Nutrition and Feeding

Feeding is the act of eating and swallowing. Nutrition refers to the quality and quantity of nourishment a child needs for physical growth, thinking and learning development and normal body processes. 

Many children who have complex conditions also experience trouble with feeding and nutrition. 

At Gillette Children's, nutrition and feeding services are provided by registered dietitians. A registered dietitian is a medical provider and trained nutrition expert that can provide individual nutrition recommendations. Our registered dietitians provide comprehensive medical nutrition therapy to infants, children, adolescents, and adults with nutrition and feeding problems. Research has proven that nutrition is the foundation of growth and development, and we aim to help all patients thrive and grow. Our team of registered dietitians works closely with other medical teams to ensure that nutrition is optimized during hospital stays and in outpatient specialty clinics. Each patient at Gillette is unique, and we strive to meet the individual needs of the patient.

Because our dietitians collaborate closely with the outpatient medical teams, including participation with the Complex Care Clinic, Feeding Clinic, Craniofacial Clinic, Neuromuscular Clinic, GI Clinic and Ketogenic Diet Clinic, they have extensive knowledge of medical and nutrition conditions that may be considered “rare” in other settings. We also see patients independently if they have been seen by a medical provider within the Gillette organization.

A registered dietitian is available on every inpatient care unit at Gillette Children’s. We participate in interdisciplinary rounds with the inpatient care team each morning. If your child requires a nutrition assessment and evaluation during their inpatient stay, the dietitian will consult with you and the medical team to develop a nutrition care plan and provide nutrition education as needed. We work closely with Regions Food and Nutrition Services to help provide meals and tube feedings that meet your child's specific needs.

Your Care Team of Registered Dietitians at Gillette Children's

• Stephanie Campbell RD, LD
• Ashley Clintsman MS, RD, LD
• Julia Lang MPH, RD, LD
• Karri Larson RD, LD
• Carol Skerbitz RD, LD

Many of the children who have feeding and nutrition issues experience the following:

• A need to follow special diets, such as the ketogenic diet or low glycemic index diet, to treat epilepsy and seizures.
• A need to take medicines that create nutritional challenges.
• A need to use feeding tubes.
• A swallowing disorder (dysphagia).
• Conditions that affect appetite, such as Prader-Willi syndrome.
• Motor conditions that affect their ability feed themselves or nurse successfully.
• Problems with the sensation of eating or swallowing food (oral aversion).
• Weak muscles in the mouth or face. 
• Inadequate weight gain.
• Excessive weight gain.

Several complex conditions can lead to nutrition and feeding problems, including:

• Cerebral palsy
• Brain injury and related neurotrauma
• Spina bifida
• Spinal cord injury
• Complex movement disorders
• Neuromuscular conditions
• Epilepsy and seizures
• Autism spectrum disorders
• Being overweight or obese
• Being underweight
• Conditions that affect bone health (or a history of taking medicines that affect bone health)
• Conditions that require a feeding tube
• Developmental delays
• Swallowing disorder (dysphagia)
• Prader-Willi syndrome
• Prematurity

Supported by the latest equipment and techniques, your child has many options for getting the nutrition they need through programs at Gillette Children’s Specialty Healthcare.

Feeding Evaluations and Therapy

During feeding evaluations, Gillette specialists test your child to measure their skills related to feeding. For example, some children:  

• Can’t tolerate certain food textures (food aversion).
• Experience anxiety at mealtimes.
• Have a hard time chewing or swallowing.

We evaluate many factors during the test, including your child’s:

• Anatomy.
• Behavior.
• Diet.
• Level of independence with feeding.

In some cases, we recommend a swallowing study. This full-motion X-ray shows whether food and liquid can move safely from your child’s mouth to their esophagus.

After a feeding evaluation, we might recommend feeding therapy sessions at Gillette. We often work with families to develop a home feeding program.

Additional Nutrition and Feeding Services

In addition to feeding evaluations and therapy, your child might benefit from the following services:

• Help starting or maintaining the ketogenic diet and low glycemic index diet to manage epilepsy and seizures.
• Neuromuscular electrical stimulation (NMES) to improve swallowing.
• Nutrition management for kids who have feeding tubes.
• Radiology and imaging tests, including upper gastrointestinal X-rays and gastric emptying tests.

Treatment approaches

Based on your child’s needs, our feeding team might recommend the following treatment approaches:

Before you can schedule a feeding evaluation at Gillette, you must get an order from a physician—either at Gillette or from another facility. The order must show the need for any of the following:

• An interdisciplinary feeding evaluation.
• An evaluation by a speech and language pathologist.
• An occupational therapist and a dietitian.

Once we receive an order, we’ll contact you to schedule a feeding evaluation. Both before and after the test, our team will be in close touch with your referring physician to organize effective care.

To help with the evaluation, we might ask you to bring the following mealtime items to your appointment, so we can better understand what routines your child is accustomed to:

• Drinks.
• Food or formula.
• Formulas, rates and quantities for tube feeding (if relevant).
• Plates and cups.
• Silverware.

Care providers can schedule a nutrition appointment with a dietitian for general nutrition concerns such as diet assessment and evaluation, tube feeding/enteral nutrition care plans, or any special nutrition needs. Families may also access nutrition services through the specialty clinic that is already treating their child. Appointments can be in person at one of our Gillette Clinics, or virtual if appropriate. If your appointment is virtual, it is very important to have a recent weight and length measurement.

If your child has trouble with eating and nutrition due to a complex condition or injury, you might need extra help making sure they get the nourishment they need. Gillette specialists understand the unique challenges you face as parents and caregivers of children who have disabilities. We also recognize that each child’s nutritional needs and feeding preferences are unique.

Working closely with you, our team of experts will develop a comprehensive nutrition and feeding plan designed for your child and your family. We take an integrated approach to nutrition and mealtime, referring your child to other Gillette specialists as needed.

Your child’s core nutrition and feeding team will include specialists in:

• Dietetics.
• Occupational therapy.
• Speech and language pathology.

As part of a comprehensive treatment plan, we’ll help you coordinate care from experts in areas such as:

• Ear, nose and throat (ENT or otolaryngology)
• Gastroenterology
• Medical genetics and genetic counseling
• Neurology
• Pediatrics and general medicine (pediatricians and nurse practitioners who specialize in height and growth concerns)
• Psychology
• Radiology and imaging