Pediatric Feeding Problems Research Articles

Adaptation and validation of Arabic version of the screening tool of feeding problems applied to children (STEP-CHILD)

Objectives Early identification of pediatric feeding problems is crucial to preventing their subsequent negative impact on children's quality of life. This study aimed to create and validate an Arabic-modified version of the Screening Tool of Feeding Problems Applied to Children (STEP-CHILD) to identify feeding problems in Arabic-speaking children. Methods The STEP-CHILD Arabic was created and administered to the parents/caregivers of 390 Arabic-speaking children aged 2-18 years. 89 typically developing children without feeding/swallowing problems and 301 children with developmental disabilities were included in the study. The data was statistically analyzed to examine the validity and reliability of the questionnaire. Results The STEP-CHILD Arabic demonstrated excellent content validity, face validity, discriminant validity, and convergent validity. Predictive validity showed that the questionnaire has moderate to high accuracy in identifying pediatric feeding problems. It also showed excellent reliability and allowed for determining the specific feeding problems that would be targeted in the intervention. Conclusions The STEP-CHILD Arabic is a valid, reliable, and easily applicable tool that can be used as a routine evaluation for Arabic-speaking children at high risk of feeding problems.

Translation and validation of traditional Chinese version of the pediatric eating assessment Tool-10

Translation and validation of traditional Chinese version of the pediatric eating assessment Tool-10

A Preliminary Survey of Pediatric Feeding Experience and Practices among Behavior Analysts

We surveyed Board Certified Behavior Analysts (BCBAs®) about their experiences with pediatric feeding problems. Results show that the most common forms of inappropriate mealtime behavior with which behavior analysts have worked are passive refusal, head turns, and elopement from the feeding area. The most common intervention techniques used by BCBA®s when working with feeding problems are shaping and graduated guidance. BCBAs® work most often with occupational therapists and speech-language pathologists when providing feeding-related services. We conclude by providing recommendations to equip behavior analysts to better manage feeding cases.

Home and Parent Training Strategies for Pediatric Feeding Disorders: The Caregivers’ Perspective

Background: Twenty to 45% of the general pediatric population experience feeding problems. When children with disabilities exhibit feeding problems, they are more likely to develop maladaptive mealtime behaviors that may lead to poor nutrition. Home training to help treat a child’s feeding delay or disorder is a vital component of feeding treatment and supports holistic, family-centered treatment models. It is important for occupational therapists working with this population to understand the impact of these behaviors on individual and family functioning. Method: This quantitative study examined caregivers’ perspectives of the training families receive to support their child’s feeding delay or disorder, and how family mealtimes may be affected. One hundred and eight participants completed an online survey using primarily Likert scale questions. Results: Caregivers report that (a) they are receiving current and evidenced-based interventions; (b) they feel supported, yet feel they need more support; (c) family relationships are adversely affected by a child’s feeding challenges; (d) caregivers desire to connect with other caregivers of children with feeding delays or disorders; and (e) they need stress management and coping strategies. Conclusion: Feeding treatment is strengthened with more family-focused topics like family relationships and interactions, caregiver burden and stress management, and increased caregiver support.

Impact of Behavioral Feeding Intervention on Child Emotional and Behavioral Functioning, Parenting Stress, and Parent-Child Attachment.

Behavioral intervention is the only treatment for pediatric feeding problems with well documented empirical support. However, parents may be hesitant to pursue behavioral intervention because of concerns about possible negative side effects on child behavioral health and the parent-child relationship. This study investigated associations between behavioral feeding treatment and parenting stress, internalizing and externalizing behavior problems in young children, and parent-child attachment quality. Participants included 16 mother-child dyads seeking treatment from a behavioral feeding clinic at a large Midwestern university medical center. Children were between the ages of 30 and 45 months (adjusted) at baseline. Caregivers completed the Child Behavior Checklist for ages 1.5 to 5 (CBCL/1.5-5), the Parenting Stress Index, 3rd Edition Short Form (PSI/SF), and mother-child dyads participated in the Strange Situation procedure at baseline and again after 6 months. The treatment group (n = 12) began outpatient behavioral feeding intervention following the baseline evaluation, whereas the control group (n = 12) remained on the clinic waitlist until after the 6-month follow-up. The treatment group demonstrated decreases in internalizing and externalizing child behavior problems and parenting stress compared with the control group. No significant differences were demonstrated in parent-child attachment quality within or between groups. Behavioral feeding intervention had positive effects on perceptions of child emotional and behavioral functioning and maternal parenting stress. Intervention also did not impact the quality of the mother-child attachment relationship. Further research with a larger sample size and additional observational measures of behavior is needed to support the replicability and generalizability of these results.

Impact of Disruptive Behavior in Childhood Feeding Difficulties.

Pediatric feeding problems occur in 25-40% of all children and disproportionately affect children with health and/or developmental concerns. Children with autism spectrum disorder (ASD) are at particularly high risk for feeding difficulties, though the connection between ASD and feeding problems is not well understood. As issues related to problematic feeding behavior frequently present to outpatient pediatric clinics, there is a need to understand the common factors that contribute to the development of both adaptive and maladaptive feeding behaviors. The current study examined predictors of problematic feeding behavior in children with and without ASD. Parents of children with ASD reported significantly greater child disruptive behavior, parenting stress, child feeding difficulties, and problematic parental feelings and strategies regarding feeding. Child disruptive behavior and parenting stress contributed the most variance in the prediction of child feeding difficulties and the relation between child disruptive behavior and feeding difficulties was partially mediated by parental strategies and feelings.

Developing and Implementing a Telehealth Enhanced Interdisciplinary Pediatric Feeding Disorders Clinic: a Program Description and Evaluation

Pediatric feeding problems are highly prevalent in the general population and reportedly higher in populations of youth with disabilities. A variety of treatment approaches and settings have been explored yet challenges with generalization to home and community settings continue to be experienced. Telehealth enhanced interdisciplinary feeding services are one response to these challenges. This study described a model for outpatient feeding services serving clients with intellectual and developmental disabilities within a coordinated health care model through a telehealth enhanced clinic. Further a cost savings analysis demonstrated a savings in travel time and travel costs relevant to receiving services. Practical recommendations for practitioners who are interested in using telehealth enhanced services for pediatric feeding problems were discussed.

“It's a Long-Term Process”: Description of Daily Family Life When a Child Has a Feeding Disorder

Pediatric feeding problems occur in 25% of the general pediatric population and up to 80% of those who have developmental delays. When feeding problems place the child at nutritional risk, families are typically encouraged to increase their child's intake. Family mealtime can become a battle, which further reinforces problematic feeding behaviors from the child and intensifies well-intentioned but unguided parental mealtime efforts. Family has an essential influence on feeding; however, studies to date neglect to address the family context of feeding difficulty. In this study we describe, in the context of everyday life, family management of feeding when a child had a significant feeding problem. Parents of children with feeding problems were interviewed with the Family Management Style Framework components as a guide. Twelve parents participated, representing nine families of children with feeding disorder. Description of family management of feeding provides a foundation for development of family feeding interventions.

Evidence to support treatment options for children with swallowing and feeding disorders: A systematic review.

A rise in pediatric patients with swallowing and feeding problems has resulted in increased interest in multidisciplinary treatments to address these issues. This evidence based systematic review (EBSR) examined the published evidence for the use of common strategies used by clinicians across disciplines to treat pediatric swallowing and feeding problems. A systematic search of 10 electronic databases was completed to identify relevant, peer reviewed literature published in English prior to December 2015 reporting original data that addressed at least one of the five identified clinical questions. Sixty-one studies of varying methodological quality were included. The majority of the included studies (60/61) focused on the use of behavioral therapies to remediate swallowing and feeding disorders in children and reported mixed findings across all of the targeted outcomes. There is insufficient quantity of evidence to determine the effects of oral motor, sensory, and pharmaceutical therapies on functional feeding outcomes in pediatric populations. A larger body of phase 1 evidence is available that establishes the efficacy of behavioral strategies to treat some swallowing and feeding difficulties in small cohort and single subject studies. This analysis identified limited high quality (phase 4) research articles that establish the efficacy and benefit of joint nutrition and behavior intervention programs and systematic desensitization and operant conditioning behavioral therapy approaches to improve functional feeding and swallowing outcomes in children.

Feeding problems in infancy and early childhood: evolutionary concept analysis.

The aim of this study was to report an analysis of the concept of pediatric feeding problems. Reviews of the literature on pediatric feeding problems and disorders repeatedly reference the lack of a shared conceptualization of feeding problems. It is difficult to track aetiology, prevalence and incidence of a phenomenon when available definitions and diagnoses lack practical utility. An evolutionary concept analysis. A search was conducted in October 2014 of Google Scholar, CINAHL, PubMed and Web of Science databases, with MeSH terms and key words including: failure to thrive, feeding disorder/difficulty/problems, infantile anorexia, oral aversion, mealtime behaviour and dysphagia. Inclusion criteria were: subject of feeding problems, index children 0-10years of age, English language and full text. The articles (n=266) were sorted into disciplines of authorship, including Psychology, Medicine, Nursing, Nutrition, Occupational Therapy, Speech Language Pathology or Other. The sample was divided into a historical sample (n=42) for pre-2000 articles and current for those published post-2000. The current sample was later reduced to 100 and coded for surrogate terms, related concepts, attributes, antecedents and consequences. The historical view of pediatric feeding problems shows a tradition of mother blame or parental culpability, both direct and indirect. Currently, there exist many different definitions and typologies, but none have sound validity or generalizability. Areas of attribute consensus across disciplines are problematic feeding behaviours and selective or restrictive intake. A spectrum conceptualization of feeding problems is suggested for further development, with attributes that would be critical to have a feeding problem.

Concept of Pediatric Feeding Problems From the Parent Perspective.

Feeding difficulties in early childhood are common, affecting approximately 25% of typically developing children and up to 80% of children with developmental disabilities. There is no interdisciplinary consensus on the definition of a feeding problem and there is no input from families in the conceptualization. Lack of common language is a barrier to effective communication between clinicians, researchers, and caregivers, and inhibits collaboration. The purpose of this study was to examine the conceptualization of pediatric feeding problems by family caregivers (parents). This study reports an empirical phase of a concept analysis. Data from interviews with 12 parents of children with feeding problems were coded for related concepts, attributes, antecedents, and consequences of feeding problems, and then analyzed for themes within conceptual categories. Conceptual elements across interviews are presented with an emphasis on shared perspectives. Parents related pediatric feeding problems to be a process or journey on which they found themselves for an unknown duration. Common themes of attributes were problematic feeding behaviors of the child, restrictive or selective intake, and child weight or growth concerns. Parents conceptualize feeding problems as a condition with symptoms experienced by the child and family that need to be incorporated into family life. In contrast, prior literature coming from providers' point of view presents this problem to be of the child. Nurses can improve care of families with children who have feeding problems by coordinating interdisciplinary, family-centered care.

Interdisciplinary Feeding Team: A Medical, Motor, Behavioral Approach to Complex Pediatric Feeding Problems.

Pediatric feeding difficulties are complex and multifactorial in nature. Children who need assessment and individualized treatment for complex feeding problems are best served by an interdisciplinary treatment team. The medical, motor, and behavioral approach to treating pediatric feeding problems is presented as an avenue to treatment. By necessity, this approach requires a well-functioning interdisciplinary team, including nurses, physicians, registered dietitians, and feeding therapists (speech-language pathologists, occupational and physical therapists). We describe a robust interdisciplinary feeding team that applies a medical, motor, and behavioral approach to treating pediatric feeding problems. Within this team, pediatric gastroenterology nurse practitioners, dietitians, and speech pathologists function as integral members of the team. Description of each team member's expertise is provided and how they operate to support children with feeding problems and their families.

Concept of Pediatric Feeding Problems From the Parent Perspective

Concept of Pediatric Feeding Problems From the Parent Perspective

Escape Extinction and Negative Reinforcement in the Treatment of Pediatric Feeding Disorders: a Single Case Analysis.

Pediatric feeding disorders are common among children with developmental disabilities and can have detrimental effects on growth and development. An escape extinction and negative reinforcement-based approach to treating food refusal was examined in a child with cerebral palsy. A changing criterion treatment design was implemented, which allowed the child to exit the treatment area contingent upon the acceptance and ingestion of a pre-determined number of bites. Food acceptance ranged from one to three bites at baseline and exceeded the pre-set criteria for mastery, at 14 bites during the final intervention phase.The study will contribute to the current literature on negative reinforcement procedures used in the treatment of pediatric feeding problems.The study will contribute to increasing the availability of literature pertaining to pediatric feeding problems among children with complex disabilities such as cerebral palsy.The intervention is brief with components to the treatment package which increases utility and ease of implementation.The study demonstrates the applicability of changing criterion design within clinical settings.

Systematic review of psychological interventions for pediatric feeding problems.

To conduct a systematic review of the research evaluating the effect of psychological interventions for pediatric feeding problems. A search was conducted to identify studies using psychological interventions for pediatric feeding problems published between 1998 and 2013. Randomized controlled trials (RCTs) and nonrandomized studies that examined aggregated outcome data were included. Primary outcomes were child mealtime behavior, nutritional status, and caregiver stress. A risk of bias assessment was conducted and the quality of the evidence rated using Grading of Recommendations Assessment, Development, and Evaluation methodology. 13 studies were identified and a narrative synthesis framework was used to report findings. The preponderance of evidence suggests positive effects of psychological intervention for the treatment of feeding problems. However, limited data and the paucity of studies using RCT methodologies limit conclusions that can be drawn regarding the efficacy of these interventions. Future studies using more rigorous research methods are needed to enhance understanding of these interventions.

Antecedent interventions for pediatric feeding problems.

Behavior analysts have implemented and evaluated several antecedent strategies for treating pediatric feeding problems. The extent to which antecedent interventions are beneficial, however, is not yet clear. This review examines recent research in the Journal of Applied Behavior Analysis (2000-2012) that evaluated antecedent interventions. We found that the feeding diagnosis (food refusal vs. food selectivity) and presence of feeding-related medical conditions were related to the differential implementation of antecedent interventions.

Feeding Problems of Neonatal Intensive Care Unit and Pediatric Intensive Care Unit Graduates: Perceptions of Parents and Providers

There is little known about family experiences with pediatric feeding problems after neonatal intensive care unit (NICU) or pediatric intensive care unit (PICU) discharge. The study purposes were to better understand the family experiences with and consequences of feeding problems among NICU and PICU graduates after they transitioned home. Using a qualitative, descriptive design, 15 parents and 10 health professionals completed in-depth interviews. Data were analyzed using qualitative content analysis. Analysis revealed that feeding problems greatly impacted families. Education and resources were considered important but generally insufficient. Although some parent-provider partnerships were strong, many others were not, and at times, partnerships were fraught with conflict, communication problems, and lack of collaboration. System barriers and financial concerns escalated parents' distress, affecting their emotional responses. Parents' perceptions of discrepancies between their family situation and those of “normal” families violated their expectations. Understanding the perspectives of parents and providers regarding feeding problems common among NICU and PICU graduates is essential to developing effective interventions.

Assessment of Feeding Problems in Children with Autism Spectrum Disorders

Feeding problems are common among children with autism spectrum disorders (ASD), but the assessment of feeding behavior in this population has received little attention. Currently, two of the most promising psychometric assessments of feeding problems in children and adolescents with ASD are the Brief Autism Mealtime Behavior Inventory (BAMBI) (Lukens and Linscheid Journal of Autism and Developmental Disorders 38:342–352, 2008) and the Parent Mealtime Action Scale (PMAS) (Hendy et al. Appetite 52:328–339, 2009). The BAMBI addresses common feeding problems exhibited by children and adolescents with ASD and the PMAS addresses parent behavior associated with child mealtime problem behavior. Additionally, there are direct observation measures that assess feeding problems. The current definition for pediatric feeding problems in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revisions [DSM-IV-TR]; American Psychiatric Association [APA] 2000) is limited and incomplete when assessing feeding problems in children with ASD; however, proposed changes to diagnostic criteria may lead to more accurate assessment of feeding problems in this population.

Empirically Supported Treatments for Feeding Difficulties in Young Children

Pediatric feeding problems are common among children and present severe issues for families. Unfortunately, treatment outcome studies with this population are sparse. The current study reviews the literature regarding treatment studies of children with severe feeding issues, provides an overview of empirically supported treatments for children who do eat orally, and finally summarizes interventions that attempt to reintroduce oral feeding to children who have been fed by gastrostomy tube or other non-oral feeding route.

Behavioral Treatments for Pediatric Feeding Disorders

The effectiveness of behavioral interventions for pediatric feedings problems has been well documented. However, the application of these procedures in the real world is often more complex and difficult than research reports reveal. Multiple factors such as the child's medical condition and history, medical monitoring requirements, and the need to adjust treatment procedures as intervention progresses make it difficult to follow the best-laid plans developed from reading structured and highly controlled experimental applications. This article details factors to be considered in the actual clinical-based application of behavioral procedures in the treatment of pediatric feeding problems. A description of how referrals are generated and initial assessment is conducted, and a model for inpatient treatment is presented. In addition, the need for efficient and effective treatment in the real world is stressed.