Feeding interactions for children with cerebral palsy: contributions of mothers' psychological state and children's skills and abilities

Beliefs about sensitive parenting among mothers of children with disabilities

The relevance of the quality of parent-child interactions for child development has long been established. Nevertheless, research on beliefs about maternal sensitivity is still scarce, to an even greater extent in the context of child disability. This inquiry aimed to describe beliefs about sensitive parenting among mothers of children with developmental disabilities and to examine how those beliefs relate to sociodemographic factors and perceived stress. Participants included 40 mothers with a child up to 7 years of age with a developmental disability. Mothers reported on sociodemographic factors and daily hassles and sorted an adapted version of the Maternal Behavior Q-Sort. Results revealed a strong convergence between maternal beliefs about the ideal mother and the attachment theory's concept of sensitivity. Daily hassles predicted beliefs about the ideal mother. These results underline the importance of implementing interventions in the context of child disability aimed at reducing parental stress.

Parents' resolution of their child's diagnosis: A scoping review

This scoping review focused on parents' resolution of their reactions to receiving a diagnosis for their child, based on Marvin and Pianta's model and Reaction to Diagnosis Interview (RDI). We aimed to map the populations examined, the prevalence of parents' narrated resolution, and what is known about its outcomes and determinants. A structured search identified 47 peer-reviewed papers published between 1992-2021. All employed the RDI and most had a cross-sectional design. Studies focused on a wide range of children's health and mental health diagnoses. Days to years after receiving the diagnosis, RDI narratives of 18.43% to 72.49% of the parents (44% on average) indicated lack of resolution. Studies reported associations between unresolved narratives and children's insecure attachment, higher parenting stress, and poorer parental health. However, findings on the associations of narrated resolution with parents' representations of their child, sensitivity, and psychological symptoms were equivocal, and findings on factors that may shape narrated resolution were limited. To advance the understanding of parents' narrated resolution and its effects, we recommend researchers employ prospective and longitudinal designs, evaluate narrated resolution as a continuous phenomenon, focus on outcomes derived from attachment theory, and systematically sample families from heterogenous cultures.

Self-Assessment of Pediatric Feeding Therapists in the State of Illinois

Introduction:

The care of infants and children with feeding and swallowing disorders requires specialized skills and strategies. Therapist certification is often available for hospital-based feeding, yet due to increasing demand, more non-certified, state-provided therapists are providing treatment. However, their skill set is uncertain and has yet to be explored. This investigation provides insight into therapist skill level and self-perceived proficiency.

Methods:

Feeding therapists throughout the state were surveyed for CEU, caseload, and work environment. Individual skill set and self-reliance with clinical vignettes were assessed a by Likert scale.

Results:

Early Intervention: (0 to 3 years of age) outnumbered outpatient, school, and hospital-based therapists. Limited training and caseload were prevalent and associated with poorer clinical skills. Both early intervention and hospital-based therapists reported proficiency in managing infants with dysphagia, however hospital-based therapists were most self-reliant.

Conclusion:

A certification process and associated clinical pathway is recommended for feeding therapists to provide standardized services throughout state.

Impact of an educational program on the feeding of neurologically impaired children

PURPOSE: To verify the impact of an educative program focused on aspects related to feeding developed with a group of caregivers of children with chronic non-progressive encephalopathy. METHODS: Cross-sectional comparative study conducted with 30 children diagnosed with chronic non-progressive encephalopathy and their caregivers with the use of a questionnaire and video recordings of a meal conducted by the main caregiver. In order to verify the impact of an educational program in the knowledge and conduct of caregivers, patients were divided into two groups: study - consisting of caregivers submitted to a questionnaire and a video recording before and after the educational program; control - group in which caregivers underwent the procedures in two occasions, but without access to the educational program. RESULTS: Around 93.33% of caregivers were females, most had low educational level, and only 10% had a professional activity. Previous knowledge of caregivers concerning feeding was restricted, with 66% of caregivers not knowing what aspiration was, 60% being unfamiliar with the complications associated with such occurrence, and 86.66% stating that there is no relation between voice and swallowing. During feeding, only 26.66% of the caregivers used verbal commands related to feeding, and 50% did not realize the difficulties presented by their children. We observed a difference with regard to knowledge and conduct in the study group only. CONCLUSION: The educational program had a positive impact on the knowledge and conduct of caregivers concerning the feeding of their children with chronic non-progressive encephalopathy.

Prevention and Treatment of Tube Dependency in Infancy and Early Childhood

Tube dependency is recognized as an unintended result of long-term tube feeding in infants and young children. The condition involves disturbing side effects such as vomiting, gagging, and active food refusal. It prevents infants from making the transition from tube to oral feeding and from starting to learn to eat in the absence of any medical indication for continuation of enteral feeding. Tube dependency can have a destructive impact on the child's development, even in cases when the nutritional influence might be beneficial. The authors set up recommendations for the prevention of tube dependency and suggest guidelines for weaning tube-dependent children based on the results of the Graz program and satellite programs using a similar model. A sample of 221 tube-dependent patients aged 4 months to 15 years of age provided the clinical study group on which this article is based. Begun in 1987, a comprehensive tube-weaning program was developed on the basis of clinical experience and encounters with more than 430 tube-dependent children in 20 years, resulting in a success rate of 78/81 (96% for 2007) and 79/84 (94% for 2008). Placement must be preceded by clear criteria and a decision as to the indicated nutritional goal and time of use. The placement of a temporary tube must generate a plan covering maintenance issues, including time, method, and team for weaning. Aspects of tube feeding that go beyond purely medical and nutritional issues need to be considered to minimize the frequency and severity of unintended tube dependency in early childhood.

Mealtime interaction patterns between young children with cerebral palsy and their mothers: characteristics and relationship to feeding impairment

BACKGROUND

A significant proportion of children with cerebral palsy have some degree of feeding impairment, which not only affects their ability to obtain adequate nourishment, but may also impinge on their ability to interact with their mothers during mealtimes. The quality of the maternal-child interaction may also be affected by the mealtime being prolonged and/or stressful. Patterns of interaction between mothers and their children with cerebral palsy have typically been described in play situations. There is limited information about interaction during mealtimes. The purpose of this study therefore, was to observe and describe the characteristics of mealtime interaction between mothers and their young children with cerebral palsy, and to determine whether feeding impairment and other sample characteristics were related to interaction patterns.

METHODS

The participants were 20 mothers and their children with cerebral palsy. Physical, cognitive, and feeding abilities varied. Video recordings of each mother-child dyad interacting during a typical mealtime were analysed in order to describe the structure of the interaction, the communicative functions used, and what method the children used to communicate. The characteristics of the interaction were summarized and compared and the relationship between feeding ability and other child factors and interaction patterns were explored.

RESULTS

Results revealed that interactions were maternally dominated. Mothers produced most of the communicative behaviour during the mealtime and used more directive functions than their children. The severity of feeding impairment was related to child patterns of interaction, but not to maternal interaction patterns. Language delay was also related to interaction patterns.

CONCLUSIONS

The results of this study highlight the importance for professionals to consider mealtime interactions for children with cerebral palsy and their mothers as an integral part of feeding investigations and ongoing interventions, as feeding impairment does seem to have a bearing on aspects of interaction.

Feeding outcomes of extremely premature infants after neonatal care

Feeding is a primary concern for families of extremely preterm (EP) infants following discharge from neonatal care. An increasing number of EP children are being referred for treatment of feeding problems, including eating only a few types of food or very small portions, difficulty transitioning to textured foods, and refusing food. These issues have the potential for significant consequences for the children's growth and development as well as their family's well-being. An understanding of the kinds of feeding problems faced by families of EP infants can help nurses guide families to be ready for and respond to these issues. In this article, the evidence for and the nature of feeding problems in EP children after discharge from neonatal care are examined.