Pediatric Feeding Disorders Research Articles

Navigating the transition from pediatric to adult eating disorder programs: Perspectives of service providers

This study aims to conduct qualitative research on the perspectives of service providers regarding the transition process from pediatric to adult specialized eating disorder tertiary care programs. Two focus groups with a diverse group of clinicians in pediatric and adult eating disorder programs and five qualitative interviews with clinicians in the community were conducted. Three themes were identified as challenges during the transition process: (1) illness related factors (ambivalence and denial); (2) the interruption of normative adolescent developmental processes by the illness; and, (3) the impact of decreased parental involvement in the adult compared to pediatric eating disorder programs. These themes were compared with empirical evidence on other chronic mental or physical health concerns for the purpose of identifying ways to facilitate a more successful service transition for young adults with anorexia nervosa. Future research and clinical implications are delineated.

COMPARISON OF UPRIGHT AND FLIPPED SPOON PRESENTATIONS TO GUIDE TREATMENT OF FOOD REFUSAL

The current study examined the effects of bite placement with a flipped versus upright spoon on expulsion and mouth clean (product measure of swallowing) in the treatment of 3 children diagnosed with a pediatric feeding disorder and oral-motor deficits. For all 3 participants, extinction in the form of nonremoval of the spoon led to improvements in inappropriate mealtime behavior and acceptance of bites; however, re-presentation did not reduce expulsion or improve mouth clean. Results showed a lower level of expulsion and higher percentage of mouth clean during flipped spoon presentations and re-presentations for all participants. Findings from follow-up analyses supported transitioning back to an upright spoon in all 3 cases, although the time required for this to occur differed across participants.

The use of multiple methods of compensatory behaviors as an indicator of eating disorder severity in treatment‐seeking youth

This study investigated the use and frequency of multiple methods of compensatory behaviors and how they relate to eating-related and general psychopathology for youth with eating disorders (ED). Participants were 398 referrals to a pediatric ED treatment program (91.2% female; M age = 14.9 ± 2.2). ANOVA and chi-square tests compared participants reporting multiple methods of compensatory behaviors, single method of compensatory behaviors, and no compensatory behaviors on measures of ED and general psychopathology. Partial correlations examined associations between compensatory behavior, frequency and severity of ED and general psychopathology. Participants reporting multiple methods of compensatory behaviors had significantly greater ED and general psychopathology than the other groups (ps < .001). Frequency of compensatory behaviors was associated with ED psychopathology (partial r = .14; p = .007) but not with general psychopathology. Engaging in multiple methods of compensatory behaviors is related to greater ED and general psychopathology, whereas frequency is only related to greater ED symptom severity.

Driven exercise among treatment-seeking youth with eating disorders

Purpose This study evaluated the prevalence and clinical significance of driven exercise (DE) in treatment-seeking youth. Methods Participants were 380 consecutive referrals to a pediatric eating disorder program (90.8% female; M age = 14.9 ± 2.2). Spearman's rho correlations examined the relation between DE frequency, and Beck Depression Inventory (BDI) and Eating Disorders Examination (EDE) Global Severity scores. ANOVA compared those reporting only DE, only vomiting, or both DE and vomiting on the aforementioned measures. Results 51.3% of participants (n = 193) reported DE in the past 3 months, with an average of 21.8 ( SD = 32.6) episodes. Frequency of DE was related to EDE global severity score (Spearman's rho = .46; p < .001) and BDI Total Score (Spearman's rho = .33; p < .001). Participants reporting both vomiting and DE had the highest EDE global severity and BDI total scores. Conclusions DE is associated with greater eating disorder and depressive symptomatology, especially when paired with vomiting. The findings highlight the importance of assessing for DE in youth presenting for eating disorder treatment.

Treatment of Upper Airway Obstruction and Feeding Problems in Robin-Like Phenotype

obin sequence (RS) was first delineated by Fairbairn in 1846 and Shukowsky in 1911; it was more formally investigated by the French stomatologist Pierre Robin in 1934, who later became the source of the eponym for this condition. Robin described it as consisting of a hypoplastic or retropositioned mandible and glossoptosis, resulting in respiratory distress, with or without a cleft palate. It fulfills criteria for a sequence, in which one or all anomalies found are secondary to another anomaly. The incidence varies between one in 8500 and one in 14 000 live births. The main functional problems associated with RS are upper airway obstruction (UAO) and failure to thrive (the latter resulting from feeding problems, UAO alone, or both problems). Feeding problems are often long-lasting, resulting in gastrostomy rates of 50% in large series. Interventions for RS should thus be assessed by their ability to improve polysomnography (PSG) results and weight gain. Although reported as used in infants with RS by 74% of US pediatric otolaryngology fellowship programs in 1994, only 39% believed PSG to be indicated for most patients with this condition, and just one in 5 performed serial PSG to test for treatment effectiveness. However, it is difficult to document the effect of treatments for RS on UAO without performing PSG, especially because anatomy does not correlate well with function. For this Medical Progress article, we searched PubMed for studies on the effectiveness of interventions suggested to improve UAO and weight gain in infants with RS (Table). It does not cover surgical techniques for which evidence in the literature is extremely scant or objective documentation of their effectiveness lacking.

Role of Parental Stress on Pediatric Feeding Disorders

The study examined the relation between parental anxiety and child feeding progress. Eighteen sets of parent and G-tube-fed child dyads participated. Caloric intake was recorded daily as the outcome measure of treatment progression. Parental anxiety was measured subjectively (self-report questionnaires) and objectively (salivary cortisol). Objective parental anxiety increased significantly (p < .001) when parents went from simply observing to actually feeding the child. There was, however, no direct relation between parental stress and caloric intake. Exploratory analyses of documented behavioral observations during feeding revealed a significant increase (p <. 001) in the child's negative behaviors with parental feeding, as opposed to staff feeding. Based on the results, further research to investigate parent–child dynamics during feeding is warranted.

Family Psychosocial Dysfunction is a Prominent Feature in Eosinophilic Esophagitis Presenting as Pediatric Feeding Disorder

Family Psychosocial Dysfunction is a Prominent Feature in Eosinophilic Esophagitis Presenting as Pediatric Feeding Disorder

1060 Eating, Drinking and Swallowing Disorders: A New Regional Clinic Review

Background: Eating, drinking and swallowing (EDS) disorders can have serious consequences for children which include dehydration, malnutrition, failure to thrive, aspiration pneumonia, choking and possibly death. Paediatric feeding disorders have been reported in up to 25% of children. This number increases to 80% in developmentally delayed children. Therefore disordered feeding should involve assessment by a multidisciplinary team. The problem is seldom limited to the child alone and non-organic factors must also be addressed. Aims: To audit the first 18 months of practice in a new regional EDS clinic from July 2007-December 2008. Methods: Retrospective chart review of clinic reports was carried out. All patients had formal assessment of EDS by a speech and language (SALT) and occupational therapist (OT), a medical review by a doctor and dietetics consult at each clinic visit. Results: 28 patients received full assessment. Average age of 1st consult was 4.16 years. 27/28 patients had an underling diagnosis, the most common being; genetic disorder(n=7), autism(n=3), cerebral palsy(n=3), Ex-prem(n=3), developmental delay of unknown aetiology(n=3). Diverse reasons for referral included(often > 1); issues with coordination of swallow(n=14), perceived behavioural issues(n=6), chronic reflux(n=5), PEG feeding(n=4), aspiration(n=4). 22/28 patients had an abnormal EDS assessment. The two most common interventions initiated were a sensory feeding programme(n=15) or food desensitisation programme(n=4) by SALT/OT. Conclusion: Our EDS clinic has provided further therapeutic intervention for children already with complex medical needs. In conjunction with medical therapy, behavioural and oromotor strategies can be applied successfully even in feeding disorders with an underlying organic cause.

Pediatric Feeding Disorders: A Quantitative Synthesis of Treatment Outcomes

A systematic review of the literature regarding treatment of pediatric feeding disorders was conducted. Articles in peer-reviewed scientific journals (1970-2010) evaluating treatment of severe food refusal or selectivity were identified. Studies demonstrating strict experimental control were selected and analyzed. Forty-eight single-case research studies reporting outcomes for 96 participants were included in the review. Most children presented with complex medical and developmental concerns and were treated at multidisciplinary feeding disorders programs. All studies involved behavioral intervention; no well-controlled studies evaluating feeding interventions by other theoretical perspectives or clinical disciplines met inclusion criteria. Results indicated that behavioral intervention was associated with significant improvements in feeding behavior. Clinical and research implications are discussed, including movement toward the identification of key behavioral antecedents and consequences that promote appropriate mealtime performance, as well as the need to better document outcomes beyond behavioral improvements, such as changes in anthropometric parameters, generalization of treatment gains to caregivers, and improvements in nutritional status.

Selective Eaters and Tactile Sensitivity

Among the various disciplines that address pediatric feeding disorders, there is increasing awareness of the complex and multifaceted factors that must be addressed. There remains a need for a universal classification system that would provide a common language and guide treatment strategies. The group of children who have been traditionally labeled “picky eaters” is examined, including the link between tactile defensiveness and selective eating, the anxiety that these children and their caregivers experience, and the need to address both sensory sensitivity and anxiety. Treatment methods are explored, including approaches that incorporate the caregiver in intervention sessions.

Eating, drinking and swallowing disorders: a new regional clinic review

Introduction Eating, drinking and swallowing (EDS) disorders can have serious consequences for children which include dehydration, malnutrition, failure to thrive, aspiration pneumonia, choking and possibly death. Adverse feeding behaviour can further perpetuate these problems leading to a cycle of food refusal, further nutritional compromise and considerable stress for the care giver. Background Paediatric feeding disorders have been reported in up to 25% of children. This number increases to 80% in developmentally delayed children. Therefore, disordered feeding should involve assessment by a multidisciplinary team. The problem is seldom limited to the child alone and non-organic factors must also be addressed. Medical treatment, behavioural modification and parental education are some interventions available for these children. Aims The aim of our study was to audit the first 18 months of practice in a new regional EDS clinic from July 2007 to December 2008. Methods Retrospective chart review of clinic reports was carried out. All patients had formal assessment of EDS by a speech and language therapist (SALT) and occupational therapist (OT), a medical review by a doctor and dietetics consult at each clinic visit. Results 28 patients received full assessment. Average age of 1st consult was 4.16 years. 12 patients referred from SALT, seven from local early intervention services, remainder from mixture of healthcare professionals. 27/28 patients had an underling diagnosis, the most common being; genetic disorder (n=7), autism (n=3), cerebral palsy (n=3), Ex-prem (n=3), developmental delay of unknown aetiology (n=3). Diverse reasons for referral included (often >1); issues with coordination of swallow (n=14), perceived behavioural issues (n=6), chronic reflux (n=5), PEG feeding (n=4), aspiration (n=4). 10 had prior video fluoroscopy. 22/28 patients had an abnormal EDS assessment. The two most common interventions initiated were a sensory feeding programme (n=15) or food desensitisation programme (n=4) by SALT/OT. There were nine specific medical interventions of which referral to another physician was the most common (n=5). Conclusion Our EDS clinic has provided further therapeutic intervention for children already with complex medical needs. In conjunction with medical therapy, behavioural and oromotor strategies can be applied successfully even in feeding disorders with an underlying organic cause.

Additive, Multi-Component Treatment of Emerging Refusal Topographies in a Pediatric Feeding Disorder

This case study describes inter-disciplinary treatment of chronic food refusal and tube dependency in a 2-year-old female with a pediatric feeding disorder. Evidence-based behavioral components—including escape extinction (EE), differential reinforcement of alterative mealtime behavior (DRA), and stimulus fading—were introduced sequentially as the focus of treatment shifted to address refusal topographies along the chain of behaviors associated with consumption. The assessment process, treatment planning and sequencing, and generalization of treatment gains to caregivers are presented in detail. In doing so, the study illustrates the core features involved in applying a flexible, evidenced-based approach to treat severe feeding difficulties.

Diagnostik und Therapie von Schluck- und Fütterstörungen bei Säuglingen und Kleinkindern: Eine interdisziplinäre Aufgabe

Schluck- und Fütterstörungen in der Pädiatrie sind meist komplexer Natur. Dieses liegt darin begründet, dass diese Störungsbilder häufig im Zusammenhang mit medizinischen Erkrankungen, psychosozialen Risikokonstellationen und Entwicklungsstörungen auftreten. Durch ihre komplexe Symptomatik, Pathogenese und Entwicklungsverlauf erfordern sie die Betrachtung durch unterschiedliche Fachdisziplinen. Eine interdisziplinäre Herangehensweise bei der Diagnostik und Therapie dieser Störungsbilder gibt dem Team die Möglichkeit, auf verschiedenen Zugangswegen eine optimale Behandlungsstrategie für das individuelle Kind zu entwickeln. Das Ziel der Behandlung von kindlichen Schluck- und Fütterstörungen ist eine ausreichende und sichere Versorgung des Kindes mit Nahrung und Flüssigkeit ohne Druck und Zwang. Essen und Trinken sollten wieder zu einer besonderen und genußvollen Erfahrung für Eltern und Kind werden. Ein Behandlungsansatz wird in dieser Arbeit vorgestellt.

Parent-Implemented Procedural Modification of Escape Extinction in the Treatment of Food Selectivity in a Young Child with Autism

Fool selectivity is characterized by the consumption of an inadequate variety of foods. The effectiveness of behavioral treatment procedures, particularly nonremoval of the spoon, is well validated by research. The role of parents in the treatment of feeding disorders and the feasibility of behavioral procedures for parent implementation in the home has not been investigated extensively. In this study, a procedural variation of escape extinction was used to treat the food selectivity of a young child with autism. Treatment occurred in the child’s home and all procedures were implemented by his mother. At the conclusion of treatment, the child independently consumed all foods presented in regular family meals within an appropriate time period. DESCRIPTORS autism, food selectivity, parent training, pediatric feeding disorders

Pediatric Feeding Disorders: Effectiveness of Multidisciplinary Inpatient Treatment of Gastrostomy-Tube Dependent Children

Effectiveness of multidisciplinary inpatient treatment of feeding-disordered children was sought through retrospective chart review of 40 gastrostomy-tube (i.e., G-tube) dependent children, ages 22 months to 7 years, with co-occurring medical conditions. Treatment effect analyzed from pre- and posttreatment measures of oral and G-tube caloric intakes resulted in a significant difference from admission to discharge for both oral intake, t(39) = 5.76, p < .001 (d = 1.02); and G-tube dependency, t(39) = 10.94, p < .001 (d = 2.03), with both showing strong treatment effects. Results indicated a highly reliable and valid method of treating severe pediatric feeding disorders.

Differential reinforcement of high rate behavior to increase the pace of self‐feeding

AbstractAlthough numerous studies have examined treatments for increasing food consumption among children with pediatric feeding disorders, very few have examined treatment of other mealtime‐related difficulties. One such problem is a slow pace of self‐feeding, which can lead to caregivers failure to adhere to treatments or be disruptive to others. We examined the effects of a differential reinforcement of high rate (DRH) intervention to increase a 9‐year‐old boy's pace of self‐feeding. During treatment, the child received reinforcement contingent on consuming his meal within 30 min. Results showed an increase in the pace of self‐feeding and a concomitant decrease in meal duration as compared to baseline. Copyright © 2008 John Wiley &amp; Sons, Ltd.

Using Motor Learning Approaches for Treating Swallowing and Feeding Disorders: A Review

This article discusses children's development of mature swallowing and feeding as a process of skill acquisition and considers the applicability of motor learning concepts for advancing these capabilities in school-aged children. The motor learning literature was reviewed, with concentration on (a) concepts that are relevant for the acquisition of skill and (b) structuring practice experiences to optimize learning. The discussion includes (a) swallowing physiology with a focus on motor task components, (b) normal development of eating skills, (c) factors that may slow or disrupt normal development, (d) motor learning concepts found to influence learning efficiency and performance adequacy, (e) applications to the assessment and treatment of pediatric swallowing and feeding disorders, and (f) an illustrative case history. Deficiencies in swallowing and feeding may encompass eating, saliva control, swallowing during oral hygiene, and swallowing medications. Motor learning literature provides a rich foundation of evidence-based theory and educational strategies for the development and remediation of motor-based skills such as swallowing and feeding.

Pediatric Feeding Disorder and Growth Decline following Mandibular Distraction Osteogenesis

Pediatric Feeding Disorder and Growth Decline following Mandibular Distraction Osteogenesis

Medication management of pediatric eating disorders

This article provides an overview of psychopharmacological treatments for pediatric eating disorders (EDs). Although EDs usually begin in adolescence, there are few pharmacological treatment trials specific to this age group and a paucity of controlled data. Empirical evidence suggests that psychological, behavioural and family interventions should be the primary modalities of treatment for these conditions. In severely underweight patients behavioural weight restoration should be attempted before pharmacological intervention, especially since starvation is known to aggravate obsessional and depressive symptomatology. Evidence from controlled trials supports the use of antidepressants for the treatment of bulimia nervosa (BN) in adults; however, similar studies have not yet been performed in youths. For anorexia nervosa (AN), there are no pharmacotherapies of proven efficacy in either adults or youths. Nonetheless, clinical experience and uncontrolled evidence suggests that some children and adolescents may benefit from thoughtful use of psychotropic medications on an individual basis in the context of a multimodal treatment plan. Regarding binge eating disorder (BED), adult literature shows positive short-term effects on binge eating for both pharmacological (especially selective serotonin reuptake inhibitors) and behavioural interventions, but unclear effects on weight. Clearly, psychopharmacological interventions for pediatric EDs would benefit from more research.

Assessment of pediatric dysphagia and feeding disorders: Clinical and instrumental approaches

Assessment of infants and children with dysphagia (swallowing problems) and feeding disorders involves significantly more considerations than a clinical observation of a feeding. In addition to the status of feeding in the child, considerations include health status, broad environment, parent-child interactions, and parental concerns. Interdisciplinary team approaches allow for coordinated global assessment and management decisions. Underlying etiologies or diagnoses must be delineated to every extent possible because treatment will vary according to history and current status in light of all factors that are often interrelated in complex ways. A holistic approach to evaluation is stressed with a primary goal for every child to receive adequate nutrition and hydration without health complications and with no stress to child or to caregiver. Instrumental swallow examinations that aid in defining physiological swallowing status are needed for some children. Successful oral feeding must be measured in quality of meal time experiences with best possible oral sensorimotor skills and safe swallowing while not jeopardizing a child's functional health status or the parent-child relationship.