If appropriate, we will schedule an initial pre-program evaluation with your family to determine your child's readiness for the program. Please note that this does not guarantee acceptance into the program.
The pre-program evaluation is typically an hour long. We are an interdisciplinary team, you will see the entire team at the same time. You will see a doctor, a dietitian, a nurse, an occupational therapist and a social worker for a pre-program evaluation. During this evaluation, we will ask about your child's medical history, growth history, feeding and nutrition history, mealtime routines and behavior at mealtimes. We will discuss your goals and concerns, and we will answer your questions about the program.
If your child is ready for the program, we will discuss potential dates with you. You must obtain approval for out-of-province care, including arrangements for accommodations in BC, before the start of the program.
Due to interprovincial licensing agreements, we are not able to make recommendations during the virtual pre-program evaluation. If your child is not ready for the program, we will provide pre-program suggestions directly to your pediatrician and community therapists to help them progress towards being ready. Your local care team must agree to assume all responsibility for implementing any pre-program suggestions.
- In the days leading up to the program, your child will have a medically approved and supervised decrease in their calories and fluids. Our dietitian will email you a reduction plan that will typically start on the Thursday before the program starts.
- Our clinic is located on the second floor of the BCCH Ambulatory Care Building. Follow the yellow ribbon on the floor to Area 10 – Gastroenterology, Hepatology and Nutrition. Check in with the feeding therapist (dietitian, occupational therapist or social worker) every morning. Most often, breakfast starts at 8:30am and lunch starts at 12:30, but we can adjust these times depending on your child's routine.
- The feeding therapist will measure your child's weight every morning, before breakfast.
- During the program, we will see your child for breakfast and lunch, 4 days per week (typically Monday to Thursday) for 2 consecutive weeks. At least one parent or caregiver needs to attend feeding therapy sessions. Sessions generally model typical family meals. A feeding therapist will facilitate each session.
- We will record everything your child eats and drinks in a food diary during the program. We will ask you to record what your child eats and drinks during snacks and dinner from Monday to Thursday, and at all mealtimes from Friday to Sunday. We will discuss this in more detail on the first day of the program.
- Depending on your child's progress and weight, the dietitian may recommend changes to your child's diet, formula or fluid intake.
- The feeding therapist will ask you standard questions each morning. These questions are asked either before or after the meal (depending on how hungry your child is), so that the focus can be on enjoying the family together once it starts. There will be no feeding "therapy" taking place during meals.
- Recommendations for the next meal or next day will be provided after the meal.
During the 2-week, in-person, intensive program:
- Our physician will provide medical recommendations as needed.
- We will provide recommendations regarding feeding and nutrition.
- We will communicate with your pediatrician and community therapists as needed.
Your child will be discharged from the Steps to Feeding – Tube Transition Clinic after the 2 weeks, in-person, intensive program. Your referring pediatrician and community therapists will resume all care at that time. Our team will provide a detailed report for you and your team, along with recommendations and a suggested plan for community team follow-up.
After the program, we can provide advice to your child's pediatrician and community therapists as needed. All communication about your child must go through your local care team.
If you have previously provided consent to be part of our research study, we will collect data at 2 weeks, 5 weeks, 9 weeks, 6 months and 1 year after the program. This will either be done through your community team or directly from you. Due to interprovincial licensing agreements, we are not able to provide recommendations directly to you, but you can reach out to your local team.
By referring your child to the Steps to Feeding program, your pediatrician and, if applicable, community therapists, agree to meet the above criteria.