In the News: CHOC’s Feeding Program

Dr. Mitchell Katz, a CHOC Children’s pediatric gastroenterologist, recently appeared on the radio program “Good Food” on KCRW to offer insight into the challenges parents face when their child can’t or won’t eat.

Dr. Katz is the director of CHOC’s Multidisciplinary Feeding Program and pediatric GI lab services.

CHOC’s multidisciplinary feeding program is one of only a handful of specialty feeding programs in the United States to offer comprehensive outpatient consultation and inpatient programs.

Children under evaluation and treatment for feeding disorders at CHOC have typically failed outpatient feeding therapy and have either a feeding tube or at risk for a feeding tube. Patients  can have a range of medical problems, or difficult behaviors that make meal times a struggle. The program receives referrals from throughout the country.

Listen to Dr. Katz’s insight below:

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A Palatable Solution For Feeding Disorders

If every meal with your child is a struggle, leaving you concerned that the problem could be more than a dislike for vegetables, it’s time to find out why. CHOC Children’s is nationally recognized for evaluating and treating young children with serious feeding problems, including those who have previously failed outpatient feeding therapy.

Learning how to eat and enjoy food is as much a developmental skill for your child as walking. If that process is interrupted by prematurity or a serious illness, an infant may miss the important first steps.

As medicine advances, more infants and young children are going home dependent on feeding tubes. new20150204_choc_00559Yet the transition to eating food by mouth is a complex learning process that involves far more than a spoon. It may also be complicated by such underlying medical conditions as acid reflux, food allergies or gastritis.

The Multidisciplinary Feeding Program at CHOC Children’s — the only one of its kind on the West Coast — offers a positive, holistic approach to feeding disorders. The program, which receives referrals from throughout the country, has grown and recently moved its treatment space to the third floor of the CHOC North Tower. The expanded space includes two feeding therapy treatment rooms, plus a central area equipped with state-of-the-art audio visual equipment, where families and staff may remotely watch therapy sessions in real time. The system also includes an audio feed, allowing therapists to provide advice and coaching when parents are alone in the room with their child.

In June 2015, a third team of physicians, nurses, nurse practitioners, occupational therapists, speech pathologists, social workers, developmental psychologists and dietitians will be added.

CHOC team members have presented at regional and national professional conferences, and have begun publishing their results in peer-reviewed journals.

“We only provide positive reinforcement,” said CHOC Children’s pediatric gastroenterologist Dr. Mitchell Katz, who directs the program. “First, we work on resolving the medical part of the puzzle, and then we focus on the behavioral aspects and work through the child’s fear and anxiety.”

In addition to outpatient services, a 19-day inpatient program is available for children with the most severe feeding disorders. A parent is admitted, too, and receives parenting and behavioral skills designed to improve the quality of life for the entire family.

“Children do not automatically grow out of severe feeding disorders,” Dr. Katz said. “But with direction and guidance, they can get better.”

For more information or to schedule an evaluation, please email feedingprogram@choc.org or call (714) 509-4884.

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When Kids Have Diarrhea

Just like constipation, diarrhea is also a common problem in children of all ages, a CHOC Children’s gastroenterologist says.

“There are many different causes from lactose intolerance to celiac disease to structural abnormalities to food allergies to inflammatory issues,” Dr. Mitchell Katz says. Infections are a common cause but so can dietary factors affect stooling. A common scenario is “toddler’s diarrhea” where an otherwise healthy toddler has persistent diarrhea due to excessive consumption of juice.

Diarrhea may go away by itself or it can last for days. Dr. Katz says it’s time for a parent or caregiver to seek help from a doctor if:

  • The child cannot drink enough in order to maintain hydration
  • There is blood in the child’s stool
  • The child has other symptoms of an illness that can’t be explained
  • The child appears ill
  • The child has significant weight loss
  • The child has a high fever
  • The child has persistent abdominal pain or his abdomen is distended

“The best way to treat diarrhea is to treat the child for the underlying illness that may be associated and to keep the child hydrated”, Dr. Katz says. If the child has a bacterial infection that is causing diarrhea, the infection may need to be treated, and antibiotics may be prescribed, he adds.

Keeping the child hydrated is critical, Dr. Katz says. When a child has diarrhea, with or without vomiting, large amounts of fluid can be lost from the body. Excessive fluid loss can lead to dehydration, and when the body loses too much water, it can body functions.

The best fluid to give the child is an electrolyte solution with a small amount of sugar in it, such as a product called Pedialyte or Enfalyte, says Dr. Katz. Also, avoid giving the child milk for at least two or three days may be advisable in certain circumstances.

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A Bright Future: Pacer’s Story

There’s no shortage of cool patients in these parts, and I just met another who has CHOC to thank for a bright future.

Pacer’s first family meal didn’t happen until he was 4 years old. Until then, he ate through a feeding tube, never experiencing a Thanksgiving feast, Halloween candy or birthday cake. But thanks to his commitment and five weeks of treatment at CHOC’s Multidisciplinary Feeding Program, Pacer learned to eat, and now he can down more chicken fingers than this always hungry bear!

Meet Pacer in this video, and hear from his parents, Quinn and Mekell, about why they traveled all the way from Montana to Orange County to get Pacer the treatment he needed to ensure a bright future.

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Kids and Stomachaches

stomach_ache_boyFACT OR FICTION?

“No matter what the cause of the stomachache, the pain is real,” says Dr. Mitchell Katz. So what causes tummy  trouble?  It can be as specific as an ulcer, a dietary issue, pneumonia or a sinus infection. “Stomachaches are extraordinarily common. Although always a concern, the majority of kids with abdominal pain do not require urgent intervention,” says Dr. Katz.

INSPECTOR GASTRO

To decide how serious the pain is and whether it’s organic (like an ulcer or appendicitis) or non-organic (like stress), parents need to pay attention to the location. “If the pain is under the belly button there is a greater likelihood that the pain is nonorganic than if it is further away from the belly button,” says Dr. Katz.

Other common causes of  abdominal issues:

  • GI tract infection
  • Acid reflux
  • Constipation

MEDS OR MEDICAL ATTENTION?

Parents have to take a step back and judge the severity of the pain when deciding to give their child medications for stomach issues, says Dr. Katz. “If they think the issues are due to something as simple as a few missed bowel movements, there’s no harm in a stool softener. If significant pain is present, it’s always better to call your primary care provider to talk about the condition,” says Dr. Katz.

WHEN WILL THE ACHE GO AWAY?

“The vast majority of stomachaches can be diagnosed and dealt with after an appropriate history and physical examination,” says Dr. Katz. If these red flags are present, call your doctor:

  • Blood in stool
  • Change in appetite, body weight
  • Pain that interrupts sleep
  • Diarrhea
  • Vomiting
  • Fever

FAST FACTS

  • The age range in which most cases of appendicitis occur: 10-30 Years Old
  • The number of hours that heartburn can last: 2 Hours
  • The number of Americans that develop at least one ulcer during their lifetime: 25 Million

View the full feature on Kids and Stomachaches

Dr. Mitchell Katz Pediatric Gastroenterologist
Dr. Mitchell Katz
Pediatric Gastroenterologist

PHYSICIAN FOCUS: DR. MITCHELL KATZ

Dr. Katz is currently director of CHOC’s multidisciplinary feeding team, pediatric GI lab services, and the division of pediatric gastroenterology and nutrition. He was a fellow in pediatric gastroenterology and nutrition at the University of California, San Francisco and is a five-time recipient of the Orange County Medical Association’s Physician of Excellence award.

Dr. Katz’s philosophy of care: “Listening carefully to the child and the parent. Explore where the child and the family are in life and understand the interrelation between health and emotional well-being.”

EDUCATION:
State University of New York at Downstate Medical School

BOARD CERTIFICATIONS:
Pediatrics and Pediatric Gastroenterology

More about Dr. Katz

This article was featured in the Orange County Register on October 27, 2013 and was written by Shaleek Wilson.