Pediatric Feeding Disorders Research Articles

Anorexia nervosa with comorbid autism spectrum disorder: Optimizing care for youth, caregivers, and health care providers.

Youth with anorexia nervosa (AN) have been reported to have high levels of comorbid autism spectrum disorder (ASD) and ASD-like traits suggesting a potential shared underlying neurodevelopmental or genetic link between the disorders. Youth with comorbid AN and ASD symptomatology generally require more intensive treatment and have worse psychological outcomes following treatment. To date, no Canadian national guidelines exist for the treatment of this comorbidity. An informal survey of tertiary paediatric eating disorder programs across Canada revealed that centres do not routinely screen for ASD at intake and few offer any treatment modifications for youth with AN and suspected/diagnosed comorbid ASD. This represents a significant care gap for this clinical sub-population and an important area for future study and healthcare provider training.

Acceptance and commitment therapy for a parent of a child with pediatric feeding disorder: A case study.

Acceptance and commitment therapy for a parent of a child with pediatric feeding disorder: A case study.

Supplemental Material for Acceptance and Commitment Therapy for a Parent of a Child With Pediatric Feeding Disorder: A Case Study

Supplemental Material for Acceptance and Commitment Therapy for a Parent of a Child With Pediatric Feeding Disorder: A Case Study

Alterations in Child Feeding Behavior: An Underrecognized Clinical Complication of Food Allergy

BackgroundFood allergy (FA) affects around 5.6 million children in the US, conferring risk for negative impacts on growth and psychosocial functioning. While evidence suggests a higher prevalence of feeding difficulties in children with FA, the link between FA and feeding dysfunction remains unclear. ObjectiveTo investigate feeding problems in children with parent-reported IgE-mediated FA and/or pediatric feeding disorder (PFD) compared to healthy children in a community-based sample, and to explore factors associated with feeding problems in children with FA. MethodsA matched cross-sectional cohort study utilized survey data from 352 parents of children aged 6 months to 7 years who reported a diagnosed IgE-mediated FA and/or PFD (50 with FA only, 67 with FA and PFD, and 235 with PFD only). Healthy children were matched based on age, gender, race, and socio-economic factors. Feeding problems were assessed using the Pediatric Eating Assessment Tool (PediEAT). Matched-pairs generalized linear regressions compared each cohort and explored factors associated with feeding problems in children with FA. ResultsChildren with FA exhibited significantly higher feeding problems compared to healthy children. Children with a diagnosed PFD had more severe feeding problems, irrespective of comorbid FA. Factors linked with feeding problems in children with FA included older age, non-White race, increased medical comorbidity, and limited dietary variety. ConclusionThis study adds to evidence indicating a higher prevalence of feeding problems in children with FA. Clinicians treating FA patients should routinely screen for feeding and growth concerns and consider referral to multidisciplinary feeding programs as needed.

Trajectory of Infant Problematic Feeding Symptoms: Study Protocol.

Infants with developmental risk factors are more likely to have feeding problems and develop chronic feeding disorders. Early detection and understanding of the progression of problematic feeding and its relationship with a child's biological functioning and the family feeding environment will enhance effective symptom management and development of interventions to prevent pediatric feeding disorders. The New Through Two (NewThru2) feeding study protocol is described. Study aims are to (a) characterize symptoms of problematic feeding and trajectories of symptoms from pre-discharge from neonatal intensive care through age 24 months; (b) determine the relationship of child biological function at discharge with symptom characteristics and trajectories; (c) describe the child's feeding environment and its relationship to symptoms from discharge through 24 months; and (d) determine the relationship between problematic feeding symptoms and growth and developmental outcomes. NewThru2 is a prospective, longitudinal, mixed method study following over 200 infants who received care in a neonatal intensive care unit and were identified as at risk for compromised development. The study follows enrolled infants through 24 months of age. Symptoms of problematic feeding are measured pre-discharge by clinical observation and medical record review and post-discharge by parent report. Biological function is measured by medical history and cardiorespiratory and autonomic nervous system function during feeding prior to discharge. Child feeding environment is measured by strategies parents use to manage feeding, the effect of feeding on the parent and family, and the use of feeding services. A subset of parents is interviewed to achieve a contextual understanding of the family feeding environment. Child outcome measures include parent-reported feeding skills and clinician-reported growth and neurodevelopment. The results of this study will improve understanding of pediatric feeding disorders during a time of development sensitive to adequate nutrition and with infants at risk for developmental delays or impairments.

Intensive Outpatient Programs for Pediatric Feeding Disorder: A Qualitative Study of Current Challenges and Future Directions.

Although intensive multidisciplinary interventions (IMIs) provide benefits for patients with pediatric feeding disorders (PFD), access to these programs is limited and challenges faced by the programs remain unclear. To better understand the barriers faced by existing day programs that provide IMI, disparities in patient care, and areas for improvement to better inform policy and improve access to treatment for PFD. Semi-structured interviews were conducted with a leader of outpatient programs providing IMI in the United States. Data regarding leader's perspectives on disparities in patient care, barriers faced by the intensive multidisciplinary feeding day programs, and future goals and directions for their programming were collected. Afterward, a qualitative content analysis was conducted to consolidate and categorize information related to patient care, access, and barriers faced by day programs and patients with PFD. Barriers and challenges were identified at the patient, program, and systems levels. Patient-level barriers included familial resources or socioeconomic status, geographic distance from the program site, and difficulty with the time commitment, whereas program-level barriers included limited site personnel and capacity and long wait times. System-level barriers primarily center on insurance, with inconsistent coverage of services and limited payer knowledge about PFD and IMI. IMIs are effective in managing PFD; however, a variety of patient-level, program-level, and systems-level factors serve as barriers for patient access to care and program success. Further research, improved reimbursement, and consensus statements on effective treatments can help improve access to and coverage for care, allowing for the development and sustainability of more programs.

Simultaneous presentation and differential reinforcement to increase consumption

AbstractMany autistic children display feeding difficulties and consume a limited food variety. These feeding difficulties could be conceptualized as change‐resistant behavior because children often exhibit rigid mealtime routines, avoid novel foods, and only consume foods according to specific types, textures, or under specific mealtime conditions. Currently, behavior‐analytic treatments for pediatric feeding disorders have the most empirical support and many studies have demonstrated the effectiveness of extinction‐based treatments. However, there is less research on alternative treatments for increasing consumption of novel or non‐preferred foods among children with autism spectrum disorder (ASD). In the current study, we evaluated simultaneous presentation and differential reinforcement to increase consumption of novel, target foods for two participants with ASD and change‐resistant feeding behavior.

A Preliminary Assessment to Determine the Starting Point for Treatment of Pediatric Feeding Disorders

A Preliminary Assessment to Determine the Starting Point for Treatment of Pediatric Feeding Disorders

A Systematic Review and Comprehensive Discussion of Social Validity Measurement in Behavioural Intervention for Paediatric Feeding Disorders

Abstract Background Social validity in the field of applied behaviour analysis is the measurement of the social significance of goals, the social appropriateness of procedures, and the social importance of the effects of a treatment. There is a paucity of rigorous research on social validity measurement as it relates to feeding treatment. Objective To our knowledge, this is the first systematic review aiming to identify the gaps in and assess the current state of the science regarding comprehensive social validity measurement of paediatric feeding treatment. Method We conducted a systematic review following PRISMA guidelines using four ProQuest databases. Results The systematic review resulted in the identification of 26 eligible articles reporting findings related to social validity post-intensive treatment or describing new measurement systems that could be used to assess social validity more comprehensively. Collectively, caregivers rated behaviour-analytic treatments high in social validity and treatments were highly effective. Caregivers reported increased broader quality of life and lasting positive impacts, decreased stress, and lack of negative effects. Conclusion In the context of these results, we discuss behaviour-analytic feeding treatment within social validity’s comprehensive definition. We identify additional data-based research needs in this area and provide recommendations to spur new investigations. Social validity measurement requires refinement to further inform the standard of care. Paediatric feeding expertise and competency are crucial in navigating social validity considerations. Accurate dissemination is needed to increase earlier access to effective feeding treatment for families and specialised training for professionals to promote data-based and individualised decision-making in this vital area.

Assessing physiological arousal and emotional valence during behavioral intervention for pediatric feeding difficulties: A pilot study

AbstractThis study's purpose is to introduce a new measurement system that objectively assesses the social validity of behavioral feeding intervention from the child's perspective via the concurrent measurement of two dimensions of emotion. To date, the primary measures of social validity for behavioral feeding intervention are caregiver treatment acceptability and satisfaction surveys. This is the first study to objectively measure two dimensions of emotion, physiological arousal and emotional valence, while children received behavioral intervention for feeding difficulties. Data collectors used a new open‐source data collection software, cometrics, developed to synchronize and record physiological and observational data. Physiological data was collected using a wearable biosensor and observers recorded an index of child happiness, unhappiness, or neither using definitions by Phipps et al. (2022) for six children with a pediatric feeding disorder. Two out of six children needed programmed habituation to the device before data collection. All children assented to wearing the device during data collection. Recorded indices mapped to separable physiological states using electrodermal activity and its constituent components, skin conductance responses and skin conductance level, in addition to skin temperature. Findings demonstrated the feasibility of measuring two dimensions of child emotions during behavioral feeding intervention and revealed that children's physiological responses were distinctly different during intervals scored as happy, unhappy, or neither. This new data collection system has implications for future research on the child's emotional experience of behavioral feeding treatment and increases the possibilities for improving clinical practice.

Clinical care for severe and persistent eating disorders in pediatric populations: Perspectives of health professionals

ObjectiveModels of treatment for adults with severe and enduring eating disorders focus on harm reduction and improving quality of life. However, there is a notable gap in the pediatric literature in this area. The current study set out to assess the perspectives of health professionals regarding clinical care for young people (e.g., ages 10–25 years) with severe and enduring eating disorders, and to explore perceptions about appropriate treatment options for these presentations.MethodsHealth professionals were invited to complete a two-stage online survey about their experiences with clinical care for pediatric eating disorders through Canadian and Australian professional eating disorder networks. Survey 1 included questions about their experiences in supporting individuals with severe and enduring presentations. Participants who completed Survey 2 reviewed clinical vignettes and shared their perspectives about treatment recommendations and models of care, including for a severe and enduring presentation.ResultsA total of 85 clinicians responded to questions on Survey 1 about severe and enduring eating disorder presentations. A portion of these respondents (n = 25) also participated in Survey 2. The majority of respondents to Survey 1 reported providing clinical care for pediatric severe and enduring eating disorder presentations. Amongst respondents to Survey 2, there was low consensus amongst respondents for the clinical care that would be most appropriate for young people with a severe and enduring eating disorder presentation. Numerous challenges in models of care for severe and enduring presentations in pediatric settings were raised in responses on Survey 2, with clinicians sharing their awareness of models focusing on quality of life, while also raising concerns about the appropriateness of these models for young people.ConclusionsThe preliminary results of this study demonstrate that the majority of clinicians report that they have provided care to young people with severe and enduring presentations. There is a clear need for establishing guidance for clinicians working in pediatric eating disorder settings around models of care focused on quality of life. Engagement with interested parties, including those with lived experience, can clarify the development of terminology and clinical pathways for severe and enduring presentations of pediatric eating disorders.

Preparedness of Speech Language Pathologists and Occupational Therapists to Treat Pediatric Feeding Disorder: A Cross-Sectional Survey.

Pediatric feeding disorder (PFD) is increasingly common and is often treated by speech language pathologists (SLPs) and occupational therapists (OTs) in the community setting. However, the preparedness of these disciplines to effectively address PFD is relatively unknown. A national (US), online survey was disseminated to providers who assess and treat PFD. For the present analysis, the responses of SLPs (N = 418) and OTs (N = 195) related to their clinical background, educational background, post-graduate training, and self-rated clinical effectiveness were statistically analyzed and compared across the two disciplines. Both SLPs and OTs report feeling underprepared to work with PFD clients immediately following their academic training, but time spent in post-graduate training and years of clinical practice both significantly (p < 0.0001) increased feelings of effectiveness in assessing and treating PFD. Most SLPs and OTs pursued self-directed learning activities to increase competence, with the most common activities being article review, podcasts, and peer case review, although SLPs were significantly more likely to use podcasts (p < 0.0001) and peer review (p = 0.0004) than OTs. The most common barriers for providers were financial, time, travel, and institutional support barriers. While PFD is a key practice area of both SLPs and OTs, both provider groups feel unprepared and under-supported in providing competent care to these patients upon graduation. Future research and policy should support advancements in training for current SLPs and OTs related to PFD and address current barriers to a specialized educational pathway.

Experiences of Allied Health Clinicians Accessing a Pilot Project ECHO® Program to Support Learning in Pediatric Feeding.

Pediatric feeding disorder is increasing in prevalence, yet low clinician confidence regarding its management is a barrier to care. Targeted clinician training is needed as traditional didactic training programs are limited in both their accessibility and capacity to provide opportunities for the application of theory-based learning. This study examined the experiences of a group of clinicians involved in a multidisciplinary PedFeed ECHO® network, a virtual community of practice established to support speech pathologists, occupational therapists, dieticians, and psychologists in Queensland, Australia, working with children with pediatric feeding disorder. Sixteen clinicians (34% of the total PedFeed ECHO network) from different professional backgrounds, clinical settings, and locations participated in semistructured interviews three months post completion of eight ECHO sessions. Inductive thematic analysis revealed three themes: (1) broad-ranging outcomes of PedFeed ECHO, (2) participant experiences of PedFeed ECHO, and (3) facilitators for future success. PedFeed ECHO was viewed very positively and provided participants with a valuable opportunity for information sharing and collaboration as a multidisciplinary team. Participants described impacts on their professional practice, knowledge, confidence, and professional isolation, as well as service and patient-level impacts. Several facilitators for the success of future PedFeed ECHO cohorts were provided. Insights from participants will serve to improve the design and delivery of ECHO training for future cohorts. Monitoring clinical skill development over a longer period of time and exploring clinician perceptions regarding direct impact on patient care are needed to further validate the impact of ECHO.

Long-Term Outcomes after Behavior-Analytic Intervention for Pediatric Feeding Disorders

AbstractMany children with autism spectrum disorder experience feeding difficulties that can lead to increased health risks (e.g., severe nutrition deficiencies, obesity-related illnesses) if left untreated. Intensive feeding programs that use behavior-analytic interventions have reported positive outcomes for treating challenging behavior associated with pediatric feeding disorders at discharge and up to 1 year post discharge. Whether these children achieve and maintain long-term goals is unknown. The purpose of the current study was to evaluate outcomes of behavior-analytic intervention for pediatric feeding disorders among children with and without autism spectrum disorder in an intensive feeding program post discharge. Caregivers of former patients reported on the positive and negative impact of the program and their child’s growth and diet variety at follow-up. 85% of caregivers reported the program had a positive impact. Increases in height-for-age z scores were significant from admission to discharge from the intensive program, and progress in growth and diet variety remained the same or improved for most children at follow-up. Results suggest that behavior-analytic intervention in an intensive feeding program produced positive short- and long-term outcomes for children and their families.

Clinical Application and Fading of Synchronous Reinforcement for Increasing Self-Feeding for a Child with Autism Spectrum Disorder and History of Trauma

In the current case study, we evaluated synchronous reinforcement (SSR) as an intervention to increase self-feeding for a 5-year-old male diagnosed with ASD and a pediatric feeding disorder who also had a history of trauma. Synchronous reinforcement is a schedule of covariation where reinforcement is delivered continuously contingent on responding. Synchronous reinforcement has not been previously reported in the literature in a feeding context. A benefit of reinforcement-based procedures, such as SSR, is that they may align with recommendations for trauma-informed care by preventing or limiting the necessity of physical guidance procedures for those with a history of physical trauma. This is of particular significance given children with disabilities are more likely to experience traumatic events and abuse. We demonstrated that SSR was an effective intervention for increasing self-feeding, as well as methods for fading SSR as a treatment component. We discuss the potential for SSR as a trauma-informed approach, and the importance of caregiver collaboration and programming for generalization.

Pediatric Feeding Disorder and the School-Based Speech-Language Pathologist: An Evidence-Based Update for Clinical Practice.

This prologue introduces the forum "Pediatric Feeding Disorder and the School-Based SLP: An Evidence-Based Update for Clinical Practice" and informs the reader of the scope of articles presented. The guest prologue author provides a brief history of pediatric feeding and swallowing services in the public-school setting, including previous forums on swallowing and feeding services in the schools (Logemann & O'Toole, 2000; McNeilly & Sheppard, 2008). The concepts that have been learned since the 2008 forum are shared. The contributing authors in the forum are introduced, and a summary is provided for each of the articles. The articles provide evidence-based information on topics that are uniquely of interest to school-based speech-language pathologists managing pediatric feeding and swallowing in their districts. The topics shared in this forum range from relevant information on anatomy, physiology, developmental milestones, and differential diagnosis to therapeutic practice when identifying and treating pediatric feeding and swallowing in the school setting. The forum also includes focused articles on the necessity of collaboration with families during the treatment process, current information on legal parameters dealing with school-based pediatric feeding disorder services, and a framework for assessment and treating pediatric feeding disorder in the school setting.

Noncontingent reinforcement in the treatment of pediatric feeding disorder: A concise review.

This concise review summarizes the literature on noncontingent reinforcement in the treatment of pediatric feeding disorder from 2018 to 2022. We reviewed 15 published behavior-analytic feeding studies to identify how often the term noncontingent reinforcement is used, what form of noncontingent reinforcement is delivered, and what the effects of noncontingent reinforcement are on behavior when it is included in treatment. Implications and directions for future research are discussed.

Dysphagia Service Delivery in the Educational Setting: Pediatric Feeding Disorder and the Culturally Responsive Clinician.

This article addresses considerations for the speech-language pathologist to ensure culturally competent dysphagia management in the school setting for children with oral motor, swallowing, and pediatric feeding disorders (PFDs). There is also discussion of the multifactorial cultural and linguistic influences that impact collaborative educational decisions when establishing and implementing school-based dysphagia services. The consideration of cultural and linguistic factors for the child with oral motor, swallowing, and/or PFDs is essential when diagnosing, treating, and planning for dysphagia service delivery. By recognizing and including culturally appropriate interventions and recommendations, speech-language pathologists enhance opportunities for positive outcomes and treatment efficacy when providing pediatric dysphagia services in the educational setting for children from culturally and linguistically diverse backgrounds.

Cross-Cultural Adaptation and Validation of the Greek Cypriot Montreal Children’s Hospital Feeding Scale

Introduction: Assessing pediatric feeding disorders (PFD) is essential for a child’s development to prevent severe consequences. The assessment procedures for PFD may include parents’ questionnaires such as the Montreal Children’s Hospital Feeding Scale (MCH-FS). The aim of this study was the cross-cultural adaptation of the MCH-FS to the Greek language. Methods: One hundred parents of Greek Cypriot children with PFD (clinical group) and 100 parents of healthy Greek Cypriot children (control group) aged 6 months to 16 years old participated in the study and completed the MCH-FS. World Health Organization (WHO) guidelines were implemented for translation and cultural adaptation. Results: The internal consistency was excellent, α = 0.85 (ICC: 0.817–0.891). Content validity was significant (S-CVI = 1) with an agreement equal to 14. A strong and significant correlation of MCH-FS was computed according to principal component analysis (14 items ranging between −0.6 and 0.7). The Kaiser-Meyer-Olkin factor analysis was equal to 0.91 with substantial correlations (Bartlett’s test = 0.001, 654,804). The MCH-FS cut-off point between the two groups was 38.00 (AUC: 0.901 [95% CI: 0.859–0.942], p U = 992.00, p p Conclusion: The MCH-FS had good psychometric properties in its current form in Greek. It is suggested that the MCH-FS can be used as a valid tool for children with PFD in the Greek Cypriot population.

The potential role of occupational therapy in the treatment of avoidant/restrictive food intake disorder.

Most individuals with avoidant/restrictive food intake disorder (ARFID) never receive treatment, and treatment needs far exceed the current capacity of mental health services. Occupational therapy (OT) focuses on enhancing function in daily activities, including eating and feeding. Given OT's rich history in mental health and pediatric feeding disorder treatment, we spotlight the potential role of OT in ARFID treatment, current knowledge, and opportunities for future research. Through a preliminary exploratory inquiry involving a review of current literature and clinical practice, we investigated OT's current involvement, knowledge, and interprofessional collaborative practice gaps in ARFID treatment. While many occupational therapy practitioners (OTPs) engage in ARFID treatment, interventions lack rigorous evaluation, and there is limited evidence defining OT's distinct role in interprofessional ARFID treatment. OTPs are uniquely positioned to provide interventions for individuals with ARFID across the lifespan, though research is needed to evaluate the efficacy of OT interventions. Future research suggestions include standardizing OT approaches to ARFID treatment and conducting single-case experiments and randomized controlled trials to compare OT approaches with alternative methods. Recommendations to address practice gaps include enhancing ARFID education for OT students and practitioners and fostering a greater understanding of OT's role on the interprofessional team. PUBLIC SIGNIFICANCE: Individuals with ARFID face barriers to eating that impact their health and function. On a multidisciplinary team, OTPs can treat diverse client populations by identifying and addressing barriers to daily participation, such as physical impairments, trauma history, and environmental barriers. More research is needed to evaluate the efficacy of OT practices in ARFID treatment.