Medical policy: Intensive Pediatric Feeding Programs

Policy number: MP 2.079

Effective date: 9/1/2026

Policy

Multidisciplinary outpatient and intensive pediatric day feeding programs may be considered medically necessary for infants, children, and adolescents (21 years of age and younger) with complex feeding and swallowing disorders when all of the following are met:

• Individual has a significant feeding disorder associated with a medical condition. Examples include, but are not limited to:
  • Prematurity
  • Cleft palate
  • Neurologic condition (e.g. cerebral palsy, muscular dystrophy)
  • Gastrointestinal disorder (e.g. reflux, esophagitis)
  • Gastrostomy tube and need to transition to oral feedings
  • Failure to thrive
  • Behavior problems interfering with feeding
  • Food refusal/selectivity
  • Short gut syndrome
  • Oral motor dysfunction (e.g. dysphagia)
  • Self-feeding deficits
  • Developmental disorder
  • Cardiorespiratory disease
  • Feeding tube dependent; and
• Adequate treatment of the contributing underlying condition has occurred without resolving the feeding problem; and
• Individual is not responsive to treatments by a single discipline (e.g., occupational therapist, dietician, or speech language pathologist) over a 2-month period.

A feeding disorder treatment program is considered investigational for infants, children, and adolescents who can eat and swallow with normal functioning, but who exhibit non-pathological selective eating or have selective eating behaviors and yet continue to meet normal growth and developmental milestones. These requests may be approved for two (2) to four (4) weeks at a time.

The following information may be considered to establish a plan of treatment:

• Growth charts which include height, weight, and/or body mass index (BMI); or
• History of treatment by the primary care physician; or
• List of co-morbidities and severity; or
• Treatment plan and estimate of duration; or
• Specific treatment goals.

This policy does not apply to feeding disorders related to mental health diagnoses.

Inpatient and residential pediatric feeding programs are considered investigational.

Cross-references:

• MP 2.015 Enteral Nutrition
• MP 2.304 Medical Treatments for Autism Spectrum Disorder
• MP 8.002 Speech Therapy (Outpatient)

Product variations

This policy is only applicable to certain programs and products administered by Capital Blue Cross and subject to benefit variations. Please see additional information below.

FEP PPO - Refer to FEP Medical Policy Manual. The FEP Medical Policy Manual can be found at: FEP Medical Policy Manual.

Description/Background

Pediatric feeding disorder (PFD) is defined by impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction. There are many medical conditions that can lead to feeding disorders, such as neurological disorders (e.g., cerebral palsy), disorders affecting suck-swallow-breathing coordination (e.g., bronchopulmonary dysplasia), structural lesions (e.g., neoplasm), connective tissue disease (e.g., muscular dystrophy), iatrogenic causes (e.g., surgical resection, medications) and anatomic or congenital abnormalities (e.g., cleft lip and/or palate). Since the publication of the World Health Organization International Classification of Functioning, Disability, and Health (ICF), there is increasing recognition that diagnoses do not necessarily predict function, and that assessment of functional limitations is critical to planning appropriate interventions to improve quality of life.

When feeding problems continue over a long period of time, the child may not grow and may suffer from frequent illnesses. Malnutrition affects 25% to 50% of children with PFD. In addition, these problems affect a child’s ability to function at home, school, and social settings, thereby creating an impact on the child’s development. Examples of severe feeding problems include:

• Inability or refusal to eat;
• Severe difficulty swallowing;
• Choking, gagging, or vomiting when eating;
• Dependence on tube feedings or difficulty weaning from a gastric feeding tube (G-tube);
• Failure to thrive; and
• Severe gastroesophageal reflux.

Early intervention can deter behavioral changes and long-term eating disorders, which can affect growth and health, and can avert the need for tube feedings. Feeding disorders are fairly common in infants and toddlers, with approximately 25%-35% of these children experiencing some difficulties with feeding. The incidence of severe feeding problems has been reported to be as high as 40%-70% in infants born prematurely or in children with chronic medical conditions. Malnutrition is found in approximately 25%-50% of children diagnosed with pediatric feeding disorder, particularly those children with chronic disease or neurodevelopmental disorder. Most of these children will respond well to suggestions offered by the nurse, nutritionist, and other specialists to parents on feeding methods, food choices, approach, and behavioral recommendations and do not require the services of a formal pediatric feeding program.

Outpatient Pediatric Feeding Programs

Pediatric Intensive Day Feeding Programs

Pediatric intensive day feeding programs are interdisciplinary programs that provide treatment for patients with impairment of oral intake. These programs combine medical and behavioral health techniques. The multidisciplinary services may include gastroenterology, behavioral psychology, psychosocial family support, education, nutritional or occupational therapy and speech therapy.

These feeding programs provide intensive feeding sessions six to eight hours per day, five days per week, and include 3-5 feeding sessions per day. Between feedings, naps, school, and playroom activities are offered. The day program usually lasts between two and four weeks.

Outpatient Therapy

Outpatient programs provide treatment for children whose feeding problems require less intensive therapy (e.g., once a week). Children frequently have a special meal at the clinic where feeding and behavioral problems are addressed. The team works with the parents to assist with helpful strategies and to provide support. Caregivers report on the child’s progress and practice the recommended feeding methods. The goals of these programs are to normalize the child’s oral intake and to maintain and improve growth patterns.

Inpatient Feeding Programs

Inpatient programs have been used for children with severe feeding difficulties and significant medical co-morbidities so that close medical assessment, nutritional monitoring, oral motor assessment and intense behavioral intervention can be conducted under 24-hour supervision.

Definitions

Failure to thrive is a term used to describe children, generally up to 3 years of age, who demonstrate a downward deviation in growth when compared to expectations from the standard growth charts of the National Center for Health Statistics (NCHS) Centers for Disease Control (CDC) growth charts. Standard growth charts of the National Center for Health Statistics (NCHS) are available at: CDC Growth Charts.

Feeding disorder is identified when a child is unable or refuses to eat or drink a sufficient quantity or variety of food to maintain proper nutrition

Disclaimer

Capital Blue Cross’ medical policies are used to determine coverage for specific medical technologies, procedures, equipment, and services. These medical policies do not constitute medical advice and are subject to change as permitted by law or applicable clinical evidence from independent treatment guidelines. Treating providers are solely responsible for medical advice and treatment of members. These policies are not a guarantee of coverage or payment. Payment of claims is subject to a determination regarding the member’s benefit program and eligibility on the date of service, and a determination that the services are medically necessary and appropriate. Final processing of a claim is based upon the terms of contract that applies to the members’ benefit program, including benefit limitations and exclusions. If a provider or a member has a question concerning this medical policy, please contact Capital Blue Cross’ Provider Services or Member Services.

Coding information

Note: This list of codes may not be all-inclusive, and codes are subject to change at any time. The identification of a code in this section does not denote coverage as coverage is determined by the terms of member benefit information. In addition, not all covered services are eligible for separate reimbursement.

Covered when medically necessary:

References

1. Ages & Stages. American Academy of Pediatrics: Healthy Children Org.
2. American Academy of Pediatrics (AAP). Recommendations for preventive pediatric health care (periodicity schedule). Elk Grove Village, IL: AAP; 2010.
3. American Speech-Language-Hearing Association (ASHA). Swallowing disorders in children. 2023.
4. Borowitz KC, Borowitz SM. Feeding problems in infants and children: assessment and etiology. Pediatr Clin North Am. 2018; 65(1):59-72.
5. CDC Growth Charts.
6. Fischer E, Silverman A. Behavioral conceptualization, assessment, and treatment of pediatric feeding disorders. Semin Speech Lang. 2007 Aug; 28(3): 223-31.
7. Motil K. Duryea T. Poor weight gain in children younger than two years in resource-abundant countries: Management. In: UpToDate. Online Journal [serial online]. Waltham, MA: UpToDate; updated May 24, 2021. Literature review current through Jan 2022.
8. Duryea, T. Motil K. Poor weight gain in children older than two years in resource-abundant countries. In: UpToDate. Online Journal [serial online]. Waltham, MA: UpToDate; updated Nov 17, 2021. Literature review current through Jan 2022.
9. Goday PS, Huh SY, Silverman A, et al. Pediatric Feeding Disorder: Consensus Definition and Conceptual Framework. J Pediatr Gastroenterol Nutr. 2019; 68(1):124-129. PMID 30358739.
10. Kerzner B, Milano K, MacLean WC, et al. A practical approach to classifying and managing feeding difficulties. Pediatrics. 2015; 135 (2):344-353.
11. Latif LA, Brizee LS, Casey S, et al.; Washington State Department of Health. Nutrition interventions for children with special health care needs. 3rd ed. Olympia, WA: Washington State Department of Health; 2010.
12. Mentz NM, Corkins MR, Lyman B, et al. Defining pediatric malnutrition: a paradigm shift toward etiology-based definitions. JPEN J Parenter Enteral Nutr. 2013; 37(4):460-481.
13. Miller CK. Updates on pediatric feeding and swallowing problems. Curr Opin Otolaryngol Head Neck Surg. 2009;17(3):194-199.
14. National Institute of Health and Care Excellence (NICE). Faltering growth: recognition and management of faltering growth in children. https://www.nice.org.uk/guidance/ng75. September 2017.
15. Puntis, JWL. Specialist Feeding Clinics. Archives of Disease in Childhood 2008; 93:164-167.
16. Sharp, William G.; Jaquess, David L.; Morton, Jane F.; Herzinger, Caitlin V. PediatriFeeding Disorders: A Quantitative Synthesis of Treatment Outcomes. Clinical Child & Family Psychology Review; Dec 2010, Vol. 13 Issue 4, p348.
17. Sharp WG, Stubbs KH, Adams H, et al. Intensive, manual-based intervention for pediatric feeding disorders: results from a randomized pilot trial. J Pediatr Gastroenterol Nutr. 2016; 62(4):658-663.
18. Sharp WG, Volkert VM, Scahill L, et al. A Systematic Review and Meta-Analysis of Intensive Multidisciplinary Intervention for Pediatric Feeding Disorders: How Standard Is the Standard of Care? J Pediatr. 2017;181:116-124.
19. Sheppard JJ. Using motor learning approaches for treating swallowing and feeding disorders: a review. Lang Speech Hear Serv Sch. 2008; 39(2):227-236.
20. Silverman AH. Interdisciplinary care for feeding problems in children. Nutr Clin Pract. 2010; 25(2):160-165. Age Limit of Pediatrics. Amy Peykoff Hardin, Jesse M. Hackell, Committee on Practice and Ambulatory Medicine. Pediatrics Sep 2017, 140 (3) e20172157; DOI: 10.1542/peds.2017-2151.
21. Jadcherla SR. Neonatal oral feeding difficulties due to sucking and swallowing disorders. In: UpToDate. Online Journal [serial online]. Waltham, MA: UpToDate; updated 12/10/2021. Literature review current through Jan 2023.
22. Sharp WG, Estrem HH, Romeo C, et al. Assessing the US treatment landscape for pediatric feeding disorder: A survey of multidisciplinary providers. Child Care Health Dev. Published online November 14, 2023. doi:10.1111/cch.13198.
23. Indi Trehan, MD, MPH, DTM, & H Mark Manary, MD. Management of uncomplicated severe acute malnutrition in children in resource-limited settings. In: UpToDate. Online Journal [serial online]. Waltham, MA: UpToDate; updated 04/07/2023. Literature review current through: Dec 2023.