Demographic and Clinical Parameters Are Comparable Across Different Types of Pediatric Feeding Disorders

Background: Knowledge and understanding of risk mechanisms associated with pediatric feeding disorders (PFD) remain limited. We aimed to investigate causative factors associated with PFD and their relation to specific PFD types according to the recent consensus WHO-based definition. Methods: We retrospectively reviewed the medical records of children with PFD and retrieved their demographic and clinical characteristics. Healthy age- and sex-matched children served as controls. Results: Included were 254 children with PFD [median (interquartile range) age 16.4 (9.5-33) months at diagnosis] and 108 children in the control group [median age 24.85 (14.5-28.5) months]. According to the WHO-based definition, disturbances in oral intake were predominantly related to nutritional dysfunction in 118 (46.6%), feeding skill dysfunction in 83 (32.3%), medical conditions in 42 (16.7%) and psychosocial dysfunction in 11 (4.4%). In multivariate analysis, children with PFD had a higher risk for lower socioeconomic background (P<0.01) and low birth weight (26.8% compared to 7.4% ,P<0.001). Moreover, significantly fewer children in the PFD group were breastfed (75% versus 89%, P=0.003). There were no significant differences in any of those variables between PFD types. Conclusions: Low socioeconomic status, lack of breastfeeding, and low birth weight were significantly more frequent in children with PFD. PDF manifest as multiple dysfunctions, thus highlighting the need to offer these children and their families multidisciplinary care.

Prevalence, aetiology, and impact of paediatric feeding disorders in preterm infants admitted to a neonatal intensive care unit in Cyprus

BACKGROUND: Advancements in neonatal care have resulted in increased survival for preterm infants, with associated risk for paediatric feeding disorders (PFDs), the prevalence of which is relatively unexplored. Risk factors for developing PFDs in this population must be identified. OBJECTIVE: The aim of this study was to determine the epidemiology and risk factors for PFDs in preterm infants with Extremely Low Birth Weight (ELBW); Very Low Birth Weight (VLBW) and Low Birth weight (LBW) in the only neonatal intensive care unit (NICU) in Cyprus. METHODS: This study comprised 2 phases: Phase 1, a retrospective 2-year file audit, informing methodology for Phase 2, a prospective epidemiological study. Profiles of 1027 preterm infants were obtained in Phase 1. In Phase 2, clinical assessment data on 458 preterm infants (N = 224) were analyzed. RESULTS: The prevalence of PFDs was 36.5%. All preterm infants with ELBW and 69%with VLBW exhibited PFDs. Risk factors were birth weight (BW), gestational age (GA), bronchopulmonary dysplasia (BPD), neurological disorders, structural anomalies, and congenital heart disease (CHD). CONCLUSIONS: This unique epidemiological data for one country will inform NICU service provision and direct international research on PFDs in neonates.

Build Independent Self-feeding Function: A Pilot Study on a Child with Autism and Feeding Disorders

The high occurrence of feeding disorders among children with autism spectrum disorder has caught the attention of professionals from different disciplines. When taking an insight into their feeding problems, mixed physical, behavioral and psychological difficulties were encountered, such as oral skill deficits (e.g., chew, swallow, and coordination), fine motor skill deficits, food selectivity (e.g., texture aversion), food neophobia, and so on. However, the traditional non-oral tube feeding method for maintaining their nutrition consumption is criticized as too intrusive and inadequate for training self-feeding skills. Therefore, to target both establishing independent self-feeding function and food consumption variety (nutrition) while using a less intrusive intervention method, the present study tested the effectiveness of a multicomponent behavioral intervention protocol on a child with autism and feeding disorder, setting across physical, behavioral and psychological background. A task analysis on self-feeding function resulted in a backward-chain training procedure on swallowing, chewing, and fine motor skills, separately and then combined. The training procedure consisted of 3 key components: 1) swallowing training, 2) chewing training starting with using a chew facilitator tube, 3) fine motor training targeting on self-feeding; and 4) fine motor-chewing-swallowing coordination training with multiple types of food. The results showed the present multi-component behavioral intervention protocol successfully established the participant’s self-feeding skills: ameliorated his oral and fine motor skills, cultivated his independent self-feeding function, and increased his food consumption volume and variety.

Multidisciplinary approach to assessment and intervention of feeding problems in children with autism spectrum disorders: a clinical perspective

Purpose The aim of this paper is to share the details of a multidisciplinary approach, which includes occupational therapy, and to review the factors that should be considered in the evaluation and treatment of children with autism spectrum disorders (ASD) who are excessively selective in their food choices. Issues in this area are complex and often related to several complementary domains (medical, nutritional, psychosocial, sensorimotor, etc.). However, feeding disorders are frequently assessed and treated from a single discipline and important issues are missed or confounded. Design/methodology/approach A team of experienced clinicians in the field of paediatric feeding disorders gathered the knowledge and experience they acquired from working with individuals with ASD as well as with individuals with other neurodevelopmental diagnosis. A review of current literature in paediatric feeding disorders was used to document and explicate the multifactorial nature of feeding disorders in children with ASD and justify the need for a multidisciplinary approach to issues in this area. Findings Feeding disorders in children with ASD are linked to multiple sensory, motor, behavioural, nutritional and gastrointestinal comorbidities. A multidisciplinary approach is needed and increasingly recommended. However, multidisciplinary teams, specialised in the care of children with ASD and feeding issues, continue to be difficult to locate and access for families. The authors sought to highlight the signs of feeding problems in children with ASD from different domains and share a model of a multidisciplinary approach that can lead to more successful interventions. Originality/value The detailed description of the domains linked to feeding issues and the clinical descriptions provided throughout the paper create a roadmap for other clinicians aiming to set up similar teams.