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Elliot C, Hopwood N, Moraby K, Crockett N, Wright S, Vanos K, Furey K, Hammond A, Handley S, Dalby-Payne J, Dadich A, Gottschalk B, Ooi CY, Woolfenden S. New consensus definition on defining and measuring care for children with paediatric feeding disorder. J Paediatr Child Health 2024; 60:58-66. [PMID: 38581288 DOI: 10.1111/jpc.16534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/31/2023] [Accepted: 03/18/2024] [Indexed: 04/08/2024]
Abstract
AIM This study addresses the absence of a definition of care for children with feeding disorders, limited agreement on key performance indicators (KPIs), and the lack of data linked to those KPIs. METHODS Clinicians, consumers and researchers involved in outpatient feeding care in New South Wales (NSW), Australia were invited to participate in a two-Phase study. In Phase 1, a modified Delphi method was used. Two rounds of voting resulted in a new consensus definition of a multidisciplinary paediatric feeding clinic. Three further rounds voting determined relevant KPIs. In Phase 2, the KPIs were piloted prospectively in 10 clinics. RESULTS Twenty-six clinicians, consumers and researchers participated in Phase 1. Participation across five voting rounds declined from 92% to 60% and a valid definition and KPI set were created. In Phase 2, the definition and KPIs were piloted in 10 clinics over 6 weeks. Data for 110 patients were collected. The final KPI set of 28 measures proposed covers clinical features, patient demographics and medical issues, parent-child interaction and outcome measures. CONCLUSIONS A new definition of a multidisciplinary paediatric feeding clinic is now available, linked to a standardised KPI set covering relevant performance measures. These proved viable in baseline data collection for 10 clinics across NSW. This sets a foundation for further data collection, systematic measurement of care provision and outcomes, and research needed to deliver care improvement for children with paediatric feeding disorder.
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Affiliation(s)
- Chris Elliot
- St George Hospital, Sydney, New South Wales, Australia
| | - Nick Hopwood
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Khadeejah Moraby
- University of South Australia, Adelaide, South Australia, Australia
| | | | - Simone Wright
- Developmental Disability Health Service, St George Hospital, Sydney, New South Wales, Australia
| | - Katelyn Vanos
- Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Krystal Furey
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Anna Hammond
- Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Siobhan Handley
- Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | | | - Ann Dadich
- School of Business, Western Sydney University, Sydney, New South Wales, Australia
| | | | - Chee Y Ooi
- University of New South Wales, Sydney, New South Wales, Australia
| | - Susan Woolfenden
- University of New South Wales, Sydney, New South Wales, Australia
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Syrmis M, Reilly C, Frederiksen N, Bell KL. Characteristics and health service utilization of children most at risk for prolonged temporary tube feeding. Nutr Clin Pract 2023; 38:1154-1166. [PMID: 37017937 DOI: 10.1002/ncp.10981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND This study aimed to describe children at risk of prolonged temporary tube feeding and evaluate associations between tube feeding duration and child and health service variables. METHODS A prospective medical hospital records audit was conducted between November 1, 2018, and November 30, 2019. Children at risk of prolonged temporary tube feeding were identified as having a tube feeding duration of >5 days. Information was collected on patient characteristics (eg, age) and service delivery provision (eg, tube exit plans). Data were collected from the pretube decision-making phase until tube removal (if applicable) or until 4 months after tube insertion. RESULTS Descriptively, 211 at-risk children (median, 3.7 years; interquartile range [IQR], 0.4-7.7) differed from 283 not-at-risk children (median age, 0.9 years; IQR, 0.4-1.8) in terms of age, geographical location of residence, and tube exit planning. Medical diagnoses of neoplasms, congenital abnormalities, perinatal problems, and digestive system diseases in the at-risk group were individually associated with longer than average tube feeding duration, as were the primary reasons for tube feeding of nonorganic growth faltering and inadequate oral intake related to neoplasms. Yet, variables independently associated with greater odds of lengthier tube feeding durations were consultations with a dietitian, speech pathologist, or interdisciplinary feeding team. CONCLUSION Children at risk of prolonged temporary tube feeding access interdisciplinary management because of their complexity. Identified descriptive differences between at-risk and not-at-risk children may be useful when selecting patients for tube exit planning and developing tube feeding management education programs for health professionals.
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Affiliation(s)
- Maryanne Syrmis
- Department of Speech Pathology, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Claire Reilly
- Department of Dietetics and Food Services, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, South Brisbane, Queensland, Australia
| | - Nadine Frederiksen
- Department of Occupational Therapy, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Kristie L Bell
- Department of Dietetics and Food Services, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Centre for Child Health Research, The University of Queensland, South Brisbane, Queensland, Australia
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Dadich A, Kaplun S, Kaplun C, Hopwood N, Elliot C. 'it was that … specialist … that finally listened to us … that's probably a weird answer to what you were expecting': Clinician and carer perspectives on brilliant feeding care. Health Expect 2022; 26:488-497. [PMID: 36482799 PMCID: PMC9854327 DOI: 10.1111/hex.13683] [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: 07/26/2022] [Revised: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION To extend research on positive aspects of health care, this article focusses on health care for children who tube-feed-this is because knowledge about tube-feeding for children is limited and fragmented. This is achieved by consulting with clinicians and carers who supported children who tube-feed to clarify their understandings of and experiences with brilliant feeding care. METHODS Nine clinicians and nine carers who supported children who tube-fed were interviewed. The interview transcripts were analysed thematically. RESULTS Findings highlighted several features of brilliant feeding care-namely: practices that go above and beyond; attentiveness; empowerment; being 'on the same page'; hopefulness and normalcy. CONCLUSIONS These findings show that seemingly trivial or small acts of care can make a significant meaningful difference to carers of children who tube-feed. Such accounts elucidate brilliant care as grounded in feasible, everyday actions, within clinicians' reach. The implications associated with these findings are threefold. First, the findings highlight the need for clinicians to listen, be attuned and committed to the well-being of children who tube-feed and their carers, share decision-making, source resources, and instil hope. Second, the findings suggest that carers should seek out and acknowledge clinicians who listen, involve them in decision-making processes, and continue to source the resources required to optimize child and carer well-being. Third, the findings point to the need for research to clarify the models of care that foster brilliant feeding care, and the conditions required to introduce and sustain these models. PATIENT OR PUBLIC CONTRIBUTION All of the carers and clinicians who contributed to this study were invited to participate in a workshop to discuss, critique, and sense-check the findings. Three carers and one clinician accepted this invitation. Collectively, they indicated that the findings resonated with them, and they agreed with the themes, which they indicated were well-substantiated by the data.
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Affiliation(s)
- Ann Dadich
- School of BusinessWestern Sydney UniversityParramattaNSWAustralia
| | - Simone Kaplun
- School of BusinessWestern Sydney UniversityParramattaNSWAustralia
| | - Cathy Kaplun
- Transforming early Education and Child Health (TeEACH) Strategic Research InitiativeWestern Sydney UniversityWestmeadNew South WalesAustralia
| | - Nick Hopwood
- Faculty of Arts and Social ScienceUniversity of Technology SydneyBroadwayNew South WalesAustralia
| | - Christopher Elliot
- Department of PaediatricsSt George HospitalKogarahNew South WalesAustralia
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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.
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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
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Syrmis M, Frederiksen N, Reilly C, Bell K. A natural history of temporary tube feeding care at a children's hospital: A prospective audit of medical records. J Child Health Care 2022:13674935221138635. [PMID: 36367960 DOI: 10.1177/13674935221138635] [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: 11/13/2022]
Abstract
This chart audit characterized the natural history of temporary tube feeding use at a children's hospital between 1 November 2018 and 30 November 2019. Data were collected from the decision-making phase until tube removal or 4 months post-tube insertion. Children's tube feeding journeys were described, and associations determined between patient and service-related variables and outcomes of tube feeding duration and being discharged with a feeding tube. Four hundred and 94 patients were followed with a median age of 1.0 years (IQR 3.6). Many had respiratory illnesses (n = 213, 43%) and received feeding tubes for inadequate oral intake related to acute illness (n = 279, 57%). Seventy-one new feeding tubes were inserted per month (SD 27.63). Fifty-nine per cent of patients (n = 290) received allied health consults. Although 40% of patients (n = 199) experienced complications, most patients (n = 460, 93%) ceased tube feeding within 4 months. Outcomes were associated with age, medical condition, reflux, primary reason for tube feeding, allied health consult, complication type, tube weaning plans and referral for longer-term feeding devices. Results highlighted a critical need for risk identification from the decision-making stage and standardization of practices during all phases of temporary tube feeding care.
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Affiliation(s)
- Maryanne Syrmis
- Speech Pathology Department, 67568Queensland Children's Hospital (QCH), Brisbane, QLD, Australia
| | | | - Claire Reilly
- Department of Dietetics and Food Services, 67568QCH, Brisbane, QLD, Australia
| | - Kristie Bell
- Department of Dietetics and Food Services, 67568QCH, Brisbane, QLD, Australia
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Hopwood N, Elliot C, Pointon K. Changing the World for Children with Complex Feeding Difficulties: Cultural-Historical Analyses of Transformative Agency. CULTURAL-HISTORICAL PSYCHOLOGY 2021. [DOI: 10.17759/chp.2021170215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
How to bring about positive change is a key concern in cultural-historical theory. There is an urgent imperative to address questions of transformation at the nexus of the individual and the social. One way to approach this is through the concept of agency, the means through which people go beyond coping with problems or adapting to the status quo, instead striving to make the future that ought to be a reality. This paper takes up ideas from Stetsenko’s transformative activist stance (TAS), Sannino’s transformative agency by double stimulation (TADS), and Edwards’ relational agency, tracing the emergence and enactment of agency among parents of children with complex feeding difficulties. These children were unable to eat orally, instead using a tube to feed. Each family strived towards, and realised, futures where their child was able to feed orally, without a tube. Parents acted agentically in ways that were contingent upon relevant cultural tools. Such tools are key to futures that are more inclusive, equitable and nurturing for all children and their families. The paper highlights the value of contemporary cultural-historical approaches to agency in understanding and provoking transformation at the nexus of the individual and social.
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