Antecedent interventions for pediatric feeding problems (original) (raw)
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A Functional Approach to Feeding Difficulties in Children
Current Gastroenterology Reports, 2019
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.
Assessment of behavioral feeding difficulties in young children
Annals of Medical Research, 2019
Aim: Feeding difficulties are common in typically developing children and the prevalence ranges from 25% to 45%. Although using an assessment tool is the best approach when planning an intervention, assessment of feeding disorders is mostly accomplished by informal parent interviews in clinical practice. This study was designed to assess the mealtime behaviours of young children with 'Feeding Difficulties' (FD) by an instrument and to compare the results with 'Typically Developing' (TD) children. Material and Methods: A total of 61 children with FDs and 63 TD children aged 6-42 months were included. The Behavioral Pediatric Feeding Assessment Scale (BPFAS) was completed to describe the child's feeding behaviors and the parents' mealtime strategies. Results:FD group had higher scores than TD group in all BPFAS subtests' scores. The mean 'Total Frequency Score' was 104.6 in FD group whereas 72.9 in TD group (p=0.0001). The FD group had more problematic feeding behaviours in comparison to TD group. The mean 'Total Problem Score' of TD group was 6.1 whereas 20.1 in children with FD (p=0.0001). Conclusion: This study supports the BPFAS to be a useful and practical feeding assessment tool and also has the advantage of incorporating parents' feelings about child's feeding behaviors.
Clinical Investigation of Feeding Difficulties in Young Children: A Practical Approach
Clinical Pediatrics, 2009
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 objective is to allow the physician to efficiently sort out the wide variety of conditions, categorize them for therapy, and where necessary refer to specialists in the field.
Broadening the parameters of investigation in treating young children's chronic food refusal
Behavior Therapy, 1998
ABSTRACT We evaluated the relationship of contextual variables and contingent mother-child interactions to feeding behaviors at home for 3 children (ages 18 to 43 months) with chronic food refusal problems. Previous research suggests that contingent attention (i.e., specific prompts, approval) affects feeding, but contextual variables (i.e., mealtime location, seating arrangement, number of meals and snacks offered daily, persons present during meals) have not been systematically examined. Using a nonconcurrent multiple baseline design across mother-child dyads, we assessed the effects of parent training in contingency management skills on maternal contingent attention, child food intake, and contextual variables of mealtimes. Parent training resulted in planned increases in contingent attention and child acceptances of target foods for each dyad. Concomitant with this training, 2 children showed positive changes in contextual variables (e.g., reduced frequency of daily meals and snacks to a recommended level, increased proportion of meals eaten at a table), and 1 child evidenced mild deterioration in contextual variables. A second parent training condition directed at correcting specific ecological parameters with 2 dyads effectively modified these variables, but its impact on child food acceptance was unclear. These findings suggest that some contextual conditions covary with children's feeding patterns and should be monitored in planning and evaluating feeding intervention.
Pediatric feeding disorder (PFD), like many childhood medical conditions, is likely to negatively impact a child's growth and development, daily learning opportunities, and family functioning. Parents who have children with a diagnosis of PFD may not yet know the most effective way to feed their children and often experience negative emotions surrounding mealtimes. These families may receive therapy services through early intervention (EI) programs. In many states, there are barriers that limit access to programs and provision of highquality care for this population. These barriers include the lack of an approved single feeding-related diagnosis that renders a child automatically eligible, lack of approved stand-alone feeding-specific testing tools with which to determine eligibility, lack of educational and clinical experience requirements for providers, and considerable variation in service provision. Method: This clinical focus article reviews the definition of PFD, the multifaceted needs of families and children in EI, support for use of responsive feeding in treatment of PFD, alignment of responsive feeding strategies with EI principles, and barriers limiting access to consistent, high-quality EI services for children with PFD. Several changes to EI programs are proposed to address these barriers. Conclusions: Use of PFD as an automatically qualifying diagnosis for EI programs and use of approved stand-alone feeding-specific assessment tools could establish more consistent and specific eligibility standards for this population, likely expanding early access to support and improving outcomes. EI provider clinical experience and training requirements would likely lead to more consistent and high-quality, evidence-based service provision. Required training should include the use of methods such as routines-based intervention, parent coaching, and anticipatory guidance to support implementation of responsive feeding practices during mealtime routines. Early intervention (EI) programs are ideal settings in which to comprehensively support children with pediatric feeding disorder (PFD) and their families; however, several barriers exist, which limit access to programs and consistent provision of high-quality services to this population. Part C of the Individuals with Disabilities Education Act (IDEA, 2004) provides guidelines that states and territories must follow when establishing EI programs; despite these guidelines, there is considerable variability between EI programs and specific practices. For children with feeding challenges, differences between practices exist in regard to eligibility
A Biopsychosocial Model of Normative and Problematic Pediatric Feeding
Children's Health Care, 2009
A comprehensive model is presented that (a) highlights factors that have been implicated in the development and maintenance of feeding problems in both normal and clinical populations; and (b) provides a framework for the prevention, management, and treatment of feeding problems across the range of physically healthy children to children with acute and chronic illnesses. Relevant literatures and feeding models were synthesized to present a comprehensive unified biopsychosocial model that may aid in the prediction and synthesis of information about feeding and eating in both normal and clinical populations and provide a framework for interdisciplinary research and intervention.
A practical approach to classifying and managing feeding difficulties
Pediatrics, 2015
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...
Empirically Supported Treatments for Feeding Difficulties in Young Children
Current Gastroenterology Reports, 2010
Pediatric feeding problems are common among children and present severe issues for families. Unfortunately, treatment outcome studies with this population are sparse. The current study reviews the literature regarding treatment studies of children with severe feeding issues, provides an overview of empirically supported treatments for children who do eat orally, and finally summarizes interventions that attempt to reintroduce oral feeding to children who have been fed by gastrostomy tube or other non-oral feeding route.
Behavioral Intervention for Feeding Disorders
Individuals with autism are often poor eaters which may put them at risk for a variety of health problems including, poor bone density, vitamin deficiencies, obesity, and constipation among other medical problems. Behavioral intervention has been well validated in the literature as evidence-based treatment of pediatric feeding disorders and has been increasingly applied to those individuals with autism and other disabilities who are poor eaters. This paper highlights some of the latest behavioral intervention shown effective in increasing food consumption and may serve as a guide for professional and families.
Providers\u27 response to child eating behaviors: A direct observation study
2016
Child care providers play an important role in feeding young children, yet little is known about children’s influence on providers’ feeding practices. This qualitative study examines provider and child (18 months −4 years) feeding interactions. Trained data collectors observed 200 eating occasions in 48 family child care homes and recorded providers’ responses to children’s meal and snack time behaviors. Child behaviors initiating provider feeding practices were identified and practices were coded according to higher order constructs identified in a recent feeding practices content map. Analysis examined the most common feeding practices providers used to respond to each child behavior. Providers were predominately female (100%), African-American (75%), and obese (77%) and a third of children were overweight/obese (33%). Commonly observed child behaviors were: verbal and non-verbal refusals, verbal and non-verbal acceptance, being “all done”, attempts for praise/attention, and askin...