Tag: Team

Interdisciplinary Team


Hello readers!

Today, I wanted to take the opportunity to define a big word for everyone! Interdisciplinary. Big long and kinda intimidating! Our great google search engine found this for me as a definition: “a team a group of health care professionals from diverse fields who work in a coordinated fashion toward a common goal for the patient.

Why is this important?

You may also hear the word, “multidisciplinary” – also a very long and kinda intimidating word. But it’s meaning is very different. That same lovely search engine helped to also define this big ‘ole word: “a group of health care workers who are members of different disciplines, each providing specific services to the patient.”

When you come to see the UNC Feeding Team, you will see three different disciplines who work together to provide a common goal to our patients…in other words…we do not work in a vacuum. We truly use the expertise each provider brings to the table to formulate a plan together.

What does this look like in practice? From the medical provider perspective, I will share an example.

Patient A has been seeing our team for 6 weeks. I have started the patient on a reflux medication and our dietitian has started him on a formula that is far easier to digest than previous. All three disciplines gather in the room for a follow up with the patient. A’s parent reports that he is no longer vomiting and is stooling regularly, at least twice daily. He has taken more volume of food at each sitting since adding in more purees (see previous post) but has really not expanded his diet to accept a greater variety of foods and flavors.

The speech therapist then moves forward with feeding the patient for her portion of the visit. Following her therapy session, she comes to both myself and the dietitian and says, “He did a great job opening his mouth, he was not exhibiting any obvious symptoms of reflux and did not gag. However, he was not interested in the food. He did not seem hungry.”

We then have a discussion and decide together to start the patient on a medication for appetite stimulation and recommend adding a high calorie additive (butter and/or cream if the child is able to tolerate dairy) to enhance flavors of puree. I prescribed the medication, the dietitian makes recommendations for the additives and the speech pathologist recommends behavioral strategies to combat any potential refusal to eat.

This example helps to illustrate our team approach. We do not go into patient rooms individually and offer suggestions only specific to our expertise. We pull on the vast knowledge of our colleagues who, together with our knowledge, can provide true best outcomes for our feeding kids.

The UNC Feeding Team is just that, a team…and if you want to get technical…call us interdisciplinary…

Expectations for Your First Visit

As a team, we thought it would be helpful to outline what you can expect for your first visit with the UNC Feeding Team.

First things first: parking at the NC Children’s Hospital takes a lot of patience and time.  Please prepare for both, by leaving your house 30 minutes earlier than you would typically to come to Chapel Hill. Please park in the visitor’s deck and know that you will walk across a sky bridge to the front of the Children’s Hospital.  You will then ask whomever you first see to direct you to the Outpatient Specialty Clinics on the ground floor.  You will then receive a ticket for a number, you will wait until that number is called, and you will then be checked in for your appointment.

You will then be directed to a waiting room. The waiting room has sand tables for kids, televisions and magazines.

You should wait about 15 minutes to come back to the clinic to get checked in by our nursing staff.  This is our goal.  We appreciate your time very much and will do our very best to run on time and to give you the courtesy of a “check in” by our nursing staff if we are running late.

In the event we are running behind, some parents have found it helpful to bring along some of their child’s favorite toys or travel activities.

Once checked in, the nurse will take your child to be weighed and measured in a small “check in” area in the front of our specialty clinics. One this task is completed, you will be taken into an exam room.  Your provider will then be notified of your readiness to be seen.

This first visit will take approximately two hours.  Please come prepared for this duration.  It is imperative that you bring food to this visit, as we are a feeding team, with the goal of assisting you and your child in a better way of eating and enjoying mealtimes together which we cannot do without watching your child eat.  We ask that you bring a food your child prefers, one he or she does not prefer and one that you would like he or she to eat.  We do have a microwave, but this is not in the exam room and takes extra time to prepare.  Foods that do not have to be warmed are best.  Please also bring spoons, cups, bottles and nipples – anything you use to feed your child.  We do have a variety of different supportive seats (highchairs) for your use.

You will meet with all three disciplines, including pediatric gastroenterology, pediatric speech/language pathology and pediatric nutrition.  Because there are three disciplines and we are a teaching hospital, the small rooms can become a bit cramped.  We try our best to accommodate for this by rotating time spent by each discipline in each room.  Each provider gathers information necessary to complete a holistic feeding history for each individual child.  We will ask questions, beginning with prenatal history, extending to the current day of the visit.  All of the information is important in building our plan of care as a team.

You can expect that we will discuss medical management.  We are a medical-behavioral program.  We believe in treating underlying GI issues and ruling out GI disorders before moving on to teaching children to eat.  We use medications and formulas to prepare the GI tract to be the most comfortable and prepared to receive and absorb nutrients for proper growth and development.

Because each patient is different, each plan of care is different.  Your child may have lab work done on the first visit. Your child may have an abdominal x-ray done on the first visit.  You may be asked to start your child on a new medication to treat reflux or constipation, two of our most common medical ailments in children with feeding difficulties.  You may be asked to switch formulas and feeding schedules through your child’s gastrostomy tube.  We may talk with you about additional procedures or referrals.

The first visit can be overwhelming, as there is a lot of information shared and interpreted, with new plans of care initiated.  We welcome your questions during the visit and following.  We will provide you with direct contact to our nurses and schedulers, who can readily reach us and allow us to communicate with you regarding any questions you may have.

Our follow up visits are typically about 4-8 weeks out with frequency determined by severity of feeding problem.