Feeding disorders

The Montreal Children’s Hospital Pediatric Feeding Program provides services to children with feeding disorders, whether or not the child already has a medical diagnosis. However, children with medical diagnoses, poor weight gain, and who are dependent on a feeding tube are given priority.

Children who are referred to the program range in age from a few months to four years of age. The treatment depends on the type of feeding disorders that the child is experiencing. For children who are dependent on a feeding tube, the program staff creates a step-by-step process (a protocol) so that the child can make the transition to oral feeding (eating by mouth). The protocol is tailored to the individual child and family. When needed, the staff call on professionals outside of the Pediatric Feeding Program. As well, the psychologists use psycho-education, and if needed, supportive psychotherapy in the process.

Children with poor weight gain receive nutritional support and are often treated with an appetite stimulant, along with restructuring mealtimes and modeling mealtime interactions. Occupational therapists focus on helping the child build feeding skills and reducing oral hypersensitivities.

Children with disruptive mealtime behaviours are treated with behavioural techniques related to behavioural analysis. The overall goals are to create normal mealtime behaviours within the home setting and reduce hospital visits, resulting in an enhanced quality of life for the children and their families.

The program staff sometimes provide consultation to second-line services in the community when requested. 

The first Feeding Disorders Clinic was established in 1988 at The Montreal Children’s Hospital by three dedicated professionals. Several years later, in 1996, an occupational therapist started the Dysphagia Clinic to compliment the services offered to children with swallowing problems.

Under the direction of Dr. Maria Ramsay, the pediatric psychologist responsible for initiating the Feeding Disorders Clinic, services expanded to provide care for more complex feeding problems. In 2008, the Quebec government approved the merger of the two clinics to create the present Pediatric Feeding Program (PFP) with the following goals:

1. Provide tertiary care for Quebec children who suffer from feeding disorders or growth failure.
2. Offer training for future health care professionals
3. Encourage and guide research in the field of feeding disorders.

Presently, the Pediatric Feeding Program offers a multidisciplinary approach (bringing people from various specialties together) for the evaluation and treatment of infants and children with a variety of feeding problems. The approach combines the expertise of clinical psychologists, nutritionists, occupational therapists, a behavioural specialist and a gastroenterologist. An intake secretary and coordinator of the program’s patient services ensures that families move smoothly through the evaluation and treatment process.

Staff members

• Rena Birnbaum, MSc, Occupational Therapist
• Nathalie Carr, MSc, Occupational Therapist
• Michelle Lyon, MA, Behavioral Specialist
• Dr. Chantal Martel, Psychologist
• Cinthia Olivier, P.Dt., Nutritionist
• Line Parent, BSc, Occupational Therapist
• Dr. Mafalda Porporino, Psychologist 
• Dr. Maria Ramsay 
• Dr. Ana Sant' Anna, Gastroenterologist
• Dr. Catherine Zygmuntowicz, Psychologist 

The Pediatric Feeding Program currently provides services in two different locations: in the Child Development offices on second floor of the Montreal Children’s Hospital, and in the basement of a separate facility (Les Tourelles). At Les Tourelles, the treatment rooms are set up with the necessary motivational toys, food, and equipment for behavioural or occupational therapy interventions. Depending on the treatment chosen, the patient may be followed in the hospital unit or at Les Tourelles. At the new MCH, the Pediatric Feeding Program will be located with the Brain, Development and Behaviour and Allied Health Services.

The Pediatric Feeding Program provides empirically supported treatment for children with feeding disorders, using a family-centered, culturally-sensitive focus. Feeding disorders include poor weight gain, feeding tube dependence, distress and anxiety with new food tastes or textures, lack of motivation to eat, and mealtime tantrums.

The following services are offered to children on an outpatient basis.

Feeding Disorders Clinic: All initial assessments for feeding disorders are conducted in this clinic by one of the pediatric psychologists. Appetite regulation, the child’s ability to eat, and mother child behaviours and interactions during an observed mealtime are assessed. Assessments form nutritional and occupational therapists follow as needed. A gastroenterologist monitors medications and medical issues in general for the child. The clinic offers psycho-education, and supportive psychotherapy for mothers combined with behavioural intervention for the mother and child together. In addition, the pediatric psychologists in this clinic regularly participate in the teaching and supervision of trainees in psychology and medicine, as well as collaborate with the various other medical services in the hospital.

Swallowing Disorders Clinic: Provides specialized assessment of dysphagia (difficulty with swallowing), along with fluoroscopy (imaging technique using X-rays).

Intensive Feeding Unit: Provides more intensive services for children who are dependent on feeding tubes, or whose feeding disorder requires a more intensive approach. This unit has two programs:

• Sensory-Motor Treatment Unit: This treatment uses a sensory-motor based individual or group approach with children who are unable to eat or become distressed by new foods or textures.
• Behavioural Treatment Unit: This treatment is based on applied behaviour analysis (ABA) and related techniques designed for children whose feeding behaviours are more disruptive in nature.