Abstract
There is currently limited evidence supporting the use of telepractice to conduct bottle-feeding assessments. This study aimed to investigate the inter-rater reliability of bottle-feeding assessments conducted via synchronous telepractice (real-time videoconferencing). Secondary aims were to investigate parent and clinician satisfaction. Bottle-feeding skills of 30 children (aged 1 month–2 years) were simultaneously assessed by a telepractice SP (T-SP) at a remote location and an in-person SP (IP-SP) at the family home. A purpose-designed assessment form was used to evaluate: (1) developmental level (screen only), (2) state, color, and respiration, (3) oral motor skills, (4), infant oral reflexes, (5) tongue tie (screen only), (6) non-nutritive suck, (7) bottle-feeding, (8) overall feeding skills and (9) recommendations. Results of the T-SP and IP-SP assessments were compared using agreement statistics. Parents reported perceptions of telepractice pre and post session, and also rated post-session satisfaction. The telepractice SP completed a satisfaction questionnaire post-appointment. The majority of assessment components (45/53, 85%) met the agreement criteria (≥80% exact agreement). Difficulties were noted for the assessment of palate integrity, gagging during non-nutritive suck assessment, and 6 components of the tongue tie screen. Parent and clinician satisfaction was high; SPs reported that they would offer telepractice services to 93% of families again in the future. Overall, the results demonstrated that most components of a bottle-feeding assessment could be reliably completed via synchronous telepractice in family homes. However, further research is required to improve the reliability of some intra-oral assessment components.
Highlights
Access to pediatric feeding assessment and treatment is critical for children with pediatric feeding disorders (PFDs) due to their potential negative impact on children and their families [1,2,3]
Many traditional pediatric feeding services are provided within a clinical setting and families have reported that their child’s feeding performance can differ between the home and clinical environment [9], suggesting that assessments conducted in a clinical environment may be less accurate than assessments performed in the home
Study results identified that the majority of elements of a clinical bottle-feeding assessment could be reliably completed via telepractice and that the telepractice model was acceptable to both parents and SPs
Summary
Access to pediatric feeding assessment and treatment is critical for children with pediatric feeding disorders (PFDs) due to their potential negative impact on children and their families [1,2,3]. Whilst the COVID-19 pandemic has significantly impacted service access due to social distancing requirements [4], there is a range of other factors that have historically negatively impacted access to feeding services. These include distance and travel, the speech pathologist’s skill and confidence, family commitments, and challenges to travelling with children with physical and/or medical needs [5,6,7,8,9,10,11]. Telepractice has the potential to overcome some of these accessibility difficulties and could enable clinic-based services to provide appointments within the child’s home. Clinical swallowing examinations (CSE) completed via telepractice are confirmed to be valid and reliable [13,14,15,16]
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