CHOC Children’s Hosts Nutrition and Feeding Conference, Sept. 27-29

An upcoming conference hosted by CHOC Children’s will highlight the impact of diet on the human microbiome, food allergies, and neonatal and surgical nutrition, among other critical topics for infants and toddlers. We spoke to Caroline Steele, director, clinical nutrition and lactation services at CHOC Children’s about what participants can expect at this event:

Q: What is the importance of the “Nutrition and Feeding in Infants and Toddlers” conference?

A: Held on Sept. 27-29, at the Marriott Newport Beach Hotel & Spa in Newport Beach, the conference will give pediatricians, neonatologists, registered dietitians, registered nurses, nurse practitioners, physician assistants, lactation consultants, speech pathologists, occupational therapists, and other pediatric healthcare providers a unique opportunity to receive advanced level education on infant and toddler nutrition.  Emphasis will be placed on the impact of diet on the human microbiome, feeding strategies, food allergies, human milk and formula handling within the healthcare setting, and optimizing care for the surgical infant.

Q: What excites you most about the conference?

A: I am excited about bringing together such an impressive slate of speakers from a variety of disciplines.  We have many nationally known speakers presenting their areas of expertise including Dr. Josef Neu, professor of pediatrics, division of neonatology at University of Florida Health, as our keynote speaker discussing the microbiome and having presentations from four of the authors from the definitive publication on handling of infant feedings within the hospital setting.  The opportunity for attendees from all over the country and from a variety of disciplines to network and share best practices is also going to be a highlight of this conference.

Q: What can attendees expect to learn about infant and toddler feeding?

A: Participants will take away specific tactics for setting up a new centralized human milk and formula preparation room or specific guidelines surrounding allergies from use of the elimination diet for breastfeeding to timing and content of complementary foods to reduce risk of allergies, to the management of food protein-induced enterocolitis syndrome (FPIES) and eosinophilic esophagitis.

Q: What other topic are you looking forward to at this conference?

A: I am looking forward to learning more about the physical and tactile aspects of eating such as what can be done from a pre-feeding standpoint for infants who will have a prolonged NPO status to help promote oral feeding when the time comes or how to prevent picky eating from developing into problem feeding.

Register and learn more about the Nutrition and Feeding in Infants and Toddlers conference.

CHOC Leads the Way in Implementing Food Standards for Dysphagia Patients

CHOC Children’s has emerged as a leader in implementing a new global standard for assessing food and liquid consistencies for patients with swallowing difficulties.

CHOC was one of the first pediatric hospitals nationwide to implement the International Dysphagia Diet Standardization Initiative (IDDSI), which aims to establish a standardized system of measuring and labeling the thickness of food and drink.

The goal is to ensure patient safety and improve treatment outcomes, say Jennifer Raminick and Danielle Monica, two CHOC speech language pathologists who spearheaded the system’s adoption.

Established in 2013 by a group of dysphagia specialists, IDDSI was created to standardize descriptions, consistencies and terminology for diet modifications for patients of all ages, locations and cultures.

The initiative is a marked departure from previous guidelines that relied on ambiguous labels and descriptions that often varied across institutions and providers, and required specialized, arcane equipment to measure food consistency.

IDDSI framework indicators and descriptors.
(c) The International Dysphasia Diet Standardisation Initiative 2016 @http://iddsi.org/framework/.

Conversely, IDDSI guidelines are simple and clear; testing is easy and takes 10 seconds or less; and testing tools are easily accessible to providers and at-home caregivers, Danielle and Jennifer say.

Here’s a brief explanation of the flow testing process to assess a liquid’s thickness: Cover the spout of a 10-mL syringe and fill it with the liquid. With a stopwatch in hand, open the spout for 10 seconds, and then stop the flow. The amount of substance remaining in the syringe is then compared to a rubric to gauge its consistency.

If 1 to 4 mL of the substance remains in the syringe, it is considered of “slightly thick”; 4 to 8 mL remaining is considered “mildly thick”; 8 to 10 mL is “moderately thick” or liquidized; and a substance with 10 mL remaining is “extremely thick” or pureed.

Beyond those categories, food is assessed and labeled as, “liquidized” “pureed” “minced and moist,” “soft and bite-sized” or “regular.” These categories are determined by how the food flows off a spoon or fork, or by measuring a food particle against a ruler.

To implement the program house-wide, the rehabilitation services team partnered with several other departments and disciplines.

Jennifer and Danielle worked with CHOC’s Clinical Nutrition and Lactation department as well as the food service team to create a specific menu for dysphagia patients. It included limited options for each level of consistency and easy-to-follow recipes with three ingredients or less. All food is made from scratch.

The rehabilitation services team developed curriculum for multi-level education of current and new dysphagia therapists, physicians, nursing, dietitians, and food service staff members.

Learn more about rehabilitation services at CHOC.