Medical Stability

Management of all medical diagnoses is crucial to the success of other interventions. If not well managed, a medical condition can further exacerbate pediatric feeding disorder (PFD) or hinder the progress of eating, feeding and swallowing interventions.  In children who have been medically unstable, or non-oral for a considerable period, confirmation of medical stability and appropriate initiation of oral feeds should be obtained by a physician or nurse practitioner. Oral feeding progress can change from feed to feed, and day-to-day; monitoring and reassessment is essential. 

To be considered medically stable for oral experiences and feeding trials, children need to be:

  • Medically stable as per a physician or nurse practitioner
  • At least 30 weeks gestation
  • Off ventilation for at least 24 hours
  • Able to maintain a resting respiratory rate of 60-70 breaths per minute or less with no respiratory distress cues
  • Maintaining wakeful periods – quiet alert state
  • Managing secretions (oral and pharyngeal)
  • Tolerating enteral feeds
  • Displaying hunger cues (preferred for feeding trials)


Examples of medical management may include but are not limited to:

  • Gastroesophageal reflux disease (see Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of NASPGHAN and ESPGHAN) (Rosen, et al., 2019)
  • Allergy management
  • Constipation and impaction management
  • Oxygenation for respiratory disease
  • ADHD-related therapy or medication
  • Sleep hygiene
  • Seizure management, and
  • Medication review to improve appetite.