Johns Hopkins All Children's Hospital

Happy Mealtimes

An Intensive Feeding Program

Why an Intensive Feeding Program?

For most children, eating is a fun and necessary part of each day. One in four children, however, experience some type of feeding problem. Some feeding problems prevent children from eating enough to grow.

Children with a medical history of tube feeding can have some of the most challenging feeding problems. Often they don't know what it feels like to be hungry or full. They may also have oral motor and sensory problems, and inexperience with feeding and aversive feeding behaviors. The complex nature of their feeding difficulties often makes traditional outpatient treatment less effective. Families become frustrated, and children remain unable to successfully transition to oral feedings.

Only a few programs in the country are designed to address the complex needs of children who are being weaned from long-term gastric (G-tube) or nasogastric (NG-tube) feeding. Happy Mealtimes specializes in helping families through this process. Additionally, the program is designed to help prevent the need for tube placement for children who are at risk or failing to thrive.

At Johns Hopkins All Children's Hospital, "Happy Mealtimes" is modeled after other nationally respected feeding programs. Our program provides multiple daytime sessions over a four-week period. Children and families may stay at the Ronald McDonald House on the Johns Hopkins All Children's Campus (for a small fee) so they can be available for a full schedule of day treatments.

What is the Goal of the Program?

The goal is simple: to get kids eating!

During this four-week program we plan to:

  • Reduce reliance on feeding tubes by 50%
  • Increase amount of food taken by mouth by 50%
  • Provide ongoing follow-up for families and their local therapists to assist with weaning from feeding tubes within one year
  • Prevent the need for supplemental feeding tube placement for children who are underweight or failing to thrive

How Does the Program Work?

Intensive treatment is the key to the program's success. But the good news is that children do not need to be hospitalized during the program. Children and parents outside of the local area may stay in the very comfortable Ronald McDonald House on the Johns Hopkins All Children's campus. This makes it easy for families to attend multiple outpatient therapy sessions each day during the four-week program.

Feeding Therapy

A certified Speech Language Pathologist who specializes in pediatric feeding sees each child for multiple sessions every day (breakfast, morning snack, lunch, and afternoon snack). The feeding therapist helps both parent and child with these strategies:

  • Enjoying positive eating
  • Decreasing behaviors that interfere with eating
  • Improving oral motor skills necessary for eating age appropriate foods
  • Increasing food intake amount and variety
  • Gradually decreasing dependence on tube feeding

Occupational Therapy

A pediatric Occupational Therapist evaluates each child and determines if occupational therapy services are needed. Each child might receive therapy up to five times a week to promote independent feeding. The occupational therapy sessions will include age-appropriate activities for each child and parent education. The therapist may use a neuro-developmental approach to assist with positioning needs and motor skills. Sensory processing activities are also used to help children tolerate new foods and textures and learn to enjoy the social aspects of eating.

Nutritional Services

A registered pediatric Nutritionist evaluates each child's current growth, caloric and nutritional needs at the start of the program. Children are seen several times during the program and intake is reviewed weekly to monitor growth and nutritional status.

Medical Services

Your physician's approval is required for participation in Happy Mealtimes.  Our team will work with your current gastroenterologist throughout the program to consult regarding the tube weaning process and any related medical issues.  If you are not currently followed by a gastroenterologist, we can assist you in obtaining an appointment to be evaluated by a board certified pediatric gastroenterologist located near our facility. 

What Happens at the End of the Four-Week Program?

After a child is discharged from our intensive feeding program, our staff keeps in touch with parents by phone. Follow-up calls are made, calorie intake is monitored, and the child's weight is monitored. We provide ongoing input and consultation with the feeding therapist who works with each child near home. This helps us meet the ultimate goal of complete tube weaning within one year.

How can I Enroll my Child?

With Physician agreement, the program is available to families with children who are:

  • 18 months or older, with cognitive skills at or near age level
  • Currently receiving a portion of nutritional needs through tube feedings, but who are medically able to achieve full oral feeding. These children must have transitioned successfully to bolus feedings equivalent to a normal mealtime schedule for their age/developmental level
  • At risk for requiring supplemental tube feedings

Families must demonstrate a strong commitment to attending and fully participating in the four-week day treatment program and follow-up outpatient services. They should have evidence of limited prior success with traditional programs despite consistent attendance. They will need to provide full and complete medical and treatment records.

For More Information Contact:

Johns Hopkins All Children's Hospital
Speech Language Pathology Dept