinical care. We are a knowledgeable, skilled and caring team and we will provide nutrition and feeding education and support to health care providers within the organization as well as the community.

Your Visit

During the visit, your child will be seen by the interdisciplinary team, comprised of a nurse, a pediatrician, a dietitian and, if required, an occupational therapist and a social worker. 

Teaching and counseling will be provided according to your child's and family’s needs. Reports will be sent to the health care professionals involved in the child’s care.

If further investigation is required, your child may be referred to the appropriate service or for diagnostic studies (Upper GI, Videofluoroscopic Swallowing Study, Endoscopy, etc.). 

If your child has a feeding impairment, we may ask you to bring some food so that we can observe your child eat.

Our Programs

We have several programs to manage feeding and nutrition problems.

The Steps to Feeding - Tube Transition clinic offers a two-week, outpatient based, intensive feeding intervention designed to increase oral eating for children who are tube fed. For more information see the handout.

Feeding impairment can be defined as the inability or the refusal to eat sufficiently to support growth and maintain adequate nutritional stores. They may be related to an underlying medical condition, swallowing difficulties, oral-motor difficulties, sensory food aversions, a poor appetite or behavioral challenges. (note - we do not have the resources and appropriate team make-up to deal with predominantly behavioral feeding issues)

Intestinal failure can be defined as the bowel’s inability to absorb nutrients and fluids sufficiently to support growth and maintain adequate nutritional stores. 

Causes of intestinal failure include:

  • short bowel syndrome
  • a history of intestinal resections
  • a history of intestinal atresia or gastroschisis

CHIRP (Children's Hospital Intestinal Rehabilitation Program) is a multidisciplinary program which provides inpatient and outpatient services to patients with intestinal failure. The CHIRP team involves members from a variety of backgrounds including pediatrics, nutrition, gastroenterology and surgery. CHIRP follows all infants and children who require home parenteral nutrition support in British Columbia. 

Our Team

The Complex Feeding and Nutrition Service is a part of the Division of Gastroenterology, Hepatology, and Nutrition at BC Children’s Hospital.

Medical director
Linda Casey, MD

Vishal Avinashi, MD


Soleina Karamali, RD (on maternity leave)
Natalie Sousa, RD (temporary)
Debby S. Martins, RD


Occupational Therapist
Rochelle Stokes, OT

Social Worker
Kathryn Urquhart, SW

Clerical staff
(604) 875-2345, local 7464

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SOURCE: Complex Feeding & Nutrition ( )
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