Intestinal rehabilitation for short bowel syndrome or intestinal failure

CHIRP program

If your child suffers from short bowel syndrome or intestinal failure, you require comprehensive care by a multidisciplinary team of experts who specialize in the digestive health of children. The sole focus of the Children's Intestinal Rehabilitation Program (ChIRP) at C.S. Mott Children's Hospital is your child’s gastrointestinal and nutritional care. We offer a full spectrum of services, from medical and nutritional management to surgical services.

The Michigan difference

University of Michigan Health C.S Mott Children’s Hospital has the largest intestinal rehabilitation program in the state. Our team currently provides care to approximately 135 children, including 40 on home total parenteral nutrition, or TPN (nutrition given through a long-term IV).

Our multidisciplinary team provides specialized care individualized to your child. In addition to improving overall outcomes, ongoing parent education and family support are key components of our program.

In 2018, the ChIRP program was awarded the Clinical Nutrition Team of Distinction Award by the American Society for Parenteral and Enteral Nutrition (ASPEN), recognizing excellence in interdisciplinary clinical nutrition practice.

Conditions treated by the ChIRP team

Our team cares for newborns to young adults (up to 25 years of age) with any of the following types of intestinal failure and/or surgical diseases that have led to shortened intestinal length. These diseases are characterized by diarrhea, malabsorption, fluid and electrolyte imbalances, and the need for IV nutrition/TPN:

  • Congenital malabsorption * Gastroschisis * Hirschsprung’s Disease
  • Intestinal atresia or stenosis
  • Intestinal dysmotility
  • Malrotation
  • Necrotizing enterocolitis (NEC)

The ChIRP team 

Research has shown that children with intestinal failure and short bowel syndrome do the best when cared for by a multidisciplinary team. Our team specializes in the challenges presented by the small, developing bodies of children and includes a:

  • pediatric gastroenterologist 
  • pediatric surgeon
  • registered dietitian
  • registered nurse
  • clinical pharmacist 
  • clinical social worker
  • program coordinator

Children followed by the ChIRP program also have the benefit of all the resources of C.S. Mott Children’s Hospital.  This includes services provided by a team of radiologists accustomed to the diagnostic needs of children with intestinal failure/short bowel syndrome and pediatric anesthesiologists who provide sedation and anesthesia for all invasive procedures. Our team also receives support from child psychiatry and occupational therapy for working with children who have feeding disorders.

Many ChIRP patients have their parenteral and enteral nutrition provided through Michigan Medicine HomeMed Infusion and Specialty Pharmacy. Using HomeMed allows for a streamlined process including both inpatient and outpatient care services, care coordination, and shared medical record documentation.

What to expect at your clinic visit

Due to the complex nature of short bowel syndrome and intestinal failure, clinic appointments can be long. They are at least 2 hours for new patients and frequently 1.5 hours for return visits. After check-in, your child’s height, weight, temperature, pulse and blood pressure will be

checked. You and your child will then have a separate visit with each ChIRP team member. The plan of care is then provided to you and your child in writing and forwarded to your child’s pediatrician/primary care provider. Frequency of visits is dependent upon stabilization of his or her condition. If you encounter any barriers to completing or implementing this plan of care in the home, ChIRP clinicians are available by phone for further assistance.

Children followed in our program often require specialized lab draws, radiologic studies and medication administration (IV iron, for example). We try to coordinate these with clinic appointments as much as possible.

Nutrition analysis

All patients also undergo a complete nutritional assessment at every clinic appointment. Our physicians and dietitian work closely together to determine recommendations regarding optimal nutritional care including fluid and electrolyte management, tube feedings, any special diet that may be needed to meet your child’s specific needs, and TPN management. Our primary goal is to give your child’s body the fuel it needs for normal growth and development. The long-term objective for our ChIRP patients is to optimize intestinal adaptions and try to wean off TPN although it is not always possible.

Surgical options

If surgery is considered for your child, our pediatric surgeons will work with your family to make recommendations specific to your child’s individual needs.  Surgical options include a number of methods to lengthen the intestine in hopes of improving intestinal absorption and motility, as well as to prevent the development of bacterial overgrowth. Additionally, a number of other surgical methods to taper the intestine are available. These options may be considered in patients with short bowel syndrome; however, they are used only after it is clear that medical management is not effective in weaning your child off TPN. Routine gastrointestinal surgeries, including feeding tube placement and management and anti-reflux procedures are provided when indicated.

Make an appointment

For more information, please call 734-232-6825.

To schedule an appointment, start with asking your primary care physician or other specialist for a referral.  Providers can fax the ChIRP referral form to 734-998-2398. Our program coordinator will reach out for scheduling after review of referral.