(238) Utilization of a Speech Language Pathologist to Provide Feeding Therapy in a Pediatric Multidisciplinary CF Clinic

Background: Optimal nutrition and appropriate growth are associated with improved outcomes in children with cystic fibrosis (CF). High caloric goals are often difficult to meet for infants and children with CF. Children with CF can develop oral aversions and other feeding problems, leading to nutritional deficiencies.[1] Interventions at an early age are necessary to help treat these complications and optimize nutrition and growth.[1] A speech language pathologist (SLP) can provide these interventions, however there are often barriers to access SLP services. Identified barriers include additional appointments for medical care, transportation/distance to appointments, lack of feeding therapy insurance coverage, and lack of SLPs familiarity with CF specific recommendations. We aim to increase access and utilization of a SLP to provide feeding therapy for CF pediatric patients to improve feeding habits and overall nutritional and pulmonary outcomes for patients with CF.

Methods: We identified a SLP who worked with CF patients on a referral basis outside of clinic. Parents provided positive feedback related to their experience. After meeting with administration, approval was given for a portion of her time to be spent in a CF clinic with the position covered by the CF center grant. We notified families of the new CF feeding clinic in a newsletter. SLP provided education on feeding therapy to the CF team and created educational handouts for families. We created a survey for families to complete after their appointment in this specialty clinic.

Results: Our first CF combined feeding clinic was held March 2, 2021; subsequent clinics filled quickly. With increased demand, SLP combined clinics doubled to twice monthly November 2021. While this clinic is open for any age of pediatric patient with a need, there is a focus on children < 2 years. We made a goal for infants with CF to be seen in this clinic within the first year of life, ideally around 3-6 months of age. This allows for our team to provide education, assess for barriers surrounding feeding, and offer interventions to optimize nutrition and growth during this developmental stage of transitioning to solid foods. Since implementation of this clinic, 78% (29/37) of children < 2y have been seen at least once by a SLP. 81% (17/21) of infants 0-1y and 75% (12/16) of children 1-2y have been seen, many more than once. A quality improvement survey with 27 participants shows parents feel a feeding therapist improves their overall clinic experience, that the information received was helpful, that they have a feeding plan for home use, and that they would like to continue to see a feeding therapist during the child’s CF clinic visits. Additional results pending.

Conclusions: Having a SLP as part of the CF team increases utilization for patients to benefit from feeding therapy. In collaboration with a RD and other members of the CF team, a SLP offers individualized feeding plans and educates families on feeding issues. By providing increased access to an SLP in CF clinic we hope to increase patient/family satisfaction and optimize nutritional and pulmonary outcomes in CF patients.

Acknowledgements:

References: < [1] Powers SW, Patton SR, Byars KC, Mitchell MJ, Jelalian E, Mulvihill MM, et al. Caloric intake and eating behavior in infants and toddlers with cystic fibrosis. Pediatrics 2002;109: E75-5.