Pediatric Feeding Research Articles

Investigation of Assessment Tools in the Area of Pediatric Feeding Evaluation: A Mixed-Methods Study.

The new diagnostic code for pediatric feeding disorder (PFD) in the International Classification of Diseases, 10th edition, Clinical Modification, requires that occupational therapists and speech-language pathologists (SLPs) use valid and reliable assessment tools that capture the complexity of PFD. To determine current assessment tools that clinicians are using across the four domains of PFD: (1) medical factors, (2) nutrition factors, (3) feeding skill factors, and (4) psychosocial factors. A secondary objective was to obtain clinicians' perceptions of the assessment tools. A mixed-methods study using survey research and focus groups. Online survey and virtual focus groups. Occupational therapists and SLPs who identified as clinicians who treat PFDs. The survey revealed that 65% of the clinicians (N = 445) used a nonstandardized assessment tool across the four domains of PFD. The focus groups (n = 26) revealed four resulting themes that expanded the survey results: (1) no one assessment tool works, (2) clinicians rely on self-created assessments, (3) it takes a team and collaboration, and (4) there are many issues with the current assessment of PFD. This study reveals the need for clinicians working with children with PFD to use feeding assessment tools with sound psychometric properties. The requirement for occupational therapists and SLPs to evaluate and treat dysphagia and disorders of feeding indicates the need to provide entry-level education on reliable and valid assessment tools that thoroughly evaluate all the domains of PFD. What This Article Adds: This article highlights current assessment tools used by occupational therapists and SLPs treating PFD and the need for more standardized procedures and tools to evaluate children across the four domains of PFD.

Association between feeding/mealtime behavior problems and internalizing/externalizing problems in autism spectrum disorder, other neurodevelopmental disorders and typically developing children.

The aim of current study was to examine the nature and prevalence of feeding problems and mealtime behavior problems in children with autism spectrum disorder (ASD) comparing to children with other neurodevelopmental disorders (NNDs) and TD children. We also investigated the impact of intelligence quotient (IQ) and/or emotional and behavioral problems on feeding and mealtime behavior problems. Participants completed the following tests: Social Communication Questionnaire (SCQ), Child Behavior Checklist (CBCL), Brief Autism Mealtime Behavior Inventory (BAMBI) and Behavioral Pediatric Feeding Assessment Scale (BPFAS). Children with ASD showed more feeding and mealtime behavior problems including food refusal (P<0.001, P<0.001) and limited variety of foods (P=0.014; P=0.018) compared with NDDs and TD children. ASD group showed more problems in mealtime behavior (P=0.034) and parent behaviors (P=0.028) compared to TD group. Internalizing (P=0.003) and externalizing (P=0.008) problems were positively related to parent frustration during mealtime in ASD group. These results suggest that routine screening for feeding and mealtime behavior problems among children with ASD is necessary to prevent dietary inadequacies that may be associated with eating habits.

Quantifying the Healthcare Burden of Pediatric Feeding Disorder after Congenital Heart Surgery

To determine the health care costs and utilization burden of pediatric feeding disorder after congenital heart surgery. A retrospective, population-based cohort study using claims data (2009-2018) was performed. Participants include patients aged 0-18 years who had undergone congenital heart surgery and were included in the insurance database ≥1 year after surgery. The main exposure variable was presence of pediatric feeding disorder, defined as a need for a feeding tube at discharge or diagnosis of dysphagia or feeding-related difficulty within the study timeframe. Main outcomes include overall and feeding-related medical care utilization, defined as readmissions and outpatient utilization, and feeding-related cost of care within 1 year of surgery. A total of 10,849 pediatric patients were identified, with 3347 (30.9%) presenting with pediatric feeding disorder within 1 year of surgery. Patients with pediatric feeding disorder spent a median of 12 days (IQR 6-33 days) in the hospital, compared with 5 days (IQR 3-8 days) in patients without (p<0.001). Rate ratios for overall readmissions, feeding-related readmissions, feeding-related outpatient utilization, and cost of care over the first year after surgery were significantly increased at 2.9 (95% CI 2.5-3.4), 5.1 (95% CI 4.6-5.7), 7.7 (95% CI 6.5-9.1), and 2.2 (95% CI 2.0-2.3) among patients with pediatric feeding disorder as compared with those without. Pediatric feeding disorder after congenital heart surgery is associated with a significant health care burden. Multidisciplinary care for and research on this health condition is needed to identify optimal management strategies to reduce this burden and improve outcomes.

Home-Based Behavioural Intervention across Skill Domains for a Child with Tube Dependency

Prolonged tube feeding has a multitude of negative outcomes. The transition to oral feeding is essential for child and family quality of life. Behaviour-analytic interventions are effective for paediatric feeding disorders, but information is lacking regarding the treatment process and outcomes. This study evaluated a home-based behavioural intervention for a 19-month-old child dependent on tube feeding. An intensive period was followed by caregiver support to advance feeding skills. We applied differential reinforcement and volume fading within a multiple probe design. Results showed clinically significant behavioural and nutritional outcomes, the cessation of tube feeding, and a process valued by the family.

Oral Sensory Issues with Feeding and Communication Skills in Autistic Children

ObjectivesOral sensory, communication, and feeding issues are frequently observed to co-occur in autistic children. The study attempted to explore the association between oral sensory deficits, feeding, and communication deficits in autistic children.MethodsBehavioral Pediatric Feeding Assessment Scale (BPFAS), Child Sensory Profile 2 (SP-2), and Communication and Symbolic Behavior Scales Developmental Profile Infant/Toddler Checklist (CSBS-DP) were administered to forty autistic children in the age range of 2.5-7 years. The correlation among the three domains was determined using Spearman’s rank correlation coefficient.ResultsA low negative correlation was found between SP-2 scores and CSBS-DP (r = −0.24, p = 0.13), indicating that the higher the oral sensory scores, the poorer the communication skills. SP-2 and BPFAS scores had a moderate positive correlation (r = 0.47, p = 0.002) i.e., higher scores in SP-2 were associated with higher scores in feeding, indicating that oral sensory issues were directly related to the feeding issues.ConclusionsThe overall findings indicated that the presence of oral sensory issues is associated with feeding and communication deficits in autistic children.Study RegistrationClinical Trial Registry of India CTRI/2020/07/02681

Pediatric feeding disorders among children with parental history of feeding disorders: a distinct group of patients with unique characteristics.

To investigate factors associated with pediatric feeding disorders (PFD) among children of parents that reported to have had feeding disorders during their own childhood compared to children with PFD with no history of parental PFD. We retrospectively reviewed the medical records of children diagnosed with PFD according to the recent WHO-based definition. The demographic and clinical characteristics of children with PFD with a parental history of PFD were compared to those of children with a PFD with no history of parental PFD. Included were 231 children with PFD (median [interquartile range] age 10months [5.5-29] at diagnosis, 58% boys) of whom 133 children had parents without PFD and 98 children had parents with PFD. Unexpectedly, children of parents without PFD had a higher rate of low birth weight (28% vs. 19%, respectively, p = 0.007), more delivery complications (10% vs. 2%, p = 0.006), more hospitalizations (33% vs. 17%, p = 0.004), more prescription medications (27% vs. 18%, p = 0.05), and a higher percent of gastrostomy tube use (6% vs. 0, p = 0.02). Moreover, more parents with PFD had academic background compared with parents without PFD (72% vs. 59%, p = 0.05). There were no significant group differences in sex, history of breastfeeding, parental marital status, or type of the child's feeding disorder. Conclusion: PFD among children with a parental history of PFD comprise a distinct group of patients with unique characteristics and outcomes. Since parental feeding history may explain their child's PFD in highly differing ways, such information may help in devising a specific family-based and multidisciplinary treatment plan for those children. What is Known: • Pediatric feeding disorder (PFD) is relatively common and its prevalence is increasing. • Information on an association between parental PFD and their child's feeding disorder is limited. What is New: • PFD among children with a parental history of PFD comprise a distinct group of patients with various characteristics and outcomes. • The parents' feeding history during childhood may provide important clues to their child's PFD.

Osteopathic Management of Pediatric Feeding Disorder, Oral Aversion, and Growth Faltering: A Case Report

Abstract Growth faltering is a complex problem in the pediatric population and can result from multiple mechanisms, including inadequate caloric intake. Feeding difficulties are common among children with growth faltering and can present significant challenges for achieving adequate nutrition and weight gain, particularly when coupled with any degree of oral aversion. The patient in this case is a 21-month-old child with oral aversion, pediatric feeding disorder (PFD), and growth faltering who had failed to gain weight while receiving the standard of care. Upon transitioning his care to an osteopathic pediatrician, who incorporated osteopathic manipulative treatment (OMT) into his care, he demonstrated weight gain, which was sustained over the 8 months of this study. This case report demonstrates the potential benefit of OMT for children with PFD, oral aversion, and growth faltering.

Translation and Psychometric Properties of the Persian Version of the Feeding/Swallowing Impact Survey in Iranian Mothers

Introduction: Feeding is an interactive process between a child and a caregiver, and its early and chronic problems can affect the stress and quality of life of parents. Since the health and support of caregivers can affect the child’s disability and performance, it is important to consider the impact of feeding and swallowing disorders on caregivers. Hence, the present study aimed to translate and investigate the validity and reliability of the Feeding/Swallowing Impact Survey (FS-IS) in Persian. Methods: This methodological study consisted of two phases: translating the test to Persian (P-FS-IS) and evaluating psychometric properties including face and content validity (through experts’ opinions and cognitive interviews), construct validity (by known-group validity and exploratory factor analysis), and reliability of the questionnaire (by internal consistency and test-retest reliability). The present study was performed on 97 Iranian mothers of children with cerebral palsy aged 2–18 years with swallowing impairments. Results: Exploratory factor analysis rendered two factors with a cumulative variance of 59.71%. When evaluating known-group validity, the questionnaire scores were significantly different across the groups with different severity of the disorder (F(2, 94) = 57.1, p ≤ 0.001). P-FS-IS had a high internal consistency with Cronbach’s alpha of 0.95, and there was an appropriate intra-class correlation coefficient of 0.97 for the total questionnaire. Conclusion: P-FS-IS has good validity and reliability and is a suitable questionnaire for assessing the impact of pediatric feeding and swallowing disorders on Persian language mothers. This scale can be used in research and clinical settings to evaluate and determine therapeutic goals.

Feeding Problems in Young Children: A Cross-Sectional Study in Sweden.

Parents of children attending regular 10-, 18-, and 36-month visits at the child health care centers (CHCCs) in Sweden answered a questionnaire including a Swedish version of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) as well as demographic questions. CHCCs were stratified according to a sociodemographic index. Parents of 238 girls (115) and boys (123) completed the questionnaire. Using international thresholds for FP detection, 8.4% of the children had a total frequency score (TFS) indicating FP. Based on the total problem score (TPS), the result was 9.3%. The mean score for all children was 62.7 for TFS (median 60; range 41-100), and 2.2 for TPS (median 0; range 0-22). Children aged 36 months had a significantly higher average TPS score than younger children, but TFS scores did not differ by age. There were no significant difference in gender, parents' education, or sociodemographic index. Prevalence numbers found in this study are similar to those found in studies with BPFAS in other countries. Children 36 months of age had a significantly higher prevalence of FP than children aged 10 and 18 months. Young children with FP should be referred to health care specializing in FP and PFD. Creating awareness of FP and PFD in primary care facilities and child health services may facilitate early detection and intervention for children with FP.

Properties of Australian thickened formulae for infants and children: Influence of preparation and nutritional content on IDDSI properties.

Between 30% and 50% of infants and children with pediatric feeding disorders demonstrate oropharyngeal aspiration. Thickening fluids are a compensatory strategy that is commonly recommended by speech pathologists for the management of oropharyngeal aspiration. Ongoing variability in the preparation of thickened fluids across infant formulas and healthcare facilities continue to limit the standardization of the preparation of thickened infant and pediatric formulas. No studies exist which examine the influence of nutritional properties of different infant formula types on IDDSI thickness levels. Our study aimed to describe the impact of standardized resting times; and understand the influence of nutritional properties on a variety of ready-to-feed liquid and powder-based Australian thickened formulae. A total of 27 ready-to-feed liquid and powder-based formulas were tested for viscosity level at baseline and when thickener was added on at least two trials. Frequency counts and percentages were used to describe categorical data. Logistic regression was used to model the binary outcome and calculate the odds ratios and their 95% confidence intervals. A total of 18 formulas proceeded to IDDSI flow testing of at least two trials because 7 formulae tested as slightly or mildly thick at baseline; while 2 formulae only had one trial of IDDSI flow testing completed. Of the 18 formulae tested, 72.22% (13/18) of commonly used powder-based and ready-to-feed formulas in Australia thickened to IDDSI slightly thick (level 1) were prepared in a standardized manner and allowed to rest for 5 min. Formulas with higher protein totals were more likely to thicken sufficiently (AOR: 7.45; 95% CI: 2.06-26.89), while formulas with higher sugar totals or those used for enteral feeds were less likely to thicken sufficiently (AOR: 0.02; 95% CI: 0.01-0.29). There was good test-retest reliability (ICC: 0.76; 95% CI: 0.22-0.97), indicating that standardizing the preparation of thickened fluids was consistently achievable. Given that not all formulae were observed to thicken to the intended consistency using standardized preparation and resting time, this study highlights the importance of using the IDDSI Flow Testing Method regularly in practice when recommending thickened infant formula recipes for managing aspiration in infants and children.

Impact of COVID‐19 in relation to the outpatient pediatric feeding therapy experience: A speech‐language pathologist's review of literature and professional experience

It is well known in the medical and pediatric feeding community how parental stress affects outcomes of pediatric nutrition and feeding behaviors. There is growing literature suggesting the impact of the COVID-19 pandemic in relation to caregiver and child stress. It could be suggested that this increase in stress contributed to or exacerbated pediatric feeding difficulties. In addition, the COVID-19 pandemic resulted in pediatric rehabilitation therapists quickly transitioning from in-person to virtual evaluation and treatment models. The purpose of this article is to review current literature regarding the definition and prevalence of pediatric feeding disorder, the impact of the COVID-19 pandemic on parent/child stress and relationships surrounding feeding, and this speech-language pathologist's perception of both the positive and negative aspects of providing ongoing outpatient feeding evaluations and treatments in the context of the COVID-19 pandemic, as well as clinical considerations for ongoing feeding therapy after the COVID-19 pandemic.

What Plays a Role in Perceived Confidence for Managing Pediatric Feeding Disorders in the Public School.

This study examined public school (PS) speech-language pathologists' (SLPs') perceived confidence in managing pediatric feeding disorders (PFDs). Perceived confidence is a rater's self-reported assurance level to manage PFDs. The study then looked for relationships between personal and professional factors that might account for perceived confidence. Geographic location as well as administrative supports and resources were also examined. Participants were PS SLPs from across the United States who were recruited via American Speech-Language-Hearing Association Special Interest Groups. This study measured perceived confidence with a 5-point Likert-type scale for 17 roles and responsibilities in PFD management. Pearson and Spearman correlations were used to identify relationships with personal and professional characteristics. PS SLPs perceived themselves as having low confidence in managing PFDs. Personal and professional characteristics account for low perceived confidence (e.g., number of graduate courses, clinical experience with swallowing and feeding in early intervention or medical settings, managing swallowing and feeding currently, having more administrative support). This study provided a more representative sample (i.e., geographic regions) of PS SLPs. Perceived confidence in PFD management is linked to factors that can be modified through personal and professional changes.

Dynamic Systems Theory: A Primer for Pediatric Feeding Clinicians

Purpose:Dynamic systems theory (DST) is a theoretical framework that has been applied to motor learning with key clinical implications. DST is increasingly used as a framework for pediatric feeding research but is lesser known to clinicians reading and implementing the research. Clinical translation of DST is therefore critical and has not yet been undertaken for children with pediatric feeding disorder at the stage of solid foods. The purpose of this tutorial is to provide clinicians with an overview of DST so that they can understand and use DST principles in their clinical practice for children with pediatric feeding disorders.Conclusions:This tutorial focuses on introducing clinicians working with pediatric feeding clients to DST. To establish a foundational understanding, a clear definition of DST is offered, and its key tenets are described. Pediatric feeding specific examples are offered for each tenet to increase comprehensibility. DST is then used to describe the general process of development as well as the development of feeding behaviors and skills. Finally, clinical applications of DST for assessment and treatment of pediatric feeding disorders are discussed. DST is growing in its use in pediatric feeding research and is extendable to clinical practice. This tutorial emphasizes the dynamic nature of feeding development; the importance of holistic, family-centered care; and the potential for changes in clinical practices to better support families from this theoretical lens.

Evaluation and Management of Pediatric Feeding Disorder

Feeding disorders are increasingly common in children, especially as medical advancements improve the life expectancy of children born with prematurity and complex medical conditions. The most common symptoms include malnutrition, refusal to eat and drink, food pocketing, disruptive feeding behavior, slow feeding, food selectivity or rigid food preferences, limited appetite, and delayed feeding milestones. A unifying diagnostic definition of pediatric feeding disorder has been proposed by a panel of experts to improve the quality of health care and advance research. Referral to specialized care should be considered when feeding problems are complex or difficult to resolve. In this review, we provide an overview of the evaluation and management of pediatric feeding disorders and information that may be useful when considering whether referral to specialized care may be beneficial.

Screening of Swallowing and Feeding-Related Problems in Typically Developing Children.

The aim of this study was to define swallowing and feeding-related problems among typically developing children aged between 2 and 6 years. The presence of food selectivity, limited appetite, chewing dysfunction, and dysphagia signs was questioned and scored as "absent" or "present" according to parent report. Children were divided into 2 groups: children with swallowing and feeding disorders and children without swallowing and feeding disorders. The Turkish version of the Behavioral Pediatrics Feeding Assessment Scale (T-BPFAS) was used to evaluate feeding behaviors of children, and Turkish version of the Feeding/Swallowing Impact Survey (T-FS-IS) was used to measure the impact on caregivers. A total of 234 children were included. Food selectivity was defined in 62.4% (n = 146), limited appetite in 26.9% (n = 63), and chewing dysfunction in 7.3% (n = 17). The most common dysphagia-related sign was coughing. There were significant differences between groups in terms of both T-BPFAS and T-FS-IS (P < .001). In conclusion, children with typical development have experienced a wide range of swallowing and feeding-related problems, which have an impact on mothers' perceptions regarding feeding and their quality of life.

Oral exploration and food selectivity: A case-control study conducted in a multidisciplinary outpatient setting.

Pediatric feeding disorders (PFDs) are common, and their great phenotypic variability reflects the breadth of the associated nosological profiles. PFDs should be assessed and managed by multidisciplinary teams. Our study aimed to describe clinical signs of feeding difficulties in a group of PFD patients assessed by such a team, and to compare them with children in a control group. In this case-control study, case group patients 1 to 6 years old were consecutively recruited through the multidisciplinary unit for the treatment of pediatric feeding difficulties based at Robert Debré Teaching Hospital in Paris, France. Children with an encephalopathy, severe neurometabolic disorder, or genetic syndrome (suspected or confirmed) were excluded. Members of the control group, consisting of children with no feeding difficulties (i.e., Montreal Children's Hospital Feeding Scale scores below 60) or severe chronic diseases, were recruited from a day care center and 2 kindergartens. Data from medical histories and clinical examination related to mealtime practices, oral motor skills, neurodevelopment, sensory processing, and any functional gastrointestinal disorders (FGIDs) were recorded and compared between groups. In all, 244 PFD cases were compared with 109 controls (mean ages: cases, 3.42 [±1.47]; controls, 3.32 [±1.17]; P = 0.55). Use of distractions during meals was much more among PFD children (cases, 77.46%; controls, 5.5%; P < 0.001), as was conflict during meals. While the groups did not differ in their members' hand-mouth coordination or ability to grab objects, cases began exploring their environments later; mouthing, especially, was less common in the case group (cases, n = 80 [32.92%]; controls, n = 102 [94.44%]; P < 0.001). FGIDs and signs of visual, olfactory, tactile, and oral hypersensitivity were significantly more frequent among cases. Initial clinical assessments showed that, in the children with PFDs, normal stages of environmental exploration were altered, and that this was often associated with signs of sensory hypersensitivity and digestive discomfort.

Interdisciplinary feeding clinic during the coronavirus disease 2019 pandemic: Implementing telehealth and social determinants of health screening.

Interdisciplinary feeding clinic during the coronavirus disease 2019 pandemic: Implementing telehealth and social determinants of health screening.

Using an intensive interdisciplinary telehealth model to treat pediatric feeding disorders.

The necessity of treatment using telehealth was apparent during the novel coronavirus (COVID-19) pandemic, as many practitioners were forced to use telehealth as a primary mode of service delivery. Although the telehealth model has been studied for different populations, little is known about its success when applied with children with feeding disorders and complex medical histories. The purpose of this study was to evaluate the efficacy of using a telehealth model from the onset of treatment. All 5 children who participated engaged in low levels of acceptance and high levels of inappropriate mealtime behavior during baseline. Caregivers were taught to implement the treatment with high integrity using behavioral skills training. Procedural integrity increased posttraining, and as a result acceptance increased and inappropriate mealtime behavior decreased. Treatment gains maintained during follow up at 1 month and 1 year. These data are discussed in relation to alternative ways of providing treatment in locations where intensive feeding programs are not available.

Changes in Medical Charges Following Intensive Multidisciplinary Intervention for Pediatric Gastrostomy Tube Dependence.

Intensive multidisciplinary intervention (IMI) is the most evidence-based approach to treat pediatric feeding disorders. The goal of this exploratory study was to assess changes in health care charges for patients with gastrostomy tube dependence following participation in IMI compared to a waitlist control. Medical charges were assessed for 9 families who participated in IMI compared to 6 control families on a multi-year waitlist for IMI. The IMI and control groups were compared on raw charges submitted as well as individual year-over-year changes in medical charges. The IMI group decreased health care charges by 71% on average in the year following IMI compared to the control group increasing charges by 22% over the same period. IMI also holds potential cost-savings in the year following treatment compared to children who do not receive treatment and adds to previous research focusing on long-term cost effectiveness of IMI.

Understanding Training Needs in Pediatric Feeding for Allied Health Professionals: An Australian Perspective.

Clinician experience and confidence can negatively impact pediatric feeding service availability, but limited research has investigated what training allied health professionals (AHPs) need to increase these factors. This study developed and distributed a survey investigating Australian AHPs' self-reported confidence and anxiousness, training needs, factors impacting training access, and training preferences. This study was conducted over two phases. Phase 1 involved development and refinement of the survey, and Phase 2 involved distribution to Australian AHPs. Questions pertained to general demographics, feeding experience, feeding confidence and skills perception, and training needs. The questions were composed of multiple-choice, Likert scale, and short-response options. Overall, 198 complete responses were received. Participants reported significantly lower confidence and higher anxiousness working with infants compared to older children (p < .01). Increased frequency of service provision predicted higher self-reported confidence and lower anxiousness (p < .01). Practical training opportunities including case discussion, videos, and clinical feedback were preferred. Access facilitators were online, on-demand training; however, respondents reported preferring hands-on training opportunities. Common barriers included cost, time, competing professional development priorities, and distance/travel. Findings have highlighted that recency and frequency of practice impact self-reported confidence and anxiousness, and that AHPs self-report lowest confidence and highest anxiety working with infants compared to older age groups. Overall, the findings highlight the need for flexible, practical, and remotely accessible training opportunities, as well as the need for access to regular clinical supervision and a pediatric feeding caseload.