Kroon Van Diest, who also has a study underway to expand the center’s current treatment outcome data, published in the American Journal of Gastroenterology in 2018, to a longer follow-up. “It’s a relatively short-term, intensive treatment, but we send them back home to school and sports and things they haven’t been able to do in years,” says Dr. The majority of patients leave the program no longer requiring feeding tubes. Children are also taught to use diaphragmatic breathing when they eat to relax the abdominal muscles and prevent the contractions that cause food to come up. Kroon Van Diest, who is the lead psychologist for the pediatric Rumination Syndrome Program at Nationwide Children’s (the only one of its kind in the country), works with patients to retrain their muscles by dry swallowing again as soon as they feel their stomach start to contract.
Fortunately, rumination experts can work with children – some of whom have not kept down a bite of solid food for years and are reliant on feeding tubes – to teach them how to eat normally again. One diagnosis that benefits substantially from the involvement of psychological care is rumination syndrome, a rare GI disorder that makes it hard for children to consume anything by mouth without vomiting almost immediately due to learned but involuntary muscle contractions. “Psychologists have a huge role in treating these patients, not because they have classic psychological conditions, but because they can see patients’ environmental and psychosocial influences on their physical health, and address them with gut-directed therapy.” “To help many of these children, you have to approach the problem from a biopsychosocial model,” says Desalegn Yacob, MD, medical director of the Center for Neurogastroenterology and Motility Disorders. She may also recommend follow up with additional therapy and program services such as massage therapy, therapeutic recreation, nutrition and more. Together, she and the treating gastroenterologist see all patients coming to the hospital’s Functional Gastrointestinal Disorders Clinic to determine diagnoses and optimal treatment plans. “We do evaluations and provide treatment recommendations for the family, and explain that it’s not all in their heads – the pain and symptoms are very real,” says Dr. Some GI conditions frequently coincide with anxiety, depression and increased sensitivity to pain, and even children without these problems often have psychosocial challenges – embarrassment about their symptoms, judgment or accusations from friends and family – that make this additional care beneficial. “GI psychologists help fill a lot of needs in patient care.” “GI psychology is increasingly being recognized as helpful in a lot of contexts as a non-medical option to treat many functional and motility conditions,” says Ashley Kroon Van Diest, PhD, a pediatric psychologist at Nationwide Children’s. “Especially for functional disorders like IBS, medications aren’t the only way to go – behavioral therapy and diet can be just as effective, if not more so,” says Peter Lu, MD, MS, a pediatric gastroenterologist and physician-scientist in the Center for Neurogastroenterology and Motility Disorders at Nationwide Children’s. The Nationwide Children’s GI nutrition team is currently working to publish data they presented at Digestive Disease Week in 2019 on the efficacy, safety and feasibility of the low-FODMAP diet for children with IBS.
From managing feeding tubes to the low-FODMAP diet (a diet plan low in the fermentable carbohydrates that create irritating gas in the GI tract) for children with irritable bowel syndrome (IBS), these highly specialized GI dietitians significantly impact the care of patients seeking to manage or even resolve sensitivity-related GI symptoms through dietary management. Many GI care programs now include dietitians to help manage the unique nutritional needs of patients with functional and motility disorders.