51
|
Iron-Segev S, Best D, Stein D. Symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID) in the Orthodox and Secular Jewish Communities in Israel. JOURNAL OF RELIGION AND HEALTH 2023; 62:268-286. [PMID: 35474030 DOI: 10.1007/s10943-022-01565-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
Symptoms related to avoidant/restrictive food intake disorder (ARFID) are not well defined in the general population. The aim of this study was to determine whether differences exist in the presentation of ARFID-related eating disturbances between healthy, religious and secular Jewish children in Israel. Sixty-four families participated in this study. Parents completed standardized questionnaires to assess ARFID behaviors of children, parental feeding problems and overall functioning, anxiety and sensory-aversion. No significant between-group differences were found for almost all assessments. However, sensory-related pleasure and sensory-seeking behavior was greater in secular children. Overall, religious and non-religious Israeli children do not differ in parental-reported ARFID-related feeding and eating behaviors.
Collapse
Affiliation(s)
- Sharon Iron-Segev
- Robert H. Smith Faculty of Agriculture, Food and Environment, School of Nutritional Sciences, Institute of Biochemistry, Food Science and Nutrition, Hebrew University of Jerusalem, Rehovot, Israel.
- School of Nutritional Sciences, Peres Academic Center, Rehovot, Israel.
| | - Danielle Best
- Robert H. Smith Faculty of Agriculture, Food and Environment, School of Nutritional Sciences, Institute of Biochemistry, Food Science and Nutrition, Hebrew University of Jerusalem, Rehovot, Israel
| | - Daniel Stein
- Pediatric Psychosomatic Department, Chaim Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
52
|
Dumont E, Jansen A, Duker PC, Seys DM, Broers NJ, Mulkens S. Feeding/Eating problems in children: Who does (not) benefit after behavior therapy? A retrospective chart review. Front Pediatr 2023; 11:1108185. [PMID: 36925666 PMCID: PMC10013195 DOI: 10.3389/fped.2023.1108185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/23/2023] [Indexed: 03/06/2023] Open
Abstract
Background Treating disordered feeding at a young age reduces risks of future feeding problems, but not all children profit equally; can we define predictors of a worse prognosis? Objectives In 252 children, with a mean age of 4; 7 years (SD = 3 years; range 5 months to 17; 10 years), who had undergone behavioral day treatment in the past, several variables were investigated, retrieved from initial consultation (t1) and re-assessed at follow-up (t2). Method Logistic regressions were carried out with sex, gastro-intestinal problems, refusal of the first nutrition, syndrome/intellectual disability, Down's syndrome, autism spectrum disorder, comorbidity of medical diseases (other than gastro-intestinal problems), restrictive caloric food intake and selective food intake, as the predictor variables from t1, and age-appropriate food intake at t2 as the dependent variable. The potential role of sensory processing problems was reviewed at t2. Results About 73% had improved towards an age-appropriate food intake. Sex (boys), syndrome/intellectual disability, and a lack of varied nutritional intake at t1 were predictors of a worse prognosis. We found a small, but significant correlation between current selective eating patterns and general sensory processing problems. Conclusion Feeding disordered children, especially boys, with intellectual disabilities or selective eating patterns are at risk for not achieving an age-adequate food intake at a later age, despite behavioral treatment.
Collapse
Affiliation(s)
- Eric Dumont
- Deparment of Research and Development, SeysCentra, Malden, Netherlands.,Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Anita Jansen
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Pieter C Duker
- Deparment of Research and Development, SeysCentra, Malden, Netherlands
| | - Daniel M Seys
- Deparment of Research and Development, SeysCentra, Malden, Netherlands
| | - Nick J Broers
- Department of Methodology & Statistics, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Sandra Mulkens
- Deparment of Research and Development, SeysCentra, Malden, Netherlands.,Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
53
|
Exploration of Treatment Response in Parent Training for Children with Autism Spectrum Disorder and Moderate Food Selectivity. J Autism Dev Disord 2023; 53:229-235. [PMID: 35032300 DOI: 10.1007/s10803-021-05406-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2021] [Indexed: 02/03/2023]
Abstract
Managing Eating Aversions and Limited Variety (MEAL) Plan is a structured parent-mediated intervention for children with autism spectrum disorder and moderate food selectivity. Our previously reported group-based clinical trial revealed a positive treatment response rate of 47.3%. Although encouraging, this response rate raises questions about factors that may affect treatment outcomes. Here, we examine the impact of child and parent characteristics and feeding behaviors on treatment response. Higher maternal education and higher child communication abilities at baseline were associated with positive treatment response. Improvement in sitting at the table and reductions in disruptive mealtime behavior promoted treatment success. Results also suggest that individually delivered MEAL Plan may offer more flexibility than group-based intervention for some parents.
Collapse
|
54
|
Desai H, Jones CE, Fogel JL, Negrin KA, Slater NL, Morris K, Doody LR, Engstler K, Torzone A, Smith J, Butler SC. Assessment and management of feeding difficulties for infants with complex CHD. Cardiol Young 2023; 33:1-10. [PMID: 36562257 DOI: 10.1017/s1047951122004024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Early surgical intervention in infants with complex CHD results in significant disruptions to their respiratory, gastrointestinal, and nervous systems, which are all instrumental to the development of safe and efficient oral feeding skills. Standardised assessments or treatment protocols are not currently available for this unique population, requiring the clinician to rely on knowledge based on neonatal literature. Clinicians need to be skilled at evaluating and analysing these systems to develop an appropriate treatment plan to improve oral feeding skill and safety, while considering post-operative recovery in the infant with complex CHD. Supporting the family to re-establish their parental role during the hospitalisation and upon discharge is critical to reducing parental stress and oral feeding success.
Collapse
Affiliation(s)
- Hema Desai
- Department of Rehabilitation Services, Children's Hospital of Orange County, Orange, CA, USA
| | - Courtney E Jones
- Acute Care Therapy Services, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Jennifer L Fogel
- Department of Pediatric Rehabilitation, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Karli A Negrin
- Department of Therapy and Rehabilitative Services, Nemours Children's Health, Wilmington, DE, USA
| | - Nancy L Slater
- Physical Medicine and Rehabilitation Services, Children's Minnesota, Minneapolis, MN, USA
| | - Kimberly Morris
- Department of Speech-Language Pathology, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Lisa R Doody
- Pediatric Rehabilitation and Development, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Katherine Engstler
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Andrea Torzone
- Heart Center, Cardiac Intensive Care Unit, Children's Medical Center Dallas, Dallas, TX, USA
| | | | | |
Collapse
|
55
|
Kamal S, Kamaralzaman S, Sharma S, Jaafar NH, Chern PM, Hassan NI, Toran H, Ismail NAS, Yusri G, Hamzaid NH. A Review of Food Texture Modification among Individuals with Cerebral Palsy: The Challenges among Cerebral Palsy Families. Nutrients 2022; 14:nu14245241. [PMID: 36558401 PMCID: PMC9782059 DOI: 10.3390/nu14245241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/03/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022] Open
Abstract
Individuals with cerebral palsy (CP) frequently present with multiple feeding problems, which may require food texture modification to ensure safe feeding. This review aims to explore the challenges individuals with CP and their caregiver's face and recommend modified food textures to ensure safety and improve the quality of life and nutritional status. A systematic search was carried out through four databases (i.e., EBSCO (Medline), PubMed, Science Direct, and Web of Science) between January 2011 and May 2022. Out of 86 articles retrieved, seven were selected based on keywords and seven other studies through manual search-five cross-sectional studies, two qualitative studies, one correlational study, one mixed method study, one case-control study, two sections of books, and two educational materials. The findings suggest that preparation and intake of food with modified texture play a necessary role in the safety of swallowing in addition to physical, social, and environmental aspects. Safety was found to be the crucial part of the food texture modification provision besides considering the stress of the caregivers and the nutritional status of individuals with CP. Currently, there are no standard guidelines available pertaining to food texture modification. This led to uncertainties in the dietary provision among caregivers, which may lead to undernourishment. Hence, standard guidelines relating to food texture modification that focuses on food preparation and menus with calorie and nutrient information are timely to be developed.
Collapse
Affiliation(s)
- Sakinah Kamal
- Center for Rehabilitation and Special Needs Studies (iCaRehab), Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
- Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Sazlina Kamaralzaman
- Center for Rehabilitation and Special Needs Studies (iCaRehab), Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Shobha Sharma
- Center for Healthy Aging and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Nurul Hazirah Jaafar
- Department of Nutrition Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia (IIUM), Jalan Sultan Ahmad Shah, Bandar Indera Mahkota, Kuantan 25200, Malaysia
| | - Phei Ming Chern
- Department of Rehabilitation Medicine (Paediatric Rehabilitation), Hospital Rehabilitasi Cheras, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
| | - Nurul Izzaty Hassan
- Department of Chemical Sciences, Faculty of Science & Technology, Universiti Kebangsaan Malaysia (UKM), Bandar Baru Bangi 43600, Malaysia
| | - Hasnah Toran
- Faculty of Education, Universiti Kebangsaan Malaysia (UKM), Bandar Baru Bangi 43600, Malaysia
| | - Noor Akmal Shareela Ismail
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
| | - Ghazali Yusri
- Akademi Pengajian Bahasa, Universiti Teknologi Mara (UiTM), Shah Alam 40450, Malaysia
- Malaysian Advocates for Cerebral Palsy (MyCP), No 4., USJ3/4X, USJ3, Subang Jaya 47600, Malaysia
| | - Nur Hana Hamzaid
- Center for Rehabilitation and Special Needs Studies (iCaRehab), Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
- Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia (UKM), Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
- Correspondence:
| |
Collapse
|
56
|
Lively EJ, McAllister S, Doeltgen SH. Parents' experiences of their child's transition from tube to oral feeding during an intensive intervention programme. Child Care Health Dev 2022. [PMID: 36478601 DOI: 10.1111/cch.13088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/21/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Persistent enteral tube feeding beyond the point of medical and/or physical necessity provides important nutrition to a child but may have implications for their development, gastrointestinal tract and quality of life. Tube dependency can affect parent-child relationships and sibling and family dynamics and place additional medical demands upon parents. It is therefore important to transition children from tube to oral eating and drinking as soon as is medically safe to do so. Tube weaning requires a skilled team to support the transition to oral intake; however, access to experienced teams is inconsistent. Without transparent discussions with their treating teams, many parents are left to navigate tube weaning options independently. METHODS Fourteen parents were interviewed using semi-structured interviews. We explored the experiences of parents across their child's progression towards oral feeding, from the decision-making process to undertaking an intensive multi-disciplinary tube weaning programme. Thematic analysis of the parents' stories shaped the development of seven themes. RESULTS Parents were unaware that tube weaning would be required and how that would be facilitated. They expressed a strong belief that their child could learn to eat-if afforded an opportunity. Furthermore, parents are prepared to disengage from current services if they feel they are not respected members of their child's therapeutic team. Three key learnings were identified relating to the need for tube exit plans, parents as key team members and parents as change agents. CONCLUSIONS Parenting a tube-fed child, initiating and engaging in tube weaning, is a stressful and emotional journey. However, by establishing care partnerships, parents are willing to put trust in a process if provided with options and afforded autonomy, empowerment, acknowledgement and relevant support.
Collapse
Affiliation(s)
- Emily Jane Lively
- Swallowing Neurorehabilitation Research Laboratory, Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Sue McAllister
- Sydney School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Sebastian Heinrich Doeltgen
- Swallowing Neurorehabilitation Research Laboratory, Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
57
|
Stubbs KH, McMahon MXH, Popler J, Berry RC, Sharp WG. Multidisciplinary feeding treatment for a patient with interstitial lung disease. Pediatr Pulmonol 2022; 57:3183-3185. [PMID: 36100872 DOI: 10.1002/ppul.26146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/26/2022] [Accepted: 09/05/2022] [Indexed: 01/11/2023]
Abstract
Children with underlying medical and developmental conditions often present with complications that include feeding difficulties. Severe feeding difficulties may meet the criteria for the psychiatric diagnosis of Avoidant Restrictive Food Intake Disorder (ARFID). ARFID is a disruption in feeding/eating which may include weight loss/faltering growth, nutrient deficiencies, and/or reliance on a nutritionally complete formula to meet caloric needs. Children with interstitial lung disease (ILD), have a higher prevalence of feeding problems than the general population. To date, no published literature exists to provide guidance for treating severe feeding difficulties experienced by children with ILD. In this paper, we present an encounter in which we safely and effectively treated ARFID as evidenced by underweight and dependence on a nutritionally complete formula in a 3-year-old male with ILD using a multidisciplinary approach to treatment. Before the admission, the patient relied primarily on oral nutritional supplementation for most of his nutritional needs and therapeutic efforts to advance food intake were complicated by mealtime behavior problems and concerns regarding swallow safety. Intervention introduced 16 new foods, established consistent caloric intake of target food, and successfully weaned the patient from bottle feeding. We also review special considerations and provide guidelines for adapting treatment at multidisciplinary programs for patients with complex cardiorespiratory disease including modifications to behavior management procedures, medical monitoring, and nutritional consultation.
Collapse
Affiliation(s)
- Kathryn H Stubbs
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| | - Meara X H McMahon
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| | - Jonathan Popler
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| | | | - William G Sharp
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| |
Collapse
|
58
|
Elsayed HE, Thompson KL, Conklin JL, Watson LR. Systematic Review of the Relation Between Feeding Problems and Sensory Processing in Children With Autism Spectrum Disorder. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2875-2899. [PMID: 36356224 DOI: 10.1044/2022_ajslp-21-00401] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Many studies have linked sensory sensitivities to feeding problems in children with autism spectrum disorder (ASD). Despite the importance of sensory processing for a variety of mealtime and eating skills, the specific sensory processes that may impact feeding problems in children with ASD have not been comprehensively reviewed. Thus, the goal of this systematic review was to understand the associations between sensory processing and feeding difficulties in children with ASD. METHOD This systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, CINAHL Plus with Full Text (EBSCOhost), Scopus (Elsevier), and Embase (Elsevier) databases were searched from their dates of inception through the final search date of April 19, 2022, for English language studies that examined both sensory processing and feeding among children with ASD. Studies were assessed for quality using the Joanna Briggs Institute critical appraisal tools. RESULTS A total of 27 studies were included. Findings supported the existence of a relationship between sensory processing and feeding problems in children with ASD. Specifically, studies reported that overall scores on sensory processing measures as well as measures of oral sensory processing were frequently associated with feeding problems. CONCLUSIONS This review supports the development of future feeding interventions focusing on sensory processing given the relationship between sensory processing and feeding problems among children with ASD. Future research should focus on utilizing consistent feeding assessments specific to children with ASD and collect information on medical diagnoses that can impact feeding in order to report on feeding more holistically in this population. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21453909.
Collapse
Affiliation(s)
- Heba E Elsayed
- Kessler Foundation, East Hanover, NJ
- Rutgers New Jersey Medical School, Newark
- Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill
| | - Kelsey L Thompson
- Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill
| | - Jamie L Conklin
- Health Sciences Library, The University of North Carolina at Chapel Hill
| | - Linda R Watson
- Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill
| |
Collapse
|
59
|
Pehlivan MJ, Miskovic-Wheatley J, Le A, Maloney D, Research Consortium NED, Touyz S, Maguire S. Models of care for eating disorders: findings from a rapid review. J Eat Disord 2022; 10:166. [PMID: 36380363 PMCID: PMC9667640 DOI: 10.1186/s40337-022-00671-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Delayed diagnosis, gaps in services and subsequent delays in specialist care and treatment lead to poorer health outcomes for individuals with eating disorders (EDs) and drive significant government healthcare expenditure. Given the significant disease burden associated with EDs, it is imperative that current implementation research is summarised to identify gaps in care and enable refinement for optimal patient outcomes. This review aimed to provide an updated synthesis on models of care for EDs in developed healthcare systems. METHODS This paper was conducted as part of a series of Rapid Reviews (RRs) to be published in a special series in the Journal of Eating Disorders. To provide a current and rigorous review, peer-reviewed articles published in the English language between 2009 and 2021 across three databases (ScienceDirect, PubMed and Ovid/Medline) were searched, with priority given to higher level evidence (e.g., meta-analyses, large population studies, Randomised Control Trials (RCTs)). The current review synthesises data from included studies investigating models of care for people with EDs. RESULTS Sixty-three studies (4.5% of the original RR) were identified, which included several diagnostic populations, the most common being Anorexia Nervosa (AN) (30.51%). Across EDs, specialist care was found to improve patient outcomes, with many patients effectively being treated in outpatient or day programs with multi-disciplinary teams, without the need for lengthy inpatient hospitalisation. Few studies investigated the interaction of different ED services (e.g., inpatient, community services, primary care), however stepped care models emerged as a promising approach to integrate ED services in a targeted and cost-effective way. Issues surrounding low treatment uptake, underdiagnosis, long waiting lists and limited hospital beds were also evident across services. CONCLUSION Findings suggested further research into alternatives to traditional inpatient care is needed, with partial and shorter 'hospitalisations' emerging as promising avenues. Additionally, to tackle ongoing resource issues and ensure timely detection and treatment of EDs, further research into novel alternatives, such as active waiting lists or a greater role for primary care clinicians is needed. This paper is part of a larger Rapid Review series carried out to guide Australia's National Eating Disorders Research and Translation Strategy 2021-2031. Rapid reviews aim to thoroughly summarise an area of research over a short time period, typically to help with policymaking in this area. This Rapid Review summarises the evidence relating to how we care for people with eating disorders in Western healthcare systems. Topics covered include inpatient/hospital care, residential care, day programs, outpatient/community care, and referral pathways. Findings suggested specialist eating disorder services may enhance detection, referral, and patient care. Stepped care models presented as a cost-effective approach which may help with linkage between different eating disorder services. There was a trend towards shorter hospital stays and approaches which allow for greater connection with the community, such as day programs. Evidence was also found of treatment delays, due to system issues (long waiting lists, lack of accurate assessment and diagnosis) and patient-related barriers (stigma, recognition). Upskilling and involving primary care clinicians in diagnosis and referral as part of a stepped care model may help to address some of these concerns. Further efforts to improve mental health literacy and de-stigmatise help-seeking for eating disorders are needed.
Collapse
Affiliation(s)
- Melissa J Pehlivan
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia.
| | - Jane Miskovic-Wheatley
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Danielle Maloney
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| | | | - Stephen Touyz
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| |
Collapse
|
60
|
McMahon MXH, Hathaway KL, Hodges AK, Sharp WG, Volkert VM. A Retrospective Consecutive Controlled Case Series of Underspoon: A Modified-Bolus Placement to Address Behavior That Interfere With Swallowing. Behav Modif 2022:1454455221129996. [DOI: 10.1177/01454455221129996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children diagnosed with pediatric feeding disorder (PFD) or avoidant/restrictive food intake disorder (ARFID) may present with comorbid oral-motor delays that often contribute to their failure to consume an adequate volume and/or variety of foods. Once the food enters the mouth, these children may exhibit additional problematic behavior such as expulsion and packing that further averts oral intake. Previous research has evaluated the impact of modified-bolus placement methods, including flipped spoon and NUK® brush, in comparison to upright spoon on expulsion and packing. Whether responses are due to performance or skill deficits, researchers hypothesize that modified-bolus placement may assist with reducing the response effort associated with swallowing. This retrospective consecutive controlled case series assessed the clinical application of an additional modified-bolus placement method, underspoon, to increase food consumption and decrease problematic behavior that interfere with mouth clean for children with PFD or ARFID.
Collapse
Affiliation(s)
- Meara X. H. McMahon
- Emory University School of Medicine, Atlanta, GA, USA
- Children’s Multidisciplinary Feeding Program at Marcus Autism Center, Atlanta, GA, USA
| | - Kristin L. Hathaway
- Children’s Multidisciplinary Feeding Program at Marcus Autism Center, Atlanta, GA, USA
| | - Abby K. Hodges
- Emory University School of Medicine, Atlanta, GA, USA
- Children’s Multidisciplinary Feeding Program at Marcus Autism Center, Atlanta, GA, USA
| | - William G. Sharp
- Emory University School of Medicine, Atlanta, GA, USA
- Children’s Multidisciplinary Feeding Program at Marcus Autism Center, Atlanta, GA, USA
| | - Valerie M. Volkert
- Emory University School of Medicine, Atlanta, GA, USA
- Children’s Multidisciplinary Feeding Program at Marcus Autism Center, Atlanta, GA, USA
| |
Collapse
|
61
|
Evaluating Outcome Measure Data for an Intensive Interdisciplinary Home-Based Pediatric Feeding Disorders Program. Nutrients 2022; 14:nu14214602. [DOI: 10.3390/nu14214602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
Background: The purpose of this study was to evaluate the effectiveness of an interdisciplinary home-based feeding program, which is a unique service delivery model. Methods: Data were provided on oral intake, tube feeding elimination, and weight for patients who were dependent on tube feedings (n = 78). Weight data were collected for patients who showed failure to thrive (n = 49). Number of foods consumed and percentage of solids were collected for patients who were liquid-dependent (n = 23), and number of foods consumed were collected for patients who were food-selective (n = 61). Results: Data were analyzed using paired sample t-test with 95% confidence interval. For patients dependent on tube feedings, 81% achieved tube feeding elimination. Tube elimination was achieved after 8 months of treatment on average. All failure-to-thrive patients showed weight gain from baseline to discharge. For liquid-dependent patients, there was an increase in foods consumed from 2 foods at admission to 32 foods at discharge. For food selective patients, there was an increase from 4 foods at admission to 35 foods at discharge. For all dependent variables, results showed statistical significance and a large-sized effect. Conclusions: These data show that an intensive interdisciplinary home-based program can be successful in treating complex feeding problems in children.
Collapse
|
62
|
Cipolla J, Reeves-Latour J, Ramsay M, Li P. Mothers' experiences and perceptions of their child's weaning process from tube feeding within a multidisciplinary Paediatric Feeding Program. Paediatr Child Health 2022; 27:353-358. [PMID: 36200097 PMCID: PMC9528776 DOI: 10.1093/pch/pxac055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/19/2022] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVES Previous studies have described the negative impact that tube feeding of children with complex chronic diseases has on the caregivers' emotions, relationships and daily life. It is unclear whether these negative experiences persist or change during and after the weaning process. We sought to explore mothers' experiences and perceptions of their child being weaned off tube feeding within a Paediatric Feeding Program (PFP). METHODS We conducted a qualitative study using semi-structured interviews with mothers whose children <4 years old had experienced feeding tube weaning within an outpatient, family-centred, telemedicine-supported PFP. The transcripts were analyzed using thematic analysis. RESULTS We conducted 9 interviews with mothers of children (n = 10) in the PFP at which point data saturation was achieved. Three main themes emerged: a) the initial emotional toll on mothers stemming from fear of perceived adverse consequences of decreasing tube feeds and uncertainty surrounding efficacy of weaning; b) achievement of weaning via a family-centered approach through gaining trust, close contact, and collaboration with the team; and c) attainment of mothers' expectations of family life through transformed relationships and social activities. A positive evolution of emotions was observed, attributable to the support of the PFP. CONCLUSIONS These experiences suggest that our outpatient weaning program had a positive impact on the stress, fear, and relational challenges that mothers reported before and during initial tube weaning. These findings highlight potential areas of discussion with families at multiple stages of the child's tube feeding experience, to help normalize emotions for families and support coping strategies.
Collapse
Affiliation(s)
- Josie Cipolla
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Jonathan Reeves-Latour
- Centre for Outcomes Research and Evaluation, the Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | - Maria Ramsay
- Department of Psychology, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Patricia Li
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal Children’s Hospital, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, the Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| |
Collapse
|
63
|
Horsley M, Hill GD, Kaskie S, Schnautz M, Brown J, Marcuccio E. Evaluation of an Outpatient and Telehealth Initiative to Reduce Tube Dependency in Infants with Complex Congenital Heart Disease. Pediatr Cardiol 2022; 43:1429-1437. [PMID: 35333946 DOI: 10.1007/s00246-022-02864-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/25/2022] [Indexed: 10/18/2022]
Abstract
Infants with congenital heart disease (CHD) often require supplemental nutrition via tube feeding, even after corrective surgical repair. The need for tube feeding can persist months after discharge home, and outpatient weaning from the tube can be a slow and difficult process. Lack of consensus exists in the literature as to the best approach to this challenge. We describe a single institution's initiative to decrease tube dependency after discharge through an intensive, telehealth-centric program for children with CHD. Of 16 children aged 1-26 months, 94% were able to be successfully tube weaned at home, with median time to tube-free of 12 days. No significant weight loss was noted during or after the wean process. Longer tube wean time was associated with older age at onset and comorbid genetic syndrome. Our telehealth-based intensive tube weaning program was successful but required a multidisciplinary team, targeted pre-participation patient evaluation, and frequent communication.
Collapse
Affiliation(s)
- Megan Horsley
- Division of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Garick D Hill
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sarah Kaskie
- Division of Speech-Language Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Maureen Schnautz
- Division of Speech-Language Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James Brown
- Department of James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Elisa Marcuccio
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
64
|
Sharp WG, Silverman A, Arvedson JC, Bandstra NF, Clawson E, Berry RC, McElhanon BO, Kozlowski AM, Katz M, Volkert VM, Goday PS, Lukens CT. Toward Better Understanding of Pediatric Feeding Disorder: A Proposed Framework for Patient Characterization. J Pediatr Gastroenterol Nutr 2022; 75:351-355. [PMID: 35687655 PMCID: PMC9365260 DOI: 10.1097/mpg.0000000000003519] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/09/2022] [Indexed: 12/10/2022]
Abstract
To establish a foundation for methodologically sound research on the epidemiology, assessment, and treatment of pediatric feeding disorder (PFD), a 28-member multidisciplinary panel with equal representation from medicine, nutrition, feeding skill, and psychology from seven national feeding programs convened to develop a case report form (CRF). This process relied upon recent advances in defining PFD, a review of the extant literature, expert consensus regarding best practices, and review of current patient characterization templates at participating institutions. The resultant PFD CRF involves patient characterization in four domains (ie, medical, nutrition, feeding skill, and psychosocial) and identifies the primary features of a feeding disorder based on PFD diagnostic criteria. A corresponding protocol provides guidance for completing the assessment process across the four domains. The PFD CRF promotes a standard procedure to support patient characterization, enhance methodological rigor, and provide a useful clinical tool for providers and researchers working with these disorders.
Collapse
Affiliation(s)
- William G. Sharp
- From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Children’s Healthcare of Atlanta, Atlanta, GA
| | - Alan Silverman
- the Department of Pediatrics, Medical College of Wisconsin, Milwaukie, WI
| | - Joan C. Arvedson
- the Department of Pediatrics, Medical College of Wisconsin, Milwaukie, WI
| | - Nancy F. Bandstra
- the Intensive Feeding Program, Helen DeVos Children’s Hospital, Grand Rapids, MI
- the Departments of Psychiatry and Pediatrics & Human Development, Michigan State University, East Lansing, MI
| | - Elizabeth Clawson
- the Pediatric Feeding Program, Payton Manning Children’s at Ascension St. Vincent, Evansville, IN
| | | | - Barbara O. McElhanon
- From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Children’s Healthcare of Atlanta, Atlanta, GA
| | - Alison M. Kozlowski
- the Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD
- the Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mitchell Katz
- the Division of Pediatric Gastroenterology and Nutrition, Children’s Hospital of Orange County, Orange, CA
| | - Valerie M. Volkert
- From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Children’s Healthcare of Atlanta, Atlanta, GA
| | - Praveen S. Goday
- the Department of Pediatrics, Medical College of Wisconsin, Milwaukie, WI
| | - Colleen T. Lukens
- the Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children’s Hospital of Philadelphia, Philadelphia, PA
| |
Collapse
|
65
|
Taylor T. Development of Medication Administration Protocols for In-Home Pediatric Feeding Cases. Behav Modif 2022:1454455221113558. [PMID: 35975706 DOI: 10.1177/01454455221113558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Medication administration can be a significant issue in pediatric populations, and especially with patients with developmental disabilities and comorbid feeding disorders. Research has focused largely on consumption of solids rather than medication and liquids in pediatric feeding programs, with most studies being conducted within specialized hospital settings in the United States. No studies to our knowledge have detailed treatment evaluations for medication administration in pediatric feeding except for a few studies on pill swallowing. We report results of treatment protocols for medication administration using empirically-supported treatments in a short-term intensive home-based behavior-analytic program in Australia. Two males with autism spectrum and pediatric feeding disorders participated. We used a multiple baseline single-case experimental design for medication administration conducted concurrently with a treatment evaluation for solid foods. Consumption increased in number (9; supplements, laxatives, pain relievers), flavors (8; chocolate, blackcurrent and apple, strawberry, lemon-lime, orange, chocolate-vanilla, cherry, apple), forms (4; thin and thick liquids, chewables, gummies), and delivery methods (5; finger-fed, spoon, cup, medicine spoon, medicine cup) within the first treatment session. For one participant, we taught open cup drinking for a variety of liquids (milk, juices, medications). For both participants, we taught self-feeding with utensils for thick liquid medications. Treatment results were similar for solids and participants increased food variety to over 160 across food groups. All goals were met including training parents to maintain gains at home.
Collapse
Affiliation(s)
- Tessa Taylor
- University of Canterbury/Te Whare Wānanga o Waitaha, Christchurch, New Zealand
| |
Collapse
|
66
|
Chen E, Borrero CSW, Frank‐Crawford MA, Borrero JC. Accumulated‐ and distributed‐reinforcer arrangements in the treatment of challenging mealtime behavior. BEHAVIORAL INTERVENTIONS 2022. [DOI: 10.1002/bin.1899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Elaine Chen
- University of Maryland, Baltimore County Baltimore Maryland USA
- Kennedy Krieger Institute Baltimore Maryland USA
| | - Carrie S. W. Borrero
- Kennedy Krieger Institute Baltimore Maryland USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Michelle A. Frank‐Crawford
- Kennedy Krieger Institute Baltimore Maryland USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - John C. Borrero
- University of Maryland, Baltimore County Baltimore Maryland USA
| |
Collapse
|
67
|
Burrows T, Teasdale S, Rocks T, Whatnall M, Schindlmayr J, Plain J, Latimer G, Roberton M, Harris D, Forsyth A. Effectiveness of dietary interventions in mental health treatment: A rapid review of reviews. Nutr Diet 2022; 79:279-290. [PMID: 35796181 PMCID: PMC9545734 DOI: 10.1111/1747-0080.12754] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/16/2022] [Accepted: 05/24/2022] [Indexed: 12/30/2022]
Abstract
AIM This rapid review of reviews aimed to determine the extent of research undertaken on the effectiveness of dietary interventions for individuals with a mental disorder. METHODS Three databases (MEDLINE, Embase, Cochrane Reviews and Cochrane Trials) were searched to February 2021 for systematic reviews including experimental studies assessing the effectiveness of dietary interventions with physical or mental health related outcomes in adults or children with one or more of: severe mental illness, depression or anxiety, eating disorders, or substance use disorder. Results are presented descriptively. RESULTS The number of included reviews was 46 (67% in severe mental illness, 20% in depression and anxiety, 7% in eating disorders, and 7% in substance use disorders). Most reviews were published since 2016 (59%), and included studies conducted in adults (63%). Interventions in the eating disorders and severe mental illness reviews were predominantly education and behaviour change, whereas interventions in the substance use disorders, and depression and anxiety reviews were predominantly supplementation (e.g. omega-3). Twenty-eight and twelve of the reviews respectively reported mental health and dietary outcomes for one or more included studies. Most reviews in severe mental illness, and depression and anxiety reported conclusions supporting the positive effects of dietary intervention, including positive effects on weight-related or mental health outcomes, and on mental health outcomes, respectively. CONCLUSIONS A larger number of systematic reviews were identified which evaluated dietary interventions in individuals with severe mental illness, and depression and anxiety, compared with substance use disorders, and eating disorders. Dietary intervention is an important component of the treatment that should be available to individuals living with mental disorders, to support their physical and mental health.
Collapse
Affiliation(s)
- Tracy Burrows
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of NewcastleCallaghanNew South WalesAustralia
- Food and Nutrition ProgramHunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
| | - Scott Teasdale
- School of Psychiatry, UNSW SydneyKensingtonNew South WalesAustralia
- Mindgardens Neuroscience NetworkSydneyNew South WalesAustralia
| | - Tetyana Rocks
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, Deakin UniversityGeelongVictoriaAustralia
| | - Megan Whatnall
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of NewcastleCallaghanNew South WalesAustralia
- Food and Nutrition ProgramHunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
| | | | - Janice Plain
- Mental Health Drug and AlcoholNorthern Sydney Local Health DistrictNorth RydeNew South WalesAustralia
| | - Georgina Latimer
- Department of Nursing and Allied HealthSchool of Health Sciences, Swinburne UniversityHawthornVictoriaAustralia
| | - Michelle Roberton
- Victorian Centre of Excellence in Eating Disorders, Royal Melbourne HospitalParkvilleVictoriaAustralia
| | - Deanne Harris
- Tamworth Rural Referral Hospital, Hunter New England HealthTamworthNew South WalesAustralia
| | - Adrienne Forsyth
- School of Allied Health, Human Services and Sport, La Trobe UniversityBundooraVictoriaAustralia
| |
Collapse
|
68
|
Sobotka SA, Laudon S, Jackson AJ, Harendt SE, Baker CD. A Literature Review of Feeding Disorders in Children with Tracheostomies and Ventilators. Pediatr Ann 2022; 51:e291-e296. [PMID: 35858218 PMCID: PMC9584144 DOI: 10.3928/19382359-20220504-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Feeding disorders and gastrostomy use are highly prevalent in children with invasive mechanical ventilation (IMV) due to both common risk factors (eg, prematurity, neurological disorders) and resultant experiential deprivation (eg, long hospitalizations, delayed feeding experiences). Feeding in children with IMV is complicated by the presence of a tracheostomy, lung vulnerability, and medical complexity. The potential comorbidity of swallowing difficulties (dysphagia) and atypical early feeding experiences can result in complex feeding disorders. In this review of pediatric feeding disorders in children with invasive mechanical ventilation (IMV), we identify gaps in clinical translational research for this patient population and opportunities for improving evidence-based management. To improve long-term feeding outcomes and maximize oral feeding in this vulnerable population, children would benefit from earlier feeding opportunities during critical developmental windows, standardized protocols for advancing oral feeding, and involvement of intensive, comprehensive therapies throughout hospitalizations and early childhood. [Pediatr Ann. 2022;51(7):e291-e296.].
Collapse
|
69
|
Williams K, Seiverling L. Behavior Analytic Feeding Interventions: Current State of the Literature. Behav Modif 2022:1454455221098118. [PMID: 35674422 DOI: 10.1177/01454455221098118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this paper was to review the current state of the behavior analytic feeding intervention literature. We highlight studies that we found to be important contributions to the recent literature in the following areas: food selectivity, chewing, packing, and food refusal/tube weaning and provide suggestions for future research and clinical work in these areas. We also discuss several current topics relevant to the field in hopes to further advance research and clinical practice. These topics include considering the benefits of innovative models of service delivery such as telehealth and caregiver-implemented interventions, the importance of evaluating long-term outcomes of behavioral feeding interventions, and lastly, ethical issues to consider in the designing and implementation of behavioral feeding interventions and training of practitioners in our field.
Collapse
|
70
|
Phipps LE, Haney SD, Zeleny J, Andersen AS, Peterson KM, Orloski S. Using Behavior-Analytic Treatment to Teach Tongue Lateralization Skills to Children With Avoidant/Restrictive Food Intake Disorder. Clin Case Stud 2022. [DOI: 10.1177/15346501221092112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Oral-motor skills needed for efficient consumption of table-textured foods (e.g., tongue lateralization) often develop as children are exposed to food at increasingly higher textures (e.g., soft meltable, crunchy, and chewy; Volkert et al., 2014). For children with avoidant/restrictive food intake disorder (ARFID; American Psychiatric Association, 2013; World Health Organization, 2019), these oral-motor skills may not develop without intervention. We review case studies of three children diagnosed with ARFID who did not display the skills necessary for efficient consumption of regular table-textured food. We collaborated with a speech-language pathologist to identify oral-motor targets and used a behavior-analytic treatment to teach tongue lateralization skills necessary for safe and effective chewing. We used a treatment package consisting of nonremoval of the utensil with prompting and differential reinforcement to shape functional tongue movements. We discuss considerations for practitioners and the importance of individualized treatment and collaboration with other disciplines while teaching oral-motor skills necessary for chewing and consuming table-textured food.
Collapse
Affiliation(s)
- Laura E. Phipps
- University of Nebraska Medical Center’s Munroe-Meyer Institute, Omaha, NE, USA
| | - Sarah D. Haney
- University of Nebraska Medical Center’s Munroe-Meyer Institute, Omaha, NE, USA
- Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jason Zeleny
- University of Nebraska Medical Center’s Munroe-Meyer Institute, Omaha, NE, USA
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - Ashley S. Andersen
- University of Nebraska Medical Center’s Munroe-Meyer Institute, Omaha, NE, USA
- Clinic 4 Kidz, Sausalito, CA, USA
| | - Kathryn M. Peterson
- Children’s Specialized Hospital, Somerset, NJ, USA
- Division of Child Neurology and Neurodevelopmental Disabilities, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | | |
Collapse
|
71
|
Taylor T, Taylor SA. Social validity of pediatric feeding treatment components across time. BEHAVIORAL INTERVENTIONS 2022. [DOI: 10.1002/bin.1879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tessa Taylor
- University of Canterbury/Te Whare Wānanga o Waitaha Christchurch New Zealand
- Paediatric Feeding International Sydney New South Wales Australia
| | - Sarah Ann Taylor
- School of Psychology University of Auckland/Waipapa Taumata Rau Auckland New Zealand
| |
Collapse
|
72
|
Edwards ST, Glynn EF, Slogic M, Davis AM, Killian HJ, Cocjin J, Attard TM. Demographics of Children with Feeding Difficulties from a large Electronic Health Record Database. JPEN J Parenter Enteral Nutr 2022; 46:1022-1030. [PMID: 35383982 DOI: 10.1002/jpen.2379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/10/2022] [Accepted: 03/24/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Feeding difficulties are amongst the most common concerns expressed by parents in younger children. However, few studies have reported on the characteristics of patients with clinically significant feeding diagnoses. The aim of the current study is to describe the characteristics of patients diagnosed with feeding difficulties including concurrent conditions, age and gender, sampled nationwide utilizing the Cerner Health Facts® Database (CHFD). METHODS We identified patients with a diagnosis of feeding difficulties (ICD9 783.3 or ICD10 R63.3), age 7 months to 17 years, with an outpatient visit between 2010 and 2017. The demographics and complex clinical conditions of this population were categorized. The cohort was then collapsed into a matrix defining recognized phenotype codes for ICD9 and ICD10 diagnoses to identify associated conditions. RESULTS We identified 39,674 patients (0.95%) representing 101,684 encounters from 68 health systems across the United States; 43% of patients were female. Gastrointestinal conditions were the most common, followed by malnutrition, developmental and behavioral diagnoses, and neurologic conditions. CONCLUSIONS This study is one of the most robust studies defining the prevalence, demographic characteristics and phenotypic profiling of patients with feeding difficulties. In the United States. Our observations have implications on screening and resource allocation to recognize and manage this poorly understood population. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Sarah T Edwards
- Division of Gastroenterology, Children's Mercy Kansas City, Kansas City, MO, USA.,University of Missouri School of Medicine, Kansas City
| | - Earl F Glynn
- Children's Research Institute, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Michael Slogic
- University of Missouri School of Medicine, Kansas City.,Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Ann M Davis
- University of Kansas Medical Center, Department of Pediatrics, Kansas City, KS, USA.,Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA
| | - Haley J Killian
- University of Missouri School of Medicine, Kansas City.,University of Kansas Medical Center, Department of Pediatrics, Kansas City, KS, USA.,Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA
| | - Jose Cocjin
- Division of Gastroenterology, Children's Mercy Kansas City, Kansas City, MO, USA.,University of Missouri School of Medicine, Kansas City
| | - Thomas M Attard
- Division of Gastroenterology, Children's Mercy Kansas City, Kansas City, MO, USA.,University of Missouri School of Medicine, Kansas City
| |
Collapse
|
73
|
Sharp WG, Volkert VM, Raol N. Evaluating Characteristics Associated with Success with Tube Weaning After Intensive Multidisciplinary Intervention. J Dev Behav Pediatr 2022; 43:e204-e209. [PMID: 34469912 DOI: 10.1097/dbp.0000000000001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/13/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Evidence suggests intensive multidisciplinary intervention holds benefit for children with feeding tube dependence complicated by comorbid medical, behavioral, and/or developmental conditions; however, much remains unknown regarding factors affecting a patient achieving full oral feeding after intervention. METHODS This retrospective review involved consecutive patients (birth to age 21 years) admitted to an intensive multidisciplinary intervention program over a 5-year period (June 2014-2019) for feeding tube dependence and food refusal. This study compared the clinical presentation and treatment outcomes for patients who successfully transitioned to full oral feeding versus patients experiencing a partial wean at the last follow-up. RESULTS Eighty-one patients completed intervention and provided outcome data (46 male patients and 35 female patients; age range 10-230 mo). Fifty-eight patients (72%) weaned from tube feeding at the last follow-up; 23 patients (28%) experienced a partial wean. The full wean group experienced greater progress by discharge (e.g., oral intake and goals achieved) and participated in longer follow-up compared with the partial wean group. Clinical characteristics associated with lack of full wean included a history of congenital heart disease requiring surgery and a history of developmental disabilities. CONCLUSION Improving response to intensive multidisciplinary intervention likely necessitates the development of treatment adjuncts for patients whose medical and/or developmental conditions complicate wean from tube feeding, tailoring treatment for at-risk populations. Future iterations of this model of care should also adjust the quantity and/or quality of follow-up support for patients who discharge from intervention below certain clinical benchmarks.
Collapse
Affiliation(s)
- William G Sharp
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Children's Healthcare of Atlanta, Atlanta, GA
| | - Valerie M Volkert
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Children's Healthcare of Atlanta, Atlanta, GA
| | - Nikhila Raol
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Children's Healthcare of Atlanta, Atlanta, GA
| |
Collapse
|
74
|
Weaning children from prolonged enteral nutrition: A position paper. Eur J Clin Nutr 2022; 76:505-515. [PMID: 34462558 DOI: 10.1038/s41430-021-00992-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/17/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023]
Abstract
Enteral nutrition (EN) allows adequate nutritional intake in children for whom oral intake is impossible, insufficient or unsafe. With maturation and health improvements, most children ameliorate oral skills and become able to eat orally, therefore weaning from EN becomes a therapeutic goal. No recommendations currently exist on tube weaning, and practices vary widely between centres. With this report, the French Network of Rare Digestive Diseases (FIMATHO) and the French-Speaking Group of Paediatric Hepatology, Gastroenterology and Nutrition (GFHGNP) aim to develop uniform clinical practice recommendations for weaning children from EN. A multidisciplinary working group (WG) encompassing paediatricians, paediatric gastroenterologists, speech-language therapists, psychologists, dietitians and occupational therapists, was formed in June 2018. A systematic literature search was performed on those published from January 1, 1998, to April 30, 2020, using MEDLINE. After several rounds of e-discussions, relevant items for paediatric tube weaning were identified, and recommendations were developed, discussed and finalized. The WG members voted on each recommendation using a nominal voting technique. Expert opinion was applied to support the recommendations where no high-quality studies were available.
Collapse
|
75
|
Tiemens DK, van Haaften L, Leenders E, van Wegberg AMJ, Gunther Moor B, Geelen J, Draaisma JMT. Feeding Problems in Patients with Noonan Syndrome: A Narrative Review. J Clin Med 2022; 11:754. [PMID: 35160209 PMCID: PMC8836779 DOI: 10.3390/jcm11030754] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/22/2022] [Accepted: 01/27/2022] [Indexed: 01/16/2023] Open
Abstract
Noonan syndrome (NS) belongs to the group of Noonan syndrome spectrum disorders (NSSD), which is a group of phenotypically related conditions. Feeding problems are often present not only in infancy but also in childhood, and even beyond that period. We describe the different aspects of feeding problems using a (theoretical) concept proposed in 2019. More than 50% of infants with NS develop feeding problems, and up to half of these infants will be tube-dependent for some time. Although, in general, there is a major improvement between the age of 1 and 2 years, with only a minority still having feeding problems after the age of 2 years, as long as the feeding problems continue, the impact on the quality of life of both NS infants and their caregivers may be significant. Feeding problems in general improve faster in children with a pathogenic PTPN11 or SOS1 variant. The mechanism of the feeding problems is complex, and may be due to medical causes (gastroesophageal reflux disease and delayed gastric emptying, cardiac disease and infections), feeding-skill dysfunction, nutritional dysfunction with increased energy demand, or primary or secondary psychosocial dysfunction. Many of the underlying mechanisms are still unknown. The treatment of the feeding problems may be a medical challenge, especially when the feeding problems are accompanied by feeding-skill dysfunction and psychosocial dysfunction. This warrants a multidisciplinary intervention including psychology, nutrition, medicine, speech language pathology and occupational therapy.
Collapse
Affiliation(s)
- Dagmar K. Tiemens
- Department of Pediatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, Amalia Children’s Hospital, 6500 HB Nijmegen, The Netherlands; (D.K.T.); (J.G.)
- Dutch Noonan Syndrome Foundation, Stationsweg 6b, 3862 CG Nijkerk, The Netherlands
| | - Leenke van Haaften
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Erika Leenders
- Department of Human Genetics, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Annemiek M. J. van Wegberg
- Department of Gastroenterology and Hepatology-Dietetics, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Bregtje Gunther Moor
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Amalia Children’s Hospital, 6500 HB Nijmegen, The Netherlands;
| | - Joyce Geelen
- Department of Pediatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, Amalia Children’s Hospital, 6500 HB Nijmegen, The Netherlands; (D.K.T.); (J.G.)
| | - Jos M. T. Draaisma
- Department of Pediatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, Amalia Children’s Hospital, 6500 HB Nijmegen, The Netherlands; (D.K.T.); (J.G.)
| |
Collapse
|
76
|
Phipps LE, Peterson KM, Piazza CC. Indices of happiness and unhappiness during treatment of pediatric feeding disorders. BEHAVIORAL INTERVENTIONS 2022. [DOI: 10.1002/bin.1863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Laura E. Phipps
- Munroe‐Meyer Institute University of Nebraska Medical Center Omaha Nebraska USA
| | - Kathryn M. Peterson
- Children's Specialized Hospital Somerset New Jersey USA
- Rutgers Robert Wood Johnson Medical School Division of Child Neurology and Neurodevelopmental Disabilities New Brunswick New Jersey USA
| | - Cathleen C. Piazza
- Children's Specialized Hospital Somerset New Jersey USA
- Graduate School of Applied and Professional Psychology Rutgers University New Brunswick New Jersey USA
| |
Collapse
|
77
|
Wilken M, Hesse M, Jockenhöfer A, Pohl N. Are feeding disorders and feeding tube dependency the same?: A discrimination study between feeding disorders, feeding tube dependency and healthy eaters. J Paediatr Child Health 2022; 58:63-68. [PMID: 34449108 DOI: 10.1111/jpc.15641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/28/2022]
Abstract
AIM Feeding disorders (FD) and feeding tube dependency (FTD) are defined by a persistent pattern of food aversion, but data regarding the frequency of food aversion symptoms are scarce. In this study, the frequency of aversion symptoms for FD, FTD and healthy eaters (HE) were compared. METHODS We compared the frequency of food aversion symptoms in a group with FD (n = 32) and FTD (n = 39) to HE (n = 38) using the AFT questionnaire. This includes growth data as well as the feeding aversion scale and the frequency of food aversion symptoms. RESULTS HE were reported to have minor frequency of symptoms, while FD children were reported to have daily aversive symptoms. FTD patients had the highest frequency in total. There were significant differences between FD and FTD regarding the frequency of food refusal, vomiting and bizarre eating patterns, and there were different correlative patterns of food aversion. CONCLUSIONS Children with FD and FTD show significantly different patterns of feeding behaviour compared to healthy norms as well as to each other. This suggests individualised assessment and treatment programs may be most beneficial for the needs of children with FD and FTD.
Collapse
Affiliation(s)
| | | | | | - Nadine Pohl
- Feeding Tube Dependency Institute, Essen, Germany
| |
Collapse
|
78
|
Adams SN. Feeding and Swallowing Issues in Autism Spectrum Disorders. Neuropsychiatr Dis Treat 2022; 18:2311-2321. [PMID: 36276431 PMCID: PMC9579053 DOI: 10.2147/ndt.s332523] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/05/2022] [Indexed: 11/06/2022] Open
Abstract
Children with autism spectrum disorder (ASD) often experience difficulties related to communication and behaviour. However, their feeding issues are most distressing to their families and healthcare professionals as they impact on the children's adaptive function and health. In comparison to typically developing children, those with ASD experience significantly more feeding difficulties. Children with ASD may display distinctive feeding difficulties and atypical feeding behaviours that include picky eating, limited independent feeding, need for increased feeding times, and a highly restrictive food repertoire. Many of these feeding difficulties continue into childhood, persist in adolescence, and even spill over into adulthood. This proves to be a formidable challenge, as feeding is an essential component for healthy nutrition, growth, and development. This article will highlight how particular food items that are eaten and preferred by affected children may be contributing to their exhibited feeding difficulties. Next, it will be shown how the children's restrictive diets supplant more healthy food options. When this is combined with the children's noted reduced physical activity, the consequences are especially serious, as they include not only malnutrition but also give rise to childhood obesity. In sum, it will be demonstrated that feeding difficulties in young children with ASD are not well understood nor managed. The dearth of knowledge about feeding issues in this population affects both assessment choices and, specifically, management practices - aspects that will be elaborated on in this article. Conclusions will include suggested future directions for enhancing and complementing knowledge of these issues for stakeholders.
Collapse
Affiliation(s)
- Skye Nandi Adams
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
79
|
Iijima H, Yanagi K, Kaname T, Kubota M. Feeding disorder in a patient with Wiedemann-Steiner syndrome. Pediatr Int 2022; 64:e15203. [PMID: 35770806 DOI: 10.1111/ped.15203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/16/2022] [Accepted: 03/25/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Hiroyuki Iijima
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kumiko Yanagi
- Department of Genome Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Tadashi Kaname
- Department of Genome Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
80
|
Patrawala MM, Vickery BP, Proctor KB, Scahill L, Stubbs KH, Sharp WG. Avoidant-restrictive food intake disorder (ARFID): A treatable complication of food allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:326-328.e2. [PMID: 34391962 DOI: 10.1016/j.jaip.2021.07.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 06/13/2023]
Affiliation(s)
| | - Brian P Vickery
- Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga.
| | | | | | | | - William G Sharp
- Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga
| |
Collapse
|
81
|
Estrem HH, Park J, Thoyre S, McComish C, McGlothen-Bell K. Mapping the gaps: A scoping review of research on pediatric feeding disorder. Clin Nutr ESPEN 2022; 48:45-55. [PMID: 35331528 PMCID: PMC8956802 DOI: 10.1016/j.clnesp.2021.12.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 12/17/2021] [Accepted: 12/27/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND & AIMS Pediatric feeding disorder (PFD) is defined as impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction. As PFD is prevalent and increasing, so are publications on the topic; however, the research literature is often disparate in terminology used and siloed by discipline. Greater understanding of the current research concerning PFD will help identify areas in need of further study. The purpose of this scoping review is to examine the extent, range, and nature of research activities concerning PFD and to identify gaps in the empirical literature. METHODS Three electronic databases (PubMed/Medline, CINAHL, PsycINFO) were searched using terms related to pediatric feeding disorder, which include, but not limited to, "feeding disorder/problem/difficulty", "avoidant restrictive food intake disorder (ARFID)", "dysphagia", "selective/picky eating", "problematic mealtime behaviors" or "food refusal". The following limits were placed on the search: full text, humans, English, and age limit (up to 18 years old), and publication date (last 10 years). Covidence software was used to facilitate a systematic data management/analysis. Two people in the research team independently reviewed each result (screening titles and abstracts first, then moving to the full texts) to identify studies that met our inclusion/exclusion criteria and conflicts were resolved through a team discussion. Data were charted regarding disciplines of the authors, study purposes, study settings/locations, study methodologies, and study participants. Descriptive statistics and thematic analyses were used to summarize the characteristics of the studies. RESULTS The initial search resulted in 5354 articles after removing duplicates between the databases. With a final set of articles (n = 415), data charting was completed. The majority of studies were completed by authors from Psychology (n = 171) and Medicine (n = 123). The most studied aims were to examine attributes of feeding problems (n = 168) and/or factors associated with feeding problems (n = 183). Sample size median was 53. A total of 166 of the 415 studies examined the effect of an intervention, treatment, or program, but dose of the intervention was difficult or impossible to report across studies. Feeding was studied as an outcome in 400 out of the 415 studies. A closer accounting of the systematically developed parent-report tools revealed 50 distinct parent report tools used across the subset of studies utilizing parent report outcomes (n = 123). CONCLUSIONS The results of this scoping review highlight the designs and methods used in research on PFD. This reveals critical gaps in knowledge generation and barriers to intervention replication.
Collapse
|
82
|
Saini V, Andersen AS, Jessel J, Vance H. On the role of operant contingencies in the maintenance of inappropriate mealtime behavior: An epidemiological analysis. J Appl Behav Anal 2021; 55:513-528. [PMID: 34971457 DOI: 10.1002/jaba.901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 11/09/2022]
Abstract
Functional analysis is the primary assessment used to determine the function of inappropriate mealtime behavior in children with feeding disorders. Based on single-case experimental design studies and recent reviews, the prevalence of negative reinforcement alone in the maintenance of inappropriate mealtime behavior appears to be much greater than positive reinforcement alone. We conducted a retrospective consecutive-controlled case series to determine the generality of previous findings. Results of the epidemiological analysis support prior research in that negative reinforcement in the form of escape (44.8%), and multiple control (i.e., positive and negative reinforcement) in the forms of escape and attention (37.2%), are considerably more prevalent than positive reinforcement alone (2.5%). We discuss the relationship between functional analysis of inappropriate mealtime behavior and treatment utility. Further, we describe avenues of future research designed to advance the application of functional analysis in feeding disorders beyond inappropriate mealtime behavior.
Collapse
|
83
|
Abstract
Approximately 5% of children experience difficulty with the complex coordination of sucking, swallowing and breathing required for feeding. Infants with craniofacial malformations may have anatomic and neurologic contributions to feeding problems. Examples include cleft lip and/or palate, micrognathia, maxillary hypoplasia, and pharyngeal dysfunction. Interventions may facilitate weight gain and avoid failure-to-thrive in these infants. An interdisciplinary approach to address feeding challenges in children with craniofacial differences is necessary. Positional changes, latching maneuvers, specialized feeder nipples, squeezable bottles, and cup feeding can be implemented early. Surgical intervention, including gastrostomy tube placement, tongue lip adhesion, mandibular distraction osteogenesis and tracheostomy, may be required in more severe cases.
Collapse
Affiliation(s)
- Mark A Green
- Instructor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine and Harvard Medical School, Oral and Maxillofacial Surgeon, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Cory M Resnick
- Harvard School of Dental Medicine and Harvard Medical School, Oral and Maxillofacial Surgeon, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.
| |
Collapse
|
84
|
Anderson S, Brill J, Kuchinski K. Russell-Silver Syndrome and Associated Feeding Challenges. J Pediatr Health Care 2021; 35:630-638. [PMID: 34215464 DOI: 10.1016/j.pedhc.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
|
85
|
Volkert VM, Burrell L, Berry RC, Waddle C, White L, Bottini S, Murphy M, Sharp WG. Intensive multidisciplinary feeding intervention for patients with avoidant/restrictive food intake disorder associated with severe food selectivity: An electronic health record review. Int J Eat Disord 2021; 54:1978-1988. [PMID: 34505302 DOI: 10.1002/eat.23602] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Expert consensus increasingly recognizes intensive multidisciplinary intervention (IMI) as the standard of care to address chronic and severe feeding problems in pediatric populations. In this study, we examined the clinical presentation, intervention characteristics, and treatment outcomes for young children receiving IMI for avoidant restrictive rood intake disorder (ARFID) involving nutritional insufficiencies associated with severe food selectivity. METHOD We followed the Strengthening the Reporting of Observational Studies in Epidemiology statement to conduct this retrospective chart review. The review focused on consecutive patients (birth to age 21 years) admitted to the IMI program over a 5-year period (June 2014 to June 2019). Inclusion criteria required micronutrient insufficiencies (vitamins A, B12, C, D, E; folic acid; calcium; iron; and zinc) and chronic mealtime refusal behavior (e.g., turning head away from food/spoon, pushing or throwing spoon, crying, screaming, and leaving the table) associated with severe food selectivity. RESULTS Over the 5-year period, 63 of the patients met study entry requirements. Of these, 60 patients (50 boys and 10 girls; mean age = 72 ± 39 months; range = 23-181) completed intervention (95% treatment completion rate). At discharge, dietary diversity improved by 16 new therapeutic foods (range: 8-22), rapid acceptance and swallowing of new foods exceeded clinical benchmarks (80% or > bites), and risk for nutritional inadequacies declined for this patient cohort. DISCUSSION Results of the current study support the benefits of IMI to increase dietary variety, improve mealtime behaviors, and enhance nutritional intake for children with ARFID presenting with severe food selectivity.
Collapse
Affiliation(s)
- Valerie M Volkert
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Lindsey Burrell
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | | | - Lydia White
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Summer Bottini
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Meredith Murphy
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - William G Sharp
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| |
Collapse
|
86
|
Tang MN, Adolphe S, Rogers SR, Frank DA. Failure to Thrive or Growth Faltering: Medical, Developmental/Behavioral, Nutritional, and Social Dimensions. Pediatr Rev 2021; 42:590-603. [PMID: 34725219 DOI: 10.1542/pir.2020-001883] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Margot N Tang
- Department of Pediatrics, Boston University School of Medicine, Boston, MA
| | - Soukaina Adolphe
- Department of Pediatrics, Boston University School of Medicine, Boston, MA
| | | | - Deborah A Frank
- Department of Pediatrics, Boston University School of Medicine, Boston, MA
| |
Collapse
|
87
|
Alexander E, Armellino A, Buchholtz J, Dinnes L, Hager M, Ruechel B, Steien DB, Boesch RP, Cofer S, Grothe R. Assessing Pediatric Feeding Disorders by Domain in Complex Aerodigestive Patients. Cureus 2021; 13:e17409. [PMID: 34589320 PMCID: PMC8459809 DOI: 10.7759/cureus.17409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: Pediatric feeding disorder (PFD) is defined as impaired oral intake, associated with dysfunction in at least one of four domains: medical, nutritional, feeding skill, and/or psychosocial. The pediatric aerodigestive patient presents with conditions impacting airway, breathing, feeding, swallowing, or growth. The objective of the study was to determine the prevalence of PFD and dysfunctional domain, in the aerodigestive patient presenting to a tertiary aerodigestive clinic. Methods: Twenty-five charts from patients enrolled in Mayo Clinic Children’s Center Aerodigestive Program were retrospectively reviewed for documentation of dysfunction within the four feeding disorder domains. Results from the aerodigestive triple scope, functional endoscopic evaluation of swallow (FEES), and videofluoroscopic swallow study (VFSS) were recorded. Height and weight z-scores were compared between the initial assessment and 6-12 months later. Results: Median age was 20 months (range 2-81 months). Of the patients, 100% (n = 25) had dysfunction in at least one PFD domain. The domain identified most frequently was medical dysfunction (96%; n = 24). Feeding dysfunction was observed in 76% (n = 19). Psychosocial dysfunction was observed in 76% (n = 19). Nutritional dysfunction was observed in 60% (n = 15). Dysfunction in three or greater domains was seen in 80% (n = 20). Weight z-score increased in 76% (n = 19) of patients 6 to 12 months after the initial aerodigestive evaluation. Conclusion: Aerodigestive patients frequently have PFD and utilizing the consensus definition of PFD at intake may enhance clinical assessment and therapeutic evaluation, and provide a framework to measure outcomes in this heterogeneous patient population.
Collapse
Affiliation(s)
| | - Andrea Armellino
- Division of Endocrinology and Diabetes, Mayo Clinic, Rochester, USA
| | - Julie Buchholtz
- Division of Endocrinology and Diabetes, Mayo Clinic, Rochester, USA
| | - Laura Dinnes
- Department of Pharmacy, Mayo Clinic, Rochester, USA
| | - Molissa Hager
- Pediatric Gastroenterology, Mayo Clinic, Rochester, USA
| | - Beth Ruechel
- Division of Nursing, Mayo Clinic, Rochester, USA
| | - Dana B Steien
- Pediatric Gastroenterology, Mayo Clinic, Rochester, USA
| | | | - Shelagh Cofer
- Pediatric Otorhinolaryngology, Mayo Clinic, Rochester, USA
| | - Rayna Grothe
- Pediatric Gastroenterology, Mayo Clinic, Rochester, USA
| |
Collapse
|
88
|
Yeung SSY, Chan R, Li L, Chan D, Leung J, Leung TF. Eating Behaviors and Diet Quality in Chinese Preschoolers with and without Autism Spectrum Disorder: A Case-Control Study. J Pediatr 2021; 237:258-266.e5. [PMID: 34144030 DOI: 10.1016/j.jpeds.2021.06.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/28/2021] [Accepted: 06/10/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To compare mealtime behaviors and diet quality in Chinese preschoolers with autism spectrum disorder (ASD) and typically developing preschoolers in Hong Kong. STUDY DESIGN This case-control study included a community sample of 65 families with preschoolers with ASD aged 3-6 years and 65 families with typically developing preschoolers matched for age and sex. Preschoolers' eating behaviors were assessed using the Brief Autism Mealtime Behaviour Inventory and the Preschoolers' Eating Behaviour Questionnaire (CPEBQ). Preschoolers' usual diet and nutrient intake were assessed using a validated food frequency questionnaire. Diet quality and diversity were generated using the Chinese Children Dietary Index total score and diet variety score. Between-group differences in various scales and dietary variables were examined using multivariate linear or logistics regression models adjusting for baseline demographic differences. RESULTS Compared with the typically developing group, the ASD group had greater scores in the Brief Autism Mealtime Behaviour Inventory food refusal domain (P < .001), the CPEBQ food fussiness (P = .001) and eating habit (P = .001) domains, and lower CPEBQ exogenous eating score (P = .003) and initiative eating score (P < .001). The Chinese Children Dietary Index total score (P = .001) and diet variety score (P = .005) and intake of soy and soy products (P = .001) were lower in the ASD group compared with the typically developing group. CONCLUSIONS Preschoolers with ASD showed more eating and mealtime problems, and lower diet quality and diversity than their typically developing counterparts. Our findings highlight the need for regular monitor and early identification of mealtime behavioral and nutrition problems among preschoolers with ASD.
Collapse
Affiliation(s)
- Suey S Y Yeung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ruth Chan
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
| | - Liz Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Dorothy Chan
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jason Leung
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ting-Fan Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|
89
|
Slater N, Spader M, Fridgen J, Horsley M, Davis M, Griffin KH. Weaning from a feeding tube in children with congenital heart disease: A review of the literature. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2021.101406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
90
|
Abstract
OBJECTIVE To document the clinical presentation of scurvy in children with autism spectrum disorder (ASD) and summarize the contemporary approaches to assessment and management in this population. Scurvy is a disease caused by vitamin C deficiency most often detected in populations at high risk for nutrition insufficiency (e.g., extreme poverty). Children with ASD and severe food selectivity consistent with avoidant-restrictive food intake disorder may also be at risk for scurvy. METHOD We searched MEDLINE, CINAHL, and PsycINFO databases (1990-2018) in peer-reviewed journals for studies of children with ASD and scurvy. Inclusion criteria required confirmed diagnosis of ASD and scurvy in children (birth to 18 years) with a clear description of restrictive dietary patterns. Cases of scurvy due to other causes were excluded. We used a standardized protocol to independently code information; agreement between coders was high. RESULTS The systematic search identified 20 case reports involving 24 children (mean age = 9 ± 3.5; 22 boys/2 girls). The eventual diagnosis of scurvy followed a wide range of negative diagnostic testing; treatment with ascorbic acid and/or a multivitamin resulted in rapid improvement. CONCLUSIONS Symptoms of scurvy mimic other pediatric conditions (e.g., cancer). The range of diagnostic testing increased costs and healthcare risks (radiation, sedation) and delayed the diagnosis of scurvy. In children with ASD and severe food selectivity, a nutrition evaluation and laboratory testing are warranted before a more elaborate testing.
Collapse
|
91
|
Cannarile MA, Gomes B, Canamero M, Reis B, Byrd A, Charo J, Yadav M, Karanikas V. Biomarker Technologies to Support Early Clinical Immuno-oncology Development: Advances and Interpretation. Clin Cancer Res 2021; 27:4147-4159. [PMID: 33766813 DOI: 10.1158/1078-0432.ccr-20-2345] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/02/2021] [Accepted: 03/08/2021] [Indexed: 11/16/2022]
Abstract
Today, there is a huge effort to develop cancer immunotherapeutics capable of combating cancer cells as well as the biological environment in which they can grow, adapt, and survive. For such treatments to benefit more patients, there is a great need to dissect the complex interplays between tumor cells and the host's immune system. Monitoring mechanisms of resistance to immunotherapeutics can delineate the evolution of key players capable of driving an efficacious antitumor immune response. In doing so, simultaneous and systematic interrogation of multiple biomarkers beyond single biomarker approaches needs to be undertaken. Zooming into cell-to-cell interactions using technological advancements with unprecedented cellular resolution such as single-cell spatial transcriptomics, advanced tissue histology approaches, and new molecular immune profiling tools promises to provide a unique level of molecular granularity of the tumor environment and may support better decision-making during drug development. This review will focus on how such technological tools are applied in clinical settings, to inform the underlying tumor-immune biology of patients and offer a deeper understanding of cancer immune responsiveness to immuno-oncology treatments.
Collapse
Affiliation(s)
- Michael A Cannarile
- F. Hoffmann-La Roche AG, Pharmaceutical Research and Early Development Oncology, Roche Innovation Center Munich, Munich, Germany
| | - Bruno Gomes
- F. Hoffmann-La Roche AG, Pharmaceutical Research and Early Development Oncology, Roche Innovation Center Basel, Basel, Switzerland
| | - Marta Canamero
- F. Hoffmann-La Roche AG, Pharmaceutical Research and Early Development Oncology, Roche Innovation Center Munich, Munich, Germany
| | - Bernhard Reis
- F. Hoffmann-La Roche AG, Pharmaceutical Research and Early Development Oncology, Roche Innovation Center Basel, Basel, Switzerland
| | | | - Jehad Charo
- F. Hoffmann-La Roche AG, Pharmaceutical Research and Early Development Oncology, Roche Innovation Center Zurich, Zurich, Switzerland
| | | | - Vaios Karanikas
- F. Hoffmann-La Roche AG, Pharmaceutical Research and Early Development Oncology, Roche Innovation Center Zurich, Zurich, Switzerland.
| |
Collapse
|
92
|
Baraskewich J, von Ranson KM, McCrimmon A, McMorris CA. Feeding and eating problems in children and adolescents with autism: A scoping review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1505-1519. [PMID: 33653157 PMCID: PMC8323334 DOI: 10.1177/1362361321995631] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
LAY ABSTRACT Feeding problems, such as picky eating and food avoidance, are common in youth with autism. Other, broader difficulties with feeding and eating (eating disorder symptoms such as restricting food intake or preoccupation with body shape or weight and insistence on specific food presentation) are also common in autistic individuals. Here, we describe the nature and extent of feeding and eating problems in youth with autism. We found no common characteristics (such as severity of autism symptoms) that best describe autistic youth who experience problems with feeding or eating. Almost all studies we reviewed focused on problems with feeding (selective or picky eating), and only a few studies focused on eating disorder symptoms (concern with weight, shape, and/or body image). However, some researchers reported that eating disorder symptoms may occur more often in autistic individuals compared to their peers without autism. Many studies used the terms "feeding" and "eating" problems interchangeably, but understanding the difference between these problems is important for researchers to be consistent, as well as for proper identification and treatment. We suggest future researchers use "eating problems" when behaviors involve preoccupation with food, eating, or body image, and "feeding problems" when this preoccupation is absent. We highlight the importance of understanding whether feeding or eating problems are separate from autism traits, and the role of caregivers and other adults in the child's treatment. Considerations for health-care providers to assist with diagnosis and treatment are also provided.
Collapse
Affiliation(s)
- Jessica Baraskewich
- University of Calgary, Canada
- Alberta Children's Hospital Research Institute, Canada
| | - Kristin M von Ranson
- University of Calgary, Canada
- Alberta Children's Hospital Research Institute, Canada
| | - Adam McCrimmon
- University of Calgary, Canada
- Alberta Children's Hospital Research Institute, Canada
| | - Carly A McMorris
- University of Calgary, Canada
- Alberta Children's Hospital Research Institute, Canada
| |
Collapse
|
93
|
Levy VY, Bhombal S, Villafane J, McBride ME, Chung S, Figueroa M, Hopper A, Johnson JN, Costello JM. Status of Multidisciplinary Collaboration in Neonatal Cardiac Care in the United States. Pediatr Cardiol 2021; 42:1088-1101. [PMID: 33870440 DOI: 10.1007/s00246-021-02586-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/18/2021] [Indexed: 02/06/2023]
Abstract
While outcomes for neonates with congenital heart disease have improved, it is apparent that substantial variability exists among centers with regard to the multidisciplinary approach to care for this medically fragile patient population. We endeavored to understand the landscape of neonatal cardiac care in the United States. A survey was distributed to physicians who provide neonatal cardiac care in the United States regarding (1) collaborative efforts in care of neonates with congenital heart disease (CHD); (2) access to neonatal cardiac training; and (3) barriers to the implementation of protocols for neonatal cardiac care. Responses were collected from 10/2018 to 6/2019. We received responses from 172 of 608 physicians (28% response rate) from 89 centers. When compared to responses received from physicians at low-volume centers (< 300 annual bypass cases), those at high-volume centers reported more involvement from the neurodevelopmental teams (58% vs. 29%; P = 0.012) and a standardized transition to outpatient care (68% vs. 52%; P = 0.038). While a majority of cardiothoracic surgery and anesthesiology respondents reported multidisciplinary involvement, less than half of cardiology and neonatology supported this statement. The most commonly reported obstacles to multidisciplinary engagement were culture (61.6%) and logistics (47.1%). Having a standardized neonatal cardiac curriculum for neonatal fellows was positively associated with the perception that multidisciplinary collaboration was "always" in place (53% vs. 40%; P = 0.09). There is considerable variation among centers in regard to personnel involved in neonatal cardiac care, related education, and perceived multidisciplinary collaboration among team members. The survey findings suggest the need to establish concrete standards for neonatal cardiac surgical programs, with ongoing quality improvement processes.
Collapse
Affiliation(s)
- Victor Y Levy
- Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, TX, USA. .,Department of Pediatrics, Texas Tech University Health Science Center School of Medicine, 701 West 5th Street, Odessa, TX, 79763, USA.
| | - Shazia Bhombal
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Juan Villafane
- Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Mary E McBride
- Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Sukyung Chung
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Mayte Figueroa
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrew Hopper
- Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Jonathan N Johnson
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic Children's Center Rochester, Rochester, MN, USA
| | - John M Costello
- Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, SC, USA
| | | |
Collapse
|
94
|
Prasetyo YB, Dewi YS, Arifin H, Kamel AD. The Effect of Learning Module Program on Mothers’ Ability to Adapt to New Foods, Feeding Styles, and Self-efficacy to Their Children with Avoidant Restrictive Food Intake Disorder. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The education to improve a mother’s knowledge is deemed to be important because it may improve children’s nutritional status.
AIM: The aim of this study was to examine the effects of learning module program on the mothers’ ability to adapt to new foods, feeding styles, and self-efficacy to their children with avoidant restrictive food intake disorder (ARFID).
METHODS: Quasi-experimental design was used to evaluate the effectiveness of learning module program. Fifteen mothers of experimental group were given four meetings within 4 weeks. Each meeting ran about 50 min. Fifteen mothers of control group were conducted home visit and received twice education about the health principals of feeding children. Both experimental group and control group had pre-test and post-test. The data were analyzed using Chi-square test, Fisher’s exact test, and Mann–Whitney U-test.
RESULTS: The participants of the experimental group have shown bigger surge of new foods adaptation (t = –2.973, p < 0.003), feeding style (t = –4.646, p < 0.001), self-efficacy (t = –3.652, p = 0.001) than the control group has.
CONCLUSION: The findings indicated that the learning module program was deemed to be effective to improve mothers’ ability to adapt to new foods, feeding styles, and self-efficacy to their children with ARFID.
Collapse
|
95
|
Kim C, Brown S, Brown J, Ornelas E. Long-term Outcomes of Children With Pediatric Feeding Disorders Treated in an Inpatient Multidisciplinary Program. J Pediatr Gastroenterol Nutr 2021; 72:388-391. [PMID: 33560757 DOI: 10.1097/mpg.0000000000002977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ABSTRACT The purpose of this longitudinal observational study was to evaluate the effectiveness of a multidisciplinary inpatient treatment model for feeding disorders by analyzing long-term nutritional and health outcomes 12 months following discharge. Fifty patients completed the study. Average caloric intake by mouth as a percentage of goal for gastrostomy tube (GT)-dependent patients (n = 31) increased from pre-admit, week 1, and week 2 of the inpatient program (30%, 70%, and 84%, respectively), and was sustained from week 3 to 12-month follow-up (85% and 86%, respectively). Eighty-one percentage were discharged without GT support and 65% remained off GT support at 12 months. Oral supplement dependence for non-GT patients (n = 19) decreased from pre-admit, discharge, and 12-month follow-up (51%, 31%, and 19% of caloric intake, respectively). BMI z-scores improved during and after treatment. The present study demonstrated an effective approach for treatment of pediatric feeding disorders, including decreased reliance on oral supplementation and GT dependence.
Collapse
Affiliation(s)
- Cindy Kim
- Cindy Kim, CHOC Children's Hospital of Orange County, CHOC Children's Feeding Program, Orange, CA
| | | | | | | |
Collapse
|
96
|
Hopwood N, Moraby K, Dadich A, Gowans J, Pointon K, Ierardo A, Reilly C, Syrmis M, Frederiksen N, Disher-Quill K, Scheuring N, Heves R, Elliot C. Paediatric tube-feeding: An agenda for care improvement and research. J Paediatr Child Health 2021; 57:182-187. [PMID: 33277951 DOI: 10.1111/jpc.15286] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/21/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
This article presents an agenda to improve the care and wellbeing of children with paediatric feeding disorder who require tube feeding (PFD-T). PFD-T requires urgent attention in practice and research. Priorities include: routine collection of PFD-T data in health-care records; addressing the tube-feeding lifecycle; and reducing the severity and duration of disruption caused by PFD-T where possible. This work should be underpinned by principles of involving, respecting and connecting families.
Collapse
Affiliation(s)
- Nick Hopwood
- School of International Studies and Education, University of Technology Sydney, Broadway, New South Wales, Australia.,Department of Curriculum Studies, University of Stellenbosch, Stellenbosch, South Africa
| | - Khadeejah Moraby
- Central Early Childhood and Families Service, Allied Health, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Ann Dadich
- School of Business, Western Sydney University, Sydney, New South Wales, Australia
| | - Jessica Gowans
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Keren Pointon
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Anna Ierardo
- Department of Paediatrics, St George Hospital, Sydney, New South Wales, Australia
| | - Claire Reilly
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Maryanne Syrmis
- Speech Pathology Department, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Nadine Frederiksen
- Department of Occupational Therapy and Music Therapy, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Kate Disher-Quill
- Department of Paediatrics, St George Hospital, Sydney, New South Wales, Australia
| | - Noémi Scheuring
- Department of Pediatrics, Heim Pál National Institute of Pediatrics, Budapest, Hungary
| | - Rudolf Heves
- Educational Technology, Web-Medu Health and Lifestyle Consulting Private Limited Company (Member of Rufusz Group), Budapest, Hungary
| | - Chris Elliot
- Department of Paediatrics, St George Hospital, Sydney, New South Wales, Australia.,Department of Community Child Health, Sydney Children's Hospital Randwick, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
97
|
Bąbik K, Patro-Gołąb B, Zalewski BM, Wojtyniak K, Ostaszewski P, Horvath A. Infant feeding practices and later parent-reported feeding difficulties: a systematic review. Nutr Rev 2021; 79:1236-1258. [PMID: 33486523 DOI: 10.1093/nutrit/nuaa135] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
CONTEXT Early feeding practices may influence the acceptance of new foods and contribute to the development of feeding difficulties later in childhood. OBJECTIVE The aim of this systematic review was to evaluate the association of breastfeeding duration, timing of complementary feeding introduction, and feeding techniques with feeding difficulties or their subtypes, namely picky or fussy eating, food refusal, and food neophobia, in children older than 1 year of age. DATA SOURCES Guidance from the Cochrane Collaboration and the Centre for Reviews and Dissemination was followed. MEDLINE, Embase, and PsycINFO databases were searched up to December 2019. Additionally, references from included articles were screened. STUDY SELECTION Interventional and observational studies were eligible. Of the 3653 records obtained after the search strategy was applied, 21 observational studies (cohort, case-control, cross-sectional), many with important methodological limitations, and 1 randomized controlled trial were included. DATA EXTRACTION Three authors extracted data independently. RESULTS Results were synthesized narratively. Twelve observational studies assessed the association of breastfeeding duration with parent-reported feeding difficulties. Longer duration of breastfeeding tended to be associated with fewer childhood feeding problems in the majority of studies, but the differences were often small and not significant. Eight observational studies that examined the timing of complementary feeding introduction in relation to parent-reported feeding difficulties showed inconsistent results. Baby-led weaning, as compared with spoon-feeding, was significantly associated with less fussiness at age 12 to 36 months in 1 of 5 studies. CONCLUSIONS This review showed no strong evidence to support the hypothesis that early feeding practices contribute significantly to specific parent-reported feeding difficulties in children older than 1 year of age. Additional methodologically rigorous studies are needed to confirm these findings. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42018115792.
Collapse
Affiliation(s)
- Katarzyna Bąbik
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | | | | | - Katarzyna Wojtyniak
- Department of Pediatrics, Pediatric Teaching Clinical Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Ostaszewski
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Andrea Horvath
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
98
|
Taylor T, Blampied N, Roglić N. Controlled case series demonstrates how parents can be trained to treat paediatric feeding disorders at home. Acta Paediatr 2021; 110:149-157. [PMID: 32441395 DOI: 10.1111/apa.15372] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022]
Abstract
AIM Paediatric feeding disorders are normally managed by specialist clinics. We examined whether treatment gains were maintained when trained parents continued the programme at home and during meals out. METHODS This controlled consecutive case series recruited 26 children (22 boys) with avoidant/restrictive food intake disorder, from a private paediatric feeding disorders practice in New South Wales, Australia. Their mean age was six (2-13) years. All had severe feeding problems and mealtime skill deficits, and most had autism and developmental delays or intellectual disabilities. The children received intensive, individualised, behaviour-analytic treatment for 11 (6-21.5) days, and the parents were trained to continue it at home. The primary treatment outcomes included the range and amount of food eaten and mealtime behaviour. RESULTS The children met all of the therapeutic goals agreed at the treatment outset. They ate a mean of 92 different foods and improved how they ate, drank and behaved during mealtimes. The mean differences before and after treatment were clinically and statistically significant, and the gains were maintained during follow-up at a mean of 2.3 years. Parental satisfaction and treatment acceptability were high. CONCLUSION Specially trained parents successfully continued paediatric eating disorder treatment at home and maintained treatment gains.
Collapse
Affiliation(s)
- Tessa Taylor
- Paediatric Feeding International Sydney NSW Australia
- Department of Psychology, and the School of Health Sciences University of Canterbury/Te Whare Wānanga o Waitaha Christchurch New Zealand
| | - Neville Blampied
- Department of Psychology, and the School of Health Sciences University of Canterbury/Te Whare Wānanga o Waitaha Christchurch New Zealand
| | | |
Collapse
|
99
|
Dipasquale V, Lecoeur K, Aumar M, Guimber D, Coopman S, Nicolas A, Turck D, Gottrand F, Ley D. Factors Associated With Success and Failure of Weaning Children From Prolonged Enteral Nutrition: A Retrospective Cohort Study. J Pediatr Gastroenterol Nutr 2021; 72:135-140. [PMID: 32810034 DOI: 10.1097/mpg.0000000000002909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The aims of the present study were to assess the efficacy of a tube weaning program, and to identify factors associated with success and failure. METHODS This was a retrospective cohort study including all pediatric patients on enteral nutrition (EN) for ≥6 months for whom at least 1 attempt of weaning was performed in a single tertiary referral center from 2012 to 2017, with a minimum follow-up of 6 months after EN discontinuation. Weaning program was individualized to each child. Weaning success was defined a priori. Factors associated with success were investigated using multivariate analysis. RESULTS Ninety-four patients were enrolled, in whom a total of 114 attempts of weaning were performed at a median age of 51 ± 40 months. Success was achieved in 80 attempts (success rate of 70%). One hundred three (92%) weaning attempts were performed at home with a follow-up in the outpatient clinic, mostly (74%) by a progressive (>1 month) reduction of tube feeding. Patients who required psychological support during weaning had more failures than patients who did not (odds ratio = 5.7, 95% confidence interval [1.2-27.0], P = 0.03). The presence of impaired oral feeding skills at the time of EN discontinuation was also predictive of failure (odds ratio = 6.2, 95% confidence interval [0.05-0.5], P = 0.005). CONCLUSIONS Our progressive, mostly outpatient-based, patient-tailored program of weaning from EN is effective for tube-dependent children. Children who need psychological support during weaning and those who present impaired oral feeding skills represent a subgroup of at-risk patients for whom alternative weaning strategies may need to be considered.
Collapse
Affiliation(s)
- Valeria Dipasquale
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille
| | - Katia Lecoeur
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille
| | - Madeleine Aumar
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille.,Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, University Lille, Lille, France
| | - Dominique Guimber
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille
| | - Stéphanie Coopman
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille
| | - Audrey Nicolas
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille
| | - Dominique Turck
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille.,Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, University Lille, Lille, France
| | - Frédéric Gottrand
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille.,Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, University Lille, Lille, France
| | - Delphine Ley
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children's Hospital, CHU Lille and University of Lille.,Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, University Lille, Lille, France
| |
Collapse
|
100
|
Norris ML, Obeid N, Santos A, Valois DD, Isserlin L, Feder S, Spettigue W. Treatment Needs and Rates of Mental Health Comorbidity in Adolescent Patients With ARFID. Front Psychiatry 2021; 12:680298. [PMID: 34349680 PMCID: PMC8327955 DOI: 10.3389/fpsyt.2021.680298] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022] Open
Abstract
The purpose of this paper is to provide a descriptive overview of a single-center ARFID-specific pilot clinic that sought to better understand the specific needs of patients with ARFID including rates of comorbidities, and to gain insight into treatment requirements. A retrospective cohort study was completed on patients meeting criteria for ARFID admitted to a specialized pilot clinic within a tertiary care hospital. Over an 18 month period, a total of 26 patients were assessed and had follow-up data for a 12 month period. Patients presented with heterogeneous manifestations of ARFID and high rates of comorbid mood and anxiety disorders were noted. Treatment plans were tailored to meet individual needs at assessment and over the treatment period. A multidisciplinary approach was most often administered, including a combination of individual therapy, family therapy, medical monitoring, and prescribed medications. Only 30% of patients were treated exclusively by therapists on the eating disorder team. The experiences gained from this pilot study highlight the need for specialized resources for assessment and treatment of patients with ARFID, the importance of a multidisciplinary approach to treatment, and the necessity of utilization of ARFID-specific measures for program evaluation purposes.
Collapse
Affiliation(s)
- Mark L Norris
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Nicole Obeid
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Alexandre Santos
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Darcie D Valois
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Leanna Isserlin
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Department of Psychiatry, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Stephen Feder
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Wendy Spettigue
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Department of Psychiatry, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|