Kim Milano | Self Employed (original) (raw)
Papers by Kim Milano
Current Gastroenterology Reports, Aug 23, 2019
Purpose of Review This review provides an approach for resolving a variety of feeding difficultie... more Purpose of Review This review provides an approach for resolving a variety of feeding difficulties in children, ranging from normal eating behavior that is misperceived as a problem to substantial feeding disorders. Recent Findings Criteria to identify pediatric feeding disorders have been thoroughly addressed in the newly established designations of avoidant restrictive food intake disorder (ARFID) and pediatric feeding disorder (PFD). These diagnostic criteria improve the accuracy of identifying, classifying, and managing significant feeding disorders in young children. Summary While recent definitions of feeding difficulties are particularly appropriate in multidisciplinary settings, in this paper, we advocate for a progressive approach of managing feeding problems in all clinical settings. It begins by identifying red flags indicative of serious threats to the child, screening for oral motor dysfunction, stabilizing nutrient intake, and eliminating aversive feeding practices. The next step, if eating behavior does not improve, involves strategies that target specific eating behaviors and parental feeding styles. In severe or resistant cases, referral to specialists or interdisciplinary feeding teams is advised.
Pediatrics, 2015
Many young children are thought by their parents to eat poorly. Although the majority of these ch... more Many young children are thought by their parents to eat poorly. Although the majority of these children are mildly affected, a small percentage have a serious feeding disorder. Nevertheless, even mildly affected children whose anxious parents adopt inappropriate feeding practices may experience consequences. Therefore, pediatricians must take all parental concerns seriously and offer appropriate guidance. This requires a workable classification of feeding problems and a systematic approach. The classification and approach we describe incorporate more recent considerations by specialists, both medical and psychological. In our model, children are categorized under the 3 principal eating behaviors that concern parents: limited appetite, selective intake, and fear of feeding. Each category includes a range from normal (misperceived) to severe (behavioral and organic). The feeding styles of caregivers (responsive, controlling, indulgent, and neglectful) are also incorporated. The object...
Children with sensory issues often exhibit feeding difficulties, particularly selectivity (limiti... more Children with sensory issues often exhibit feeding difficulties, particularly selectivity (limiting the number or types of foods consumed). Disorders with a high occurrence of sensory processing dysfunction such as autism, developmental delay, genetic disorders or conditions such as prematurity or head injury are often associated with feeding problems. Typically developing children who exhibit early tactile defensiveness may also have similar sensory related feeding difficulties. Both hyper-sensitive and hyposensitive responses to stimuli and how they relate to feeding are discussed as well as the potential impact of selectivity on growth and development. Interventions for selectivity that are used in a clinical setting are reviewed with practical suggestions for managing patients with sensory feeding issues.
Current Gastroenterology Reports
Pediatrics, 2015
Many young children are thought by their parents to eat poorly. Although the majority of these ch... more Many young children are thought by their parents to eat poorly. Although the majority of these children are mildly affected, a small percentage have a serious feeding disorder. Nevertheless, even mildly affected children whose anxious parents adopt inappropriate feeding practices may experience consequences. Therefore, pediatricians must take all parental concerns seriously and offer appropriate guidance. This requires a workable classification of feeding problems and a systematic approach. The classification and approach we describe incorporate more recent considerations by specialists, both medical and psychological. In our model, children are categorized under the 3 principal eating behaviors that concern parents: limited appetite, selective intake, and fear of feeding. Each category includes a range from normal (misperceived) to severe (behavioral and organic). The feeding styles of caregivers (responsive, controlling, indulgent, and neglectful) are also incorporated. The object...
Current Gastroenterology Reports, Aug 23, 2019
Purpose of Review This review provides an approach for resolving a variety of feeding difficultie... more Purpose of Review This review provides an approach for resolving a variety of feeding difficulties in children, ranging from normal eating behavior that is misperceived as a problem to substantial feeding disorders. Recent Findings Criteria to identify pediatric feeding disorders have been thoroughly addressed in the newly established designations of avoidant restrictive food intake disorder (ARFID) and pediatric feeding disorder (PFD). These diagnostic criteria improve the accuracy of identifying, classifying, and managing significant feeding disorders in young children. Summary While recent definitions of feeding difficulties are particularly appropriate in multidisciplinary settings, in this paper, we advocate for a progressive approach of managing feeding problems in all clinical settings. It begins by identifying red flags indicative of serious threats to the child, screening for oral motor dysfunction, stabilizing nutrient intake, and eliminating aversive feeding practices. The next step, if eating behavior does not improve, involves strategies that target specific eating behaviors and parental feeding styles. In severe or resistant cases, referral to specialists or interdisciplinary feeding teams is advised.
Pediatrics, 2015
Many young children are thought by their parents to eat poorly. Although the majority of these ch... more Many young children are thought by their parents to eat poorly. Although the majority of these children are mildly affected, a small percentage have a serious feeding disorder. Nevertheless, even mildly affected children whose anxious parents adopt inappropriate feeding practices may experience consequences. Therefore, pediatricians must take all parental concerns seriously and offer appropriate guidance. This requires a workable classification of feeding problems and a systematic approach. The classification and approach we describe incorporate more recent considerations by specialists, both medical and psychological. In our model, children are categorized under the 3 principal eating behaviors that concern parents: limited appetite, selective intake, and fear of feeding. Each category includes a range from normal (misperceived) to severe (behavioral and organic). The feeding styles of caregivers (responsive, controlling, indulgent, and neglectful) are also incorporated. The object...
Children with sensory issues often exhibit feeding difficulties, particularly selectivity (limiti... more Children with sensory issues often exhibit feeding difficulties, particularly selectivity (limiting the number or types of foods consumed). Disorders with a high occurrence of sensory processing dysfunction such as autism, developmental delay, genetic disorders or conditions such as prematurity or head injury are often associated with feeding problems. Typically developing children who exhibit early tactile defensiveness may also have similar sensory related feeding difficulties. Both hyper-sensitive and hyposensitive responses to stimuli and how they relate to feeding are discussed as well as the potential impact of selectivity on growth and development. Interventions for selectivity that are used in a clinical setting are reviewed with practical suggestions for managing patients with sensory feeding issues.
Current Gastroenterology Reports
Pediatrics, 2015
Many young children are thought by their parents to eat poorly. Although the majority of these ch... more Many young children are thought by their parents to eat poorly. Although the majority of these children are mildly affected, a small percentage have a serious feeding disorder. Nevertheless, even mildly affected children whose anxious parents adopt inappropriate feeding practices may experience consequences. Therefore, pediatricians must take all parental concerns seriously and offer appropriate guidance. This requires a workable classification of feeding problems and a systematic approach. The classification and approach we describe incorporate more recent considerations by specialists, both medical and psychological. In our model, children are categorized under the 3 principal eating behaviors that concern parents: limited appetite, selective intake, and fear of feeding. Each category includes a range from normal (misperceived) to severe (behavioral and organic). The feeding styles of caregivers (responsive, controlling, indulgent, and neglectful) are also incorporated. The object...