Paediatric Feeding Team referrals

The Fiona Stanley Hospital Paediatric Feeding Team provides multidisciplinary outpatient care for children with paediatric feeding disorder (PFD).

PFD is defined as ‘impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skills and/or psychosocial dysfunction” (Goday et al., 2019).

Medical conditions associated with PFD include:

  • malnutrition or faltering growth
  • prematurity
  • enteral tube feeding
  • multiple food allergies impacting on feeding
  • ENT/airway issues (laryngomalacia, interarytenoid notch, laryngeal cleft)
  • gastroenterology issues including gastro-oesophageal reflux disease (GORD) and eosinophilic esophagitis (EoE)
  • cardiac issues
  • aspiration pneumonia.

Indicators a child may have PFD include:

  • <20 foods accepted, whole food groups missing, food refusal
  • difficult behaviours and family stress at mealtimes
  • difficulty maintaining growth
  • bottle refusal or aversion
  • difficulty transitioning to solids
  • coughing, choking, excessive gagging when eating or drinking
  • oral motor difficulties (reliance on purees, difficulty chewing, spitting out foods) .

Referral criteria

Inclusion

Referred patients must:

  • be 8 years of age and under
  • live in the Fiona Stanley Hospital catchment*
  • present with PFD requiring medical assessment and monitoring
  • require input for PFD from 3 or more allied health disciplines.

* Patients who live outside the Fiona Stanley Hospital catchment but within the South Metropolitan Health Service (SMHS) catchment (external PDF 2MB) may be eligible to access the service on a case-by-case basis with consideration of:

  • availability of a tertiary multidisciplinary feeding team in the child’s local catchment area
  • the risk of hospitalisation if services are not provided
  • the requirement for medical governance and allied health input from 3 or more disciplines.

Patients with PFD who access National Disability Insurance Scheme (NDIS) supports may be seen for case formulation and provision of recommendations for their community service provider where their feeding complexity necessitates tertiary medical monitoring. This is time-limited service for assessment and provision of a multidisciplinary report.

Exclusion

Referrals will be declined if the patient meets any of the following exclusion criteria:

  • lives outside the SMHS catchment
  • is over 8 years of age
  • fussy eating in line with normal development.

Refer a patient

When making a referral please include the following information:

  • patient name and UMRN
  • ‘Referral to Multidisciplinary Feeding Clinic’
  • presenting feeding difficulty
  • relevant medical and growth history, current growth parameters
  • current community health involvement
  • NDIS eligibility and involvement 
  • important psychosocial circumstances.

Referrals are triaged on eReferrals fortnightly by the consultant paediatrician following case discussions at multidisciplinary (MDT) intake meetings.

GP referral

Referrals should be sent to the WA Health Central Referral Service (external site).

  • Fax: 1300 365 056
  • Postal address: GPO Box 2566, St Georges Terrace, WA 6831

Referrals are accepted on the letterhead of the consultant or GP, generated from your practice software or using an online referral form templates (external site)

Internal referral

If the child is a Fiona Stanley Hospital inpatient, or an outpatient with medical governance at Fiona Stanley Hospital, please refer via eReferrals (external site) and complete the site and unit fields as follows:

  • Site – Fiona Stanley Hospital
  • Unit – Paediatric Medicine [PAE] / Medical [MEDI].

Our team

Our multidisciplinary team provides the following care.

Paediatrician

  • Medical governance for the care of patients.
  • Medical assessment and management:
    • for underlying medical conditions causing, or contributing to, feeding difficulties.
    • of comorbidities associated with feeding difficulties, for example aspiration pneumonia, growth restriction, anaemia.
  • Screening for associated developmental delays and disorders and on refer to developmental services as appropriate.

Dietitian

  • Assesses food and nutrition related history including:
    • current dietary and fluid intake
    • mealtime routine and preparation
    • physical activity and function
    • access to food
    • food knowledge, beliefs, attitudes and behaviour.
  • Nutrition focused physical findings.
  • Practical recommendations on dietary improvements regarding the quantity, quality, routine and variety of the diet.
  • Dietary advice to support adequate growth including caloric fortification and micronutrient supplementation as required.
  • Starting, adjusting and transitioning from enteral feeds.

Occupational therapist

  • Assesses:
    • how physiological and sensory regulation impact child’s ability to participate in feeding and mealtimes and provides adjustments to feeding environment set up.
    • the impact of acute and chronic medical needs on mealtimes, for example pain/trauma, gut function, tube feeding, reflux, prematurity, nausea, etc
    • daily routines and sleep-wake routines to support mealtimes.
  • Assessment and intervention of developmental factors to support successful mealtimes.
  • Supports transition from tube feeding to oral feeding.
  • Provision of aides and equipment as required (postural seating, modified cutlery, etc).

Speech pathologist

  • Infant feeding assessment (breast or bottle feeding) where there are concerns for swallow safety or coordination.
  • Developmental feeding assessment for babies starting solids and learning to chew.
  • Recommendations on texture modification for drinks and/or diet.
  • Referral for videofluoroscopic swallow study where needed.

Clinical psychologist

  • Short-term assessment, support and treatment (up to 10 sessions) to caregivers and the caregiver-infant dyad, when worry or fear is exacerbating and/or maintaining the feeding problem (parental anxiety/tension at mealtimes is contributing to distress in infant).
  • Assesses and treats for parental/carer emotional and psychological distress, and recommendations for ongoing psychological supports if required.
  • Assessment and intervention for family system dynamics which may contribute to feeding challenges.

Social worker

  • Welfare assessment and liaison with child safety services as required.
  • Assistance with onward referrals to appropriate services and community supports on behalf of the family.
  • Support and advocacy for families to access the care they need from various health professionals.
  • Practical assistance to patients and families experiencing financial hardship.
Last Updated: 18/06/2024