NSU Horizons Fall 2017

21 NSU HORIZONS a feeding tube or expand the nutrition variety from formula, said Lesack. Services are provided Monday through Friday for multiple meals per day during a six- to eight-week period. Clients range from nine months old through adolescence. The clinic also serves as a teaching program for students representing multiple disciplines, such as clinical psychol- ogy and applied behavior analysis from NSU’s College of Psychology, and speech-language pathology from NSU’s Dr. Pallavi Patel College of Health Care Sciences. The clinic’s staff includes NSU speech-language pathologist Jennifer Pusins, C.Sc.D., CCC-SLP, a lactation consultant who works with nursing infants having swallowing difficulties. Lesack said children can learn to like new flavors and textures, which she introduces through gradual exposure. Some children might spit out a small piece of broccoli, for example, so it is pureed to a serving size no larger than a grain of rice as to make the experience as least aversive as possible. Clinicians may start with four bites of a preferred food before introducing a tiny bit of broccoli. “The phobia is a fear of anything new,” Lesack said. “Every parent is really afraid their child is going to go hungry. The child has learned over time if they cry loud enough, they’re probably going to get what they want.” Successful treatment is about breaking patterns, she added. “We tell them we have to make sure they’re going to stay healthy and the food is so tiny, it’s not even worth the screaming or the kicking because it’s going to go away so fast once they swallow it,” said Lesack. Slowly, over time, the amount of food is increased. Eventually, it is “not so scary anymore,” she noted. Toys, movies, and iPads are used to enrich the environ- ment. Sometimes staff members engage with the clients by singing songs to ensure the child is having a good time during treatment. This also may include getting the child to drink something new such as milk or water or even take medication. Lesack tells parents there are three reasons humans want to eat: nutrition necessary for survival, social interaction such as birthday parties or family dinners, and emotional impact. “That’s an important piece of what food represents in our culture and inte- grating that is something we target for all treatments we do,” she said. In outpatient cases, Lesack typically sees significant progress in eating new foods within two months, with four to eight months being a normal course of treatment. The program is data driven, including measuring the length of time until a child accepts a bite of food and the child’s behavior during the feeding. Lesack says one aspect of her job she finds most mean- ingful is helping parents with the stress and desperation they feel over feeding issues. “A parent’s first responsibility is to care for their child, so when they are not able to do that because the child won’t eat, it causes such stress in the home,” she said. “If they’re not getting the proper nutrition, they’re not going to be able to do all of the things we expect our children to do on a daily basis.” One otherwise healthy child demonstrated a food phobia that manifested itself on his second birthday, when he appeared to be repulsed by his birthday cake. The cause was unknown. Occupational therapy that included food therapy did not derive satisfactory results. He finally started drinking smoothies that his mother blended from a variety of nutritional food items to augment his preference for crunchy foods. After several months of twice-weekly treatment with Lesack, the boy has been doing “amazing,” eating a greater variety of foods, some of which he previously rejected, his mother said. “Parents are crying because it changes their whole dynamic when they can sit down and have a meal together,” said Lesack. “I love my job.” Visit nova.edu/unicornclinics for more information on the feeding clinic. n The NSU Feeding Disorders Clinic is one of seven of its kind nationwide.