Transitioning the child fed by gastrostomy into school.

Young children dependent on gastrostomy feeding are examples of special-needs children now eligible for expanded nutrition services in schools through Public Law 99-457. With the implementation of this law, nutritionists have an opportunity to expand their roles as consultants to special education teachers. A team approach involving nutrition, nursing, and special education was used to prepare a gastrostomy-fed preschool child and his family for school. The family of the multihandicapped child had been isolated by the child's feeding problems and viewed the problems as barriers to his entering school. Components of a nutrition care plan for an interdisciplinary team included oral feeding readiness, nutritional adequacy and timing of meals, and mechanical aspects of gastrostomy feeding in the classroom. Nutrition interventions were adjusted for the classroom from those used in the home or clinical setting. The major activity in the transition program was behavioral management of the child's rumination, which affected nutritional status and feeding. The major outcome of the transition program was enrollment of the child in school, with gastrostomy feeding as a routine activity. A transition program for a gastrostomy-fed child is an appropriate mechanism for expanding the role of the nutritionist into the classroom.