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Hays NP, Alenazi R, Al-Zaatreh R, Lavalle L, Sameer M, Sroda I, Vissers Y, Mizyed M. Gastrointestinal Tolerance of Formula-Fed Infants During the Immediate Postnatal Period in Saudi Arabia: An Observational Study. Glob Pediatr Health 2024; 11:2333794X241260261. [PMID: 39049879 PMCID: PMC11268007 DOI: 10.1177/2333794x241260261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 07/27/2024] Open
Abstract
Objective. Feeding intolerance during the early postnatal period can be distressing for families. To assess this, infants (n = 150) of mothers who had previously decided to exclusively or partially formula feed were enrolled ≤24 hours after birth. Methods. Infants were fed with a single ready-to-feed, 100% partially hydrolyzed whey protein-based formula until discharge, in accordance with standard hospital practice. Parents recorded daily the presence/severity of gastrointestinal (GI) symptoms/behaviors, rated from 0 (never) to 5 (always). A validated questionnaire was completed at discharge to evaluate symptoms of GI discomfort; scores can range from 0 to ~140 (lower scores indicate fewer symptoms). Results. Mean ± SD daily scores ranged from 0.12 ± 0.40 (fussiness/irritability) to 1.26 ± 0.90 (spitting up), indicating that GI symptoms/behaviors occurred, on average, "never" or "almost never." Mean GI discomfort scores were also very low (9.9 ± 7.4). Conclusion. These results indicate that the ready-to-feed formula was very well accepted and well tolerated during this period among healthy newborns in Saudi Arabia.
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Affiliation(s)
| | - Rasha Alenazi
- Dr. Sulaiman Al Habib Hospital, Riyadh, Saudi Arabia
| | | | | | | | | | - Yvonne Vissers
- Nestlé Product Technology Center—Nutrition, Konolfingen, Switzerland
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Richardson TN, Reis P, Swanson M. Mental Health and Feeding Styles in Parents of Formula-Fed Infants. Child Obes 2024; 20:178-187. [PMID: 37130301 PMCID: PMC10979682 DOI: 10.1089/chi.2022.0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background: Nonresponsive feeding styles can contribute to rapid weight gain in infancy and subsequent obesity in childhood. There is a need to investigate factors such as parental mental health symptoms (stress, depression, and anxiety) that may contribute to nonresponsive feeding styles. The purpose of this study was to investigate the relationship between parental mental health symptoms and feeding styles in parents of healthy, term formula-fed infants during the first year of life. Methods: A cross-sectional, descriptive correlational design was employed using online surveys. We recruited participants through Facebook groups and pediatricians' offices. Instruments included a demographic questionnaire, the Perceived Stress Scale-10, Patient Health Questionnaire-Depression Module-9, 7-item Generalized Anxiety Disorder Assessment, and Infant Feeding Style Questionnaire. Results: Participants were 306 parents of formula-fed infants. Greater depressive symptoms was the strongest predictor of the pressuring style (β = 0.54), while greater symptoms of stress (β = -0.13) and anxiety (β = -0.28) were associated with lower pressuring scores. Greater depressive symptoms was the strongest predictor of the laissez-faire style (β = 0.48), while greater symptoms of stress (β = -0.17) and anxiety (β = -0.23) were associated with lower laissez-faire scores. Engaging in ≤50% of the infant's feeds was the strongest control variable predictor for the pressuring and laissez-faire styles. None of the mental health variables were significantly related to the restrictive style. Conclusions: We recommend increased screening for depressive symptoms in parents of infants and responsive feeding support, especially for those experiencing depressive symptoms.
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Affiliation(s)
| | - Pamela Reis
- College of Nursing, East Carolina University, Greenville, NC, USA
| | - Mel Swanson
- College of Nursing, East Carolina University, Greenville, NC, USA
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Pados BF, Hill RR. Development, Psychometric Testing, and Reference Values of the Infant Eating Assessment Tool (InfantEAT). Adv Neonatal Care 2024; 24:E2-E10. [PMID: 38181670 DOI: 10.1097/anc.0000000000001132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
BACKGROUND Problematic feeding is common in infancy, particularly in infants with a history of premature birth or medical complexity. A concise, valid, and reliable measure of feeding that can be used across feeding methods is needed for clinical practice and research. PURPOSE The purpose of this study was to create an assessment tool to evaluate symptoms of problematic feeding in infants that can be used across all feeding methods (breastfeeding, bottle-feeding, and mixed feeding), then test its psychometric properties and establish reference values. METHODS Item response theory (IRT) was used to identify the most important items on the Neonatal Eating Assessment Tool (NeoEAT) related to symptoms of problematic feeding in infants (N = 1054) to create the Infant Eating Assessment Tool (InfantEAT). Reliability of the InfantEAT was tested using Cronbach's α and interitem correlations. Reference values of the InfantEAT were determined from a sample of healthy, full-term infants (n = 561). Percent agreement in identifying problematic feeding between the NeoEAT and the InfantEAT was calculated. RESULTS The InfantEAT is comprised of 31 items in 9 subscales. The InfantEAT has evidence of acceptable reliability (α = 0.88). There was 74% agreement between the NeoEAT and the InfantEAT, with the InfantEAT being more sensitive to identifying problematic feeding. References values are presented for infants 0 to 2, 2 to 4, 4 to 6, and 6 to 7 months. IMPLICATIONS PRACTICE AND RESEARCH The InfantEAT is a reliable and sensitive tool to evaluate symptoms of problematic feeding across feeding methods for infants younger than 7 months in both practice and research.
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Affiliation(s)
- Britt F Pados
- Infant Feeding Care, Wellesley, Massachusetts (Dr Pados); and MGH Institute of Health Professions School of Nursing, Charlestown, Massachusetts (Dr Hill)
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Cordray H, Raol N, Mahendran GN, Tey CS, Nemeth J, Sutcliffe A, Ingram J, Sharp WG. Quantitative impact of frenotomy on breastfeeding: a systematic review and meta-analysis. Pediatr Res 2024; 95:34-42. [PMID: 37608056 DOI: 10.1038/s41390-023-02784-y] [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: 05/30/2023] [Accepted: 07/31/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Symptoms related to infant ankyloglossia/tongue-tie may deter mothers from breastfeeding, yet frenotomy is controversial. METHODS Databases included PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Google Scholar from 1961-2023. Controlled trials and cohort studies with validated measures of surgical efficacy for breastfeeding outcomes were eligible. Meta-analyses synthesized data with inverse-variance weighting to determine standardized mean differences (SMD) between pre-/postoperative scores. RESULTS Twenty-one of 1568 screened studies were included. Breastfeeding self-efficacy improved significantly post-frenotomy: medium effect after 5-10 days (SMD 0.60 [95% CI: 0.48, 0.71; P < 0.001]), large effect after 1 month (SMD 0.91 [CI: 0.79, 1.04; P < 0.001]). Nipple pain decreased significantly post-frenotomy: large effect after 5-15 days (SMD -1.10 [CI: -1.49, -0.70; P < 0.001]) and 1 month (SMD -1.23 [CI: -1.79, -0.67; P = 0.002]). Frenotomy had a medium effect on infant gastroesophageal reflux severity at 1-week follow-up (SMD -0.63 [CI: -0.95, -0.31; P = 0.008]), with continued improvement at 1 month (SMD -0.41 [CI: -0.78, -0.05; P = 0.04]). From LATCH scores, breastfeeding quality improved after 5-7 days by a large SMD of 1.28 (CI: 0.56, 2.00; P = 0.01). CONCLUSIONS Providers should offer frenotomy to improve outcomes in dyads with ankyloglossia-associated breastfeeding difficulties. PROTOCOL REGISTRATION PROSPERO identifier CRD42022303838 . IMPACT This systematic review and meta-analysis showed that breastfeeding self-efficacy, maternal pain, infant latch, and infant gastroesophageal reflux significantly improve after frenotomy in mother-infant dyads with breastfeeding difficulties and ankyloglossia. Providers should offer frenotomy to improve breastfeeding outcomes in symptomatic mother-infant dyads who face challenges associated with ankyloglossia.
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Affiliation(s)
- Holly Cordray
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Nikhila Raol
- Children's Healthcare of Atlanta, Atlanta, GA, USA.
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
| | - Geethanjeli N Mahendran
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA
| | - Ching Siong Tey
- Children's Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - John Nemeth
- Emory University Woodruff Health Sciences Center Library, Atlanta, GA, USA
| | - Alastair Sutcliffe
- Population, Policy, and Practice Department, Institute of Child Health, University College London, London, UK
| | | | - William G Sharp
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Marcus Autism Center, Atlanta, GA, USA
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Tauriello S, Moding K, Aronoff N, Kubiniec E, Anzman-Frasca S. Examining links between child temperament and feeding, eating, and weight outcomes: An updated systematic review of the literature. Eat Behav 2023; 49:101739. [PMID: 37209569 DOI: 10.1016/j.eatbeh.2023.101739] [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: 01/03/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Weight outcomes have been associated with child temperament, defined as individual differences in reactivity and self-regulation. The current systematic review aims to provide an updated summary of the evidence linking temperamental negative reactivity, surgency, and regulation superfactors to early childhood feeding, eating, and weight outcomes. METHODS PubMed, PsycINFO and Embase databases, as well as scientific meeting programs, were searched using keywords and subject headings. Publication dates were limited to 2012-2019 as prior reviews were published in 2012 and 2014. Identified studies were eligible if they included children ages 0-5 years, a measure of child temperament, and a measure of parent/caregiver feeding, child eating, or child weight. 7113 studies were identified and 121 met inclusion criteria. RESULTS Feeding, eating, and weight outcomes were largely unrelated to overarching negative reactivity, surgency, and effortful control superfactors. Examination of individual temperament dimensions suggested difficult temperament was frequently linked to non-responsive feeding practices, whereas elevated emotionality and decreased self-regulation were linked to maladaptive eating behaviors, and lower inhibitory control to adiposity. Analyses with infants reported greater percentages of significant associations compared to children, and cross-sectional studies generally reported fewer significant associations than other study designs. CONCLUSIONS Difficult temperament, greater emotionality and lower self-regulation and inhibitory control were the aspects of temperament most consistently related to poorer early childhood feeding, eating, and weight outcomes. Associations tended to be stronger in infancy, and when examined within a non-cross-sectional study design. Findings can inform the development of tailored efforts to promote healthy eating and growth throughout childhood.
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Affiliation(s)
- Sara Tauriello
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
| | - Kameron Moding
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, United States of America
| | - Nell Aronoff
- University Libraries, University at Buffalo, Buffalo, NY, United States of America
| | - Elizabeth Kubiniec
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America; Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY, United States of America.
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Jayapradha G, Venkatesh L, Amboiram P, Sudalaimani P, Balasubramanium RK, Pados BF. Cross-Cultural Adaptation and Psychometric Evaluation of the Neonatal Eating Assessment Tool-Breastfeeding Into Tamil. J Obstet Gynecol Neonatal Nurs 2022; 51:450-460. [PMID: 35568097 DOI: 10.1016/j.jogn.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To adapt the Neonatal Eating Assessment Tool-Breastfeeding (NeoEAT-Breastfeeding) into Tamil, a language spoken in several South Asian countries, to identify the tool's factor structure, and to assess its psychometric properties. DESIGN Cross-sectional. SETTING Tertiary care hospital in South India. PARTICIPANTS A cohort of 323 mothers of infants ages 1 week to 7 months, including infants with and without feeding difficulties. METHOD To adapt the English tool to Tamil, we followed standard procedures specified by the tool developers and international guidelines for tool translation and adaptation, including pilot testing and personal interviews with participants who had infants younger than 7 months. Participants completed the NeoEAT-Breastfeeding (Tamil) after assessment of breastfeeding by professionals. The 62-item tool involves rating each item on a 6-point scale, and higher scores indicate increased feeding difficulties. RESULTS After exploratory factor analysis, we divided the tool into five subscales in the Tamil version compared to the seven subscales in the original English version. The Tamil version demonstrated high internal consistency reliability (Cronbach's α = 0.97) and test-retest reliability (intraclass correlation = 0.99) for the total scores. Infants with feeding concerns demonstrated significantly higher total and subscale scores on the NeoEAT-Breastfeeding (Tamil) than infants without feeding concerns (p = .000; construct validity). CONCLUSION The NeoEAT-Breastfeeding (Tamil) holds promise as a culturally appropriate, clinically useful parent-report tool with evidence for initial reliability and validity for identifying feeding-related concerns among infants younger than 7 months in the Tamil-speaking population.
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Hill RR, Lyons KS, Kelly-Weeder S, Pados BF. Effect of Frenotomy on Maternal Breastfeeding Symptoms and the Relationship Between Maternal Symptoms and Problematic Infant Feeding. Glob Pediatr Health 2022; 9:2333794X211072835. [PMID: 35071696 PMCID: PMC8771742 DOI: 10.1177/2333794x211072835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022] Open
Abstract
The relationship between maternal symptoms and problematic infant feeding in the context of tongue-tie is unknown. In a sample of infants with tongue-tie undergoing frenotomy and their mothers, the aims of this study were to: (1) describe changes in maternal symptoms pre- and post-frenotomy, and (2) evaluate the relationships between maternal symptoms and symptoms of problematic feeding pre- and post-frenotomy. Mother-infant dyads were recruited from 1 pediatric dental office between July and November 2020. The sample included 102 mother-infant dyads; 84 completed the follow-up survey. Maternal symptoms of painful and difficult latch, creased/cracked nipples, bleeding, or abraded nipples, chewing of the nipple, and feelings of depression were significantly less common after tongue-tie revision. Poor latch onto the breast was associated with feeding difficulties at both time points. Frenotomy resulted in a decrease of symptoms in breastfeeding mothers. Maternal symptoms and feeding problems persisting post-frenotomy warrant further evaluation.
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Pados BF, Hill RR, Yamasaki JT, Litt JS, Lee CS. Prevalence of problematic feeding in young children born prematurely: a meta-analysis. BMC Pediatr 2021; 21:110. [PMID: 33676453 PMCID: PMC7936467 DOI: 10.1186/s12887-021-02574-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/24/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Difficulties related to eating are often reported in children born preterm. The objective of this study was to quantitatively synthesize available data on the prevalence of problematic feeding in children under 4 years of age who were born preterm. METHODS Literature was identified from PubMed, CINAHL, and PsycInfo. The search was limited to English language and publication years 2000-2020. To be included in the meta-analysis, the article had to report the prevalence of problematic oral feeding within a population of children born prematurely (< 37 weeks' gestation), and the child age at the time of study had to be between full-term corrected age and 48 months. For studies meeting inclusion criteria, the following data were extracted: sample size and subsamples by gestational age and/or child age at time of study; definition of problematic feeding; measures used for assessment of feeding; gestational age at time of birth of sample; child age at time of study; exclusion criteria for the study; and prevalence of problematic feeding. Random-effects meta-analyses were performed to estimate the prevalence of problematic feeding across all studies, by gestational age at birth, and by child age at time of study. RESULTS There were 22 studies that met inclusion criteria. Overall prevalence of problematic feeding (N = 4381) was 42% (95% CI 33-51%). Prevalence was neither significantly different across categories of gestational age nor by child age at the time of study. Few studies used psychometrically-sound assessments of feeding. CONCLUSION Problematic feeding is highly prevalent in prematurely-born children in the first 4 years of life regardless of degree of prematurity. Healthcare providers of children born preterm should consider screening for problematic feeding throughout early childhood as a potential complication of preterm birth. SYSTEMATIC REVIEW REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Britt Frisk Pados
- Boston College William F. Connell School of Nursing, 140 Commonwealth Avenue, Maloney Hall 268, Chestnut Hill, MA, 02467, USA.
| | - Rebecca R Hill
- Boston College William F. Connell School of Nursing, 140 Commonwealth Avenue, Maloney Hall 268, Chestnut Hill, MA, 02467, USA
| | - Joy T Yamasaki
- CHA Hollywood Presbyterian Medical Center, Los Angeles, CA, USA
| | - Jonathan S Litt
- Beth Israel Deaconess Medical Center, Boston Children's Hospital, Harvard Medical School, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Christopher S Lee
- Boston College William F. Connell School of Nursing, 140 Commonwealth Avenue, Maloney Hall 268, Chestnut Hill, MA, 02467, USA
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Hill RR, Park J, Pados BF. Bottle-Feeding Challenges in Preterm-Born Infants in the First 7 Months of Life. Glob Pediatr Health 2020; 7:2333794X20952688. [PMID: 32953946 PMCID: PMC7479869 DOI: 10.1177/2333794x20952688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/03/2020] [Accepted: 07/24/2020] [Indexed: 11/30/2022] Open
Abstract
Preterm infants frequently experience oral feeding challenges while in the
neonatal intensive care unit, with research focusing on infant feeding during
this hospital stay. There is little data on symptoms of problematic feeding in
preterm-born infants in the months after discharge. The purpose of this study
was to describe symptoms of problematic bottle-feeding in the first 7 months of
life in infants born preterm, compared to full-term infants. Parents of infants
less than 7 months old completed an online survey that included the Neonatal
Eating Assessment Tool—Bottle-feeding and questions about the infant’s medical
and feeding history. General linear models were used to evaluate differences in
NeoEAT—Bottle-feeding total score and subscale scores by preterm category,
considering other significant factors. Very preterm infants had more symptoms of
problematic bottle-feeding than other infants. Current age, presence of
gastroesophageal reflux, and anomalies of the face/mouth were associated with
problematic bottle-feeding.
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Affiliation(s)
- Rebecca R. Hill
- MGH Institute of Health Professions,
Boston, MA, USA
- Rebecca R. Hill, DNP, FNP-C, MGH Institute
of Health Professions, 36 First Avenue, Boston, MA 02129, USA.
| | - Jinhee Park
- William F. Connell School of Nursing,
Boston College, Chestnut Hill, MA, USA
| | - Britt F. Pados
- William F. Connell School of Nursing,
Boston College, Chestnut Hill, MA, USA
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Pados BF, Johnson J, Nelson M. Neonatal Eating Assessment Tool-Mixed Breastfeeding and Bottle-feeding: Reference values and factors associated with problematic feeding symptoms in healthy, full-term infants. J Am Assoc Nurse Pract 2020; 33:938-946. [PMID: 32773534 DOI: 10.1097/jxx.0000000000000476] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/26/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Neonatal Eating Assessment Tool-Mixed Breastfeeding and Bottle-feeding (NeoEAT-Mixed Feeding) is a parent-report assessment of symptoms of problematic feeding in infants who are feeding by both breast and bottle. PURPOSE To establish reference values for the NeoEAT-Mixed Feeding and evaluate factors that contribute to symptoms of problematic feeding in healthy, full-term infants. METHODS Parents of 409 infants less than 7 months old completed an online survey. Median and percentile scores are presented for infants aged 0-2, 2-4, 4-6, and 6-7 months old. RESULTS Neonatal Eating Assessment Tool-Mixed Feeding total score and scores for the Gastrointestinal Tract Function and Energy & Physiologic Stability subscales decreased with increasing infant age. Infant Regulation and Feeding Flexibility subscale scores remained stable over time, whereas Sensory Responsiveness subscale scores increased with increasing infant age. Infants with more gastrointestinal symptoms had higher NeoEAT-Mixed Feeding total scores. IMPLICATIONS FOR PRACTICE The reported reference values may be used to identify infants in need of further assessment, referral, and intervention. In healthy, full-term infants with concurrent gastrointestinal symptoms and problematic feeding, interventions targeted at gastrointestinal symptoms may help to improve symptoms of problematic feeding as well.
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Affiliation(s)
- Britt Frisk Pados
- Boston College William F. Connell School of Nursing, Chestnut Hill, Massachusetts
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Suiter DM, Daniels SK, Barkmeier-Kraemer JM, Silverman AH. Swallowing Screening: Purposefully Different From an Assessment Sensitivity and Specificity Related to Clinical Yield, Interprofessional Roles, and Patient Selection. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:979-991. [PMID: 32650661 DOI: 10.1044/2020_ajslp-19-00140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The purpose of this clinical focus article is to summarize the goal and process by which identification of individuals at risk for having feeding problems or dysphagia is clinically screened across the life span by speech-language pathologists (SLPs). The topic of this clinical focus article was presented at the Charleston Swallowing Conference in Chicago, Illinois, in July 2018. The contents of this clinical focus article offer an expanded summary of information discussed at this meeting with focus on critical considerations to guide clinical decisions by SLPs regarding the optimal feeding and dysphagia screening approach and process. Conclusion Screening is a critical first step in the identification of individuals at risk for feeding problems and dysphagia across the life span. Understanding the difference between screening and assessment objectives as well as having the knowledge, skills, and clinical competency to implement psychometrically sound screening approaches is a recommended clinical practice standard for SLPs working with these clinical populations. This clinical focus article summarizes critical considerations for identifying individuals at risk for feeding problems and dysphagia across the life span to guide clinicians working with dysphagia populations.
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Affiliation(s)
- Debra M Suiter
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington
| | - Stephanie K Daniels
- Department of Communication Sciences and Disorders, University of Houston, TX
| | | | - Alan H Silverman
- Section of Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee
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Pados BF, Basler A. Gastrointestinal Symptoms in Healthy, Full-Term Infants Under 7 Months of Age. J Pediatr Nurs 2020; 53:1-5. [PMID: 32222609 DOI: 10.1016/j.pedn.2020.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 03/20/2020] [Accepted: 03/21/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To describe symptoms of gastrointestinal distress experienced by healthy, full-term infants in the first 7 months of life and test the psychometric properties of the Infant Gastrointestinal Symptoms Questionnaire (IGSQ). DESIGN AND METHODS Parents of infants <7 months (n = 320) completed the IGSQ, the Infant Gastroesophageal Reflux Questionnaire - Revised (I-GERQ-R), and the Neonatal Eating Assessment Tool (NeoEAT) - Breastfeeding and/or Bottle-feeding. Median and percentile scores were calculated for the IGSQ scores for each age group: 0-2, 2-4, 4-6, and 6-7 months. Change in IGSQ scores with age were evaluated using the Kruskal-Wallis test with Mann-Whitney U tests for post-hoc comparisons. Internal consistency reliability was assessed using Cronbach's alpha. Concurrent validity was tested using Spearman's rho between the IGSQ and the I-GERQ-R and NeoEAT. RESULTS IGSQ scores decreased significantly with increased infant age, from a median of 28 at 0-2 months to 23 at 6-7 months old. The IGSQ had acceptable internal consistency reliability (Cronbach's alpha = 0.74). IGSQ total score was significantly correlated with I-GERQ-R total score (Spearman's rho (rs) = 0.69, p < .001), NeoEAT - Breastfeeding: Gastrointestinal Function subscale score (rs = 0.46, p < .001), and NeoEAT - Bottle-feeding: Gastrointestinal Tract Function subscale score (rs = 0.47, p < .001). CONCLUSIONS Gastrointestinal symptoms decrease with increasing age in the first 7 months of life. The IGSQ has evidence of acceptable internal consistency reliability and concurrent validity. PRACTICE IMPLICATIONS These data can be used to guide IGSQ score interpretation.
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Affiliation(s)
- Britt Frisk Pados
- Boston College William F. Connell School of Nursing, MA, United States of America.
| | - Audrey Basler
- Boston College William F. Connell School of Nursing, United States of America
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Pados BF, Park J, Thoyre SM. Neonatal Eating Assessment Tool-Breastfeeding: Reference Values for Infants Less Than 7 Months old. J Hum Lact 2020; 36:236-244. [PMID: 31465698 DOI: 10.1177/0890334419869598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The Neonatal Eating Assessment Tool-Breastfeeding is a valid and reliable 62-item parent-report assessment of symptoms of problematic breastfeeding behavior intended for infants less than 7 months old. RESEARCH AIM The aim of this study was to describe the Neonatal Eating Assessment Tool-Breastfeeding total score and subscale scores within a sample of full-term, healthy, typically-developing infants under 7 months old. METHODS Parents of healthy, full-term breastfeeding infants (N = 475) less than 7 months old completed the Neonatal Eating Assessment Tool - Breastfeeding through an online survey. Descriptive statistics were calculated for the total score and seven subscale scores within each age group: 0-2, 2-4, 4-6, and 6-7 months. RESULTS Neonatal Eating Assessment Tool-Breastfeeding total scores were highest (i.e., more problematic symptoms) at 0-2 months and decreased in older infant age groups. All subscale scores also had a downward trajectory in symptoms of problematic breastfeeding except the subscale Compelling Symptoms of Problematic Feeding, which was very low across age groups. Scores on the Infant Regulation subscale remained elevated for the first 6 months of life, then declined markedly in the 6-7 month age group. CONCLUSION The Neonatal Eating Assessment Tool-Breastfeeding now has reference values to facilitate interpretation of scores and guide decision-making, personalization of interventions, and assessment of response to interventions. For research, the Neonatal Eating Assessment Tool-Breastfeeding can be used to follow longitudinal development of breastfeeding as well as to test efficacy of breastfeeding interventions.
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Affiliation(s)
- Britt Frisk Pados
- 6019 Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - Jinhee Park
- 6019 Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - Suzanne M Thoyre
- 2331 University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
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Abstract
OBJECTIVE To explore parents' descriptions of and concerns about their infants' feeding in the first 6 months of life. DESIGN Descriptive study. SETTING Online survey. PARTICIPANTS We recruited 29 parents of infants younger than 7 months old from a variety of online local, regional, and international communities to complete a survey about their infants' feeding. MEASUREMENTS The survey included a combination of selection and open-text entry questions. Qualitative data from open-text questions were analyzed with directed content analysis to identify factors that influenced infant feeding. Two coders coded all data. RESULTS Concerns about feeding were common, and many parents made changes to facilitate feeding. Parents described characteristics of the infant (e.g., temperament), the task of feeding (e.g., milk flow), and factors external to the infant (e.g., breast anatomy) that affected feeding. Although some parents described feeling happy, calm, and bonded during feeding, others described feeling terrified, anxious, and worried. Health care providers played a significant role in helping parents navigate feeding, but they sometimes provided conflicting and even unsafe advice. CONCLUSION Understanding the experience of feeding from the parent perspective may help to identify targets for intervention to support parents and infants when feeding is difficult.
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Pados BF, Thoyre SM, Galer K. Neonatal Eating Assessment Tool - Mixed Breastfeeding and Bottle-Feeding (NeoEAT - Mixed Feeding): factor analysis and psychometric properties. Matern Health Neonatol Perinatol 2019; 5:12. [PMID: 31384477 PMCID: PMC6668191 DOI: 10.1186/s40748-019-0107-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/04/2019] [Indexed: 01/11/2023] Open
Abstract
Background Early identification of feeding difficulty in infancy is critical to supporting breastfeeding and ensuring optimal nutrition for brain development. The Neonatal Eating Assessment Tool (NeoEAT) is a parent-report assessment that currently has two versions: NeoEAT – Breastfeeding and NeoEAT – Bottle-feeding for use in breast and bottle-fed infants, respectively. There are currently no valid and reliable parent-report measures to assess feeding through a combination of both breast and bottle delivery. The purpose of this study was to conduct a factor analysis and test the psychometric properties of a new measure, the NeoEAT – Mixed Breastfeeding and Bottle-Feeding (NeoEAT – Mixed Feeding), including internal consistency reliability, test-retest reliability, construct validity and known-groups validity. Methods Parents of infants younger than 7 months who had fed by both bottle and breast in the previous 7 days were invited to participate. Internal consistency reliability was tested using Cronbach’s α. Test-retest reliability was tested between scores on the NeoEAT – Mixed Feeding completed 2 weeks apart. Construct validity was tested using correlations between the NeoEAT – Mixed-Feeding, the Infant Gastroesophageal Reflux Questionnaire - Revised (I-GERQ-R), and the Infant Gastrointestinal Symptoms Questionnaire (IGSQ). Known-groups validation was tested between healthy infants and infants with feeding problems. Results A total of 608 parents participated. Exploratory factor analysis revealed a 68-item scale with 5 sub-scales. Internal consistency reliability (Cronbach’s α = .88) and test-retest reliability (r = 0.91; p < .001) were both acceptable. Construct validity was demonstrated through correlations with the I-GERQ-R (r = 0.57; p < .001) and IGSQ (r = 0.5; p < .001). Infants with feeding problems scored significantly higher on the NeoEAT – Mixed Feeding, indicating more problematic feeding symptoms, than infants without feeding problems (p < .001), supporting known-groups validity. Conclusions The NeoEAT – Mixed Feeding is a 68-item parent-reported measure of breast- and bottle-feeding behavior for infants less than 7 months old that now has evidence of validity and reliability for use in clinical practice and research. The NeoEAT – Mixed Feeding can be used to identify infants with problematic feeding, guide referral decisions, and evaluate response to interventions.
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Affiliation(s)
- Britt Frisk Pados
- 1Boston College William F. Connell School of Nursing, Maloney 268, Chestnut Hill, MA 02467 USA
| | - Suzanne M Thoyre
- 2University of North Carolina at Chapel Hill School of Nursing, Carrington Hall, Chapel Hill, NC 27599 USA
| | - Kara Galer
- 1Boston College William F. Connell School of Nursing, Maloney 268, Chestnut Hill, MA 02467 USA
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