Developing the Mansoura Early Feeding Skills Assessment Scale for Preterm Infants / 대한소아소화기영양학회지

Purpose@#This study aimed to develop a new bedside scoring system scale that assesses preterm infants’ oral feeding skills (OFS) in the neonatal intensive care unit (NICU). @*Methods@#A literature review and critical appraisal of available oral feeding assessment tools/ scores were performed. Subsequently, we developed the “Mansoura Early Feeding Skills Assessment” (MEFSA) scale, an 85-item observational measure of oral feeding skills with three main sections. Forty-one preterm infants who did not receive oral feeding but were clinically stable enough to initiate oral feeding were included in the study. Next, we applied and interpreted the MEFSA to describe and score their feeding skills. @*Results@#Applying the MEFSA resulted in a smooth feeding transition, early start of oral feeding, full oral feeding, and discharge with a shorter period of tube feeding in preterm infants. @*Conclusion@#The MEFSA is a successful bedside scoring system that assesses the OFS of preterm infants in the NICU.

Assessment of functional feeding and swallowing biomechanics in normal children

There has been little research on functional feeding and swallowing pathophysiology in children. Ftuthermore, the parameters that define adults swallowing can not always be applied to the children because of differences in the relationships of anatomic structures and lack of neurological maturation. The aims of the study were to assess the functional feeding and swallowing biomechanics of normal children in order to understand when feeding and swallowing vary or deviate and also to provide a frame of reference for creating therapeutic programs for the children with impaired deglutition. This study was conducted on 10 normal children [7 females and 3 males] with their ages ranged between 3.2-10.3 [mean 6.8 +/- 2.3] years. All children were observed during eating using. "The Pediatric Feeding Assessment checklist". The feeding domains assessed were spoon feeding, cup and straw drinking, biting, chewing, and drooling. Behaviors in each domain are rated as normal and abnormal. The swallowing function was then evaluated for all children using Videofluoroscopy. The child was asked to swallow different bolus consistencies [thin and thick liquids, semisolid and solid] in small and large volumes [3 and 5 ml]. The selected swallowing observations and measures were: [1] Number of swallows per bolus in different consistencies and volumes. [2] Temporal measures of bolus and hyoid movements during swallowing; [3] Oro-pharyngeal residue; [4] Laryngeal penetration/aspiration observation and [5] Oropharyngeal Swallow Efficiency [OPSE] score. All Children demonstrated a 100% competence on all feeding behaviors. Multiple swallows per boius were observed as the bolus consistency increases especially with large volumes. Most of the children [60-90%] demonstrated oropharyngeal residue in both thick liquid and semisolid consistencies regardless the volume of the bolus. No laryngeal penetration and/or aspiration were observed in different bolus consistencies and volumes. All the temporal measures of swallowing demonstrated statistically significant increases as the bolus volume and/or consistency increase. Normal OPSE score was recorded for all children with different bolus consistencies and volumes. A normative data for the functional feeding and swallowing biomechanical parameters for normal children was presented. Further research is recommended to apply these data in children with oropharyngeal dysphagia due to different etiologies

Assessment and behavioral management of drooling in children

Drooling is common in children with mental retardation and cerebral palsy and may even persist to adult life. Persistent drooling can cause physical morbidities and social embarrassment. The aim of this prospective study was to develop a quasi-objective protocol for assessment of drooling in children in order to describe the clinical profile of children suffering from this problem, and to investigate the effectiveness of the behavioral management in reducing their drooling severity and frequency. The study group consisted of 12 children with their ages ranged between 5 and 10 [mean 6.6 +/- 1.5] years. All children were mentally retarded and eight of them had also brain damage motor handicapping [BDMH]. The IQ for the children ranged between 45 and 69 [mean 59.91 +/- 8.13]. All children had varying degrees of drooling problem. All the children were evaluated through a specially designed diagnostic protocol that included simple clinical quasi-objective tests to assess severity, frequency and the amount of drooling and drooling quotient Reasons for drooling in these children included poor head/ body control constant open mouth posture, inadequate lip and tongue control and impaired lips and intra-oral sensation. Behavior Re-Adjustment Therapy [BRAT] was used to control drooling for all children. The Program consisted of head/body positioning and motor and sensory enhancement techniques. The patients were reassessed after 3 months period of treatment and 6 months follow-up to evaluate the effectiveness of the behavioral therapy. Statistically significant improvements were found in all drooling parameters at the end of therapy with the maintenance of the newly acquired skills at the follow-up. The simple clinical quasi-objective tests used in this study to assess drooling were well-tolerated by the children and reflected the beneficial outcome of BRAT to control drooling in children with mental retardation and/or BDMH. Also, active participation of the caregivers contributed to the maintenance of the newly acquired skills