Transforming Moments

Jacori’s Story

The Case for Day Patient Treatment

When Carol Elliott, OTR/L, Occupational Therapist, began treating Jacori last fall, her first goal was to get him to sit in a highchair without screaming. As she worked to prepare him for treatment, she partnered with the Feeding Team’s physician to adjust his reflux medications and other team members to work on behavioral issues and identification of allergy-safe foods for Jacori’s diet. Given the complexities of Jacori’s challenges, she recommended day patient treatment to provide a more intensive approach.

After Jacori began calmly sitting in the highchair, Carol focused on weaning him from the bottle, which had replaced daytime use of the feeding tube, and increasing the amount and types of food Jacori ate so she could eventually wean him from the feeding tube altogether. Carol used positive reinforcement like watching a few seconds of a favorite video to teach Jacori to take a bite and swallow without spitting.

Carol gradually introduced new, pureed foods to let Jacori adjust to the new flavors, test him for allergic responses and increase his stomach’s tolerance for adding food volume. In only 8 weeks, he went from eating 18 grams to 179 grams of food at each meal. He also learned to feed himself small amounts with a spoon, drink formula from a squeeze bottle instead of a baby bottle and chew select table foods without spitting.

Carol will continue to use the TV’s structured positive reinforcement until Jacori becomes more adept at feeding himself and is able to handle larger volumes of food. In time, TV will be phased out with the ultimate goal being that the joy of eating is its own reward.

“Carol and the Feeding Team have done a great job changing Jacori’s mindset,” said Jacqueline. He now sits in a highchair, eats 15-16 foods, has improved tongue movement and jaw strength and has started asking for certain foods, including sweet potatoes and dry snacks.

After living in Richmond for two months during Jacori’s day patient treatment, his family, including his 10-month-old sister, Jamilette, prepared to return home to Cumberland, Va. in mid-January 2010. To ease the transition, the Feeding Team taught Jacqueline and Jerome how to shop for and puree foods and feed Jacori without the spitting and screaming that used to accompany every meal. Although Jacori will continue outpatient treatment once a week for probably a year, the family will not have the daily structure of the day patient program and will need to learn to create it at home.

“Prior to coming here we did a lot of trial and error,” commented Jacqueline of the Feeding Program’s parent education component. “The Feeding staff helped us calculate calories and determine if Jacori’s nutritional needs were being met.”

Carol also stressed the importance that psychology plays in treatment. Psychological principles are used to develop reward systems to improve positive mealtime behavior, increase the rate at which skills are learned and set mealtime rules and expectations so parents stay in control.

In the coming months, Carol will revise her goals based on Jacori’s progress and input from his parents and other Feeding team members. Her next steps include teaching Jacori to feed himself an entire meal, chew and eat table foods and reduce the amount of pureed foods in his diet.

“Carol took the time to figure out what Jacori likes,” said Jerome. “She gained his trust and built a bond. I love this place.”

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