Feeding Problems as an Indicator of Developmental Delay in Early Childhood.

OBJECTIVE: To determine whether feeding problems are indicators of developmental delay. STUDY DESIGN: In this prospective longitudinal cohort study, mothers of 3597 children (49% female, 35% multiples) reported on their children's feeding problems and developmental delays (using the Ages and Stages Questionnaire [ASQ]) when children were age 18, 24, and 30 months. Average scores of feeding problems were computed at each age, as well as a categorical score indicating a persistently high number of feeding problems ≥90th percentile across time. The Battelle Developmental Inventory, Second Edition (BDI-2) was used to assess development in 5 domains for a subset of children at 4 years. RESULTS: In adjusted analyses, feeding problems (per point increase) were increasingly associated with 6 ASQ domains from 18 months (OR, 1.30-1.98) to 24 months (OR, 2.07-2.69) to 30 months (OR, 3.90-5.64). Compared with children who never experienced feeding problems, children who experienced a high number of feeding problems at 1 or 2 time points were more than twice as likely to have a delay on all ASQ domains (OR, 2.10-2.50), and children who experienced a high number of feeding problems at all 3 time points were ≥4-fold more likely to have a delay on all ASQ domains (OR, 3.94-5.05). Children with 1-point higher feeding problems at 30 months scored 3-4 points lower in all BDI-2 domains at 4 years. CONCLUSIONS: Frequent feeding problems, especially those that persist into the third year, could be used to identify children at risk for developmental delay for more targeted screening.

Relationship between Anthropometric Parameters and Sensory Processing in Typically Developing Brazilian Children with a Pediatric Feeding Disorder.

In this study, we aimed to relate anthropometric parameters and sensory processing in typically developing Brazilian children diagnosed with a pediatric feeding disorder (PFD). This was a retrospective study of typically developing children with a PFD. Anthropometric data were collected and indices of weight-for-age, length/height-for-age, and body mass index-for-age (BMI-for-age) were analyzed as z-scores. Sensory profile data were collected for auditory, visual, tactile, vestibular, and oral sensory processing. We included 79 medical records of children with a PFD. There were no statistically significant (p > 0.05) relationships between the anthropometric variables (weight-, length/height-, or BMI-for-age) and the sensory variables (auditory, visual, tactile, vestibular, or oral sensory processing). In conclusion, we found no relationship between anthropometric parameters and sensory processing in the sample of typically developing Brazilian children diagnosed with a PFD under study.

Dietary transition difficulties in preterm infants: critical literature review / Dificuldades de transição alimentar em crianças prematuras: revisão crítica de literatura

ABSTRACT OBJECTIVE: To analyze the scientific literature on dietary changes in preterm children during the first years of life. DATA SOURCE: The PubMed database was used for article selection. The texts were analyzed according to their objectives, research design, and research group characteristics. The following were selected to comprise the criteria: (1) publications in the period from 1996 to 2014; (2) participation of infants and children from birth to 10 years of age; (3) development of oral motor skills necessary for feeding; (4) development of the feeding process; and (5) feeding difficulties during childhood. SUMMARY OF THE FINDINGS: There were 282 studies identified, of which 17 were used in the review, and five more articles were identified through the reference list of selected articles, totaling 22 references. CONCLUSION: Very low birth weight preterm newborns are more likely to have feeding problems in early postnatal stages and during childhood when compared with full-term infants. Monitoring the feeding of these infants after hospital discharge is strictly recommended in an early intervention program aiming at better development of feeding skills.

RESUMO OBJETIVO: Analisar a literatura científica sobre alterações alimentares em crianças prematuras durante os primeiros anos de vida. FONTE DOS DADOS: A base de dados do Pubmed foi a precursora para a seleção dos artigos. Os textos foram analisados quanto aos seus objetivos, desenhos da pesquisa e características do grupo pesquisa e foram selecionados os seguintes temas para compor os critérios: (1) publicações de 1996 a 2014; (2) participação de bebês e crianças, do nascimento até os 10 anos; (3) desenvolvimento das habilidades motoras orais necessárias para a alimentação; (4) desenvolvimento do processo de alimentação e (5) dificuldades alimentares durante a infância. SÍNTESE DOS DADOS: Foram identificados 282 estudos, 17 foram usados e cinco artigos foram identificados por meio da lista de referência bibliográfica dos artigos selecionados, totalizando 22 referências bibliográficas. CONCLUSÃO: A revisão permitiu concluir que recém-nascidos pré-termo muito baixo peso (RNPTMBP) são mais propensos a apresentar problemas de alimentação nos estágios iniciais pós-natal e durante a infância quando comparados com crianças a termo. O monitoramento da alimentação após a alta hospitalar é estritamente recomendado em um programa de intervenção precoce com vistas ao melhor desenvolvimento das habilidades alimentares.

Dietary transition difficulties in preterm infants: critical literature review.

OBJECTIVE: To analyze the scientific literature on dietary changes in preterm children during the first years of life. DATA SOURCE: The PubMed database was used for article selection. The texts were analyzed according to their objectives, research design, and research group characteristics. The following were selected to comprise the criteria: (1) publications in the period from 1996 to 2014; (2) participation of infants and children from birth to 10 years of age; (3) development of oral motor skills necessary for feeding; (4) development of the feeding process; and (5) feeding difficulties during childhood. SUMMARY OF THE FINDINGS: There were 282 studies identified, of which 17 were used in the review, and five more articles were identified through the reference list of selected articles, totaling 22 references. CONCLUSION: Very low birth weight preterm newborns are more likely to have feeding problems in early postnatal stages and during childhood when compared with full-term infants. Monitoring the feeding of these infants after hospital discharge is strictly recommended in an early intervention program aiming at better development of feeding skills.

Problemas de la alimentación en lactantes. Primera parte: generalidades / Feeding problems in infants. First part: basic concepts

Desde la etapa prenatal, la organización neuro-fisiológica del bebé lo prepara para realizar con efectividad los procesos vitales de succión, deglución y respiración. Los reflejos y experiencias intrauterinas le permitirán poder alimentarse inmediatamente al nacer. Se estima que cerca del término de la gestación, el feto humano deglute entre 500-1000cc de líquido amniótico cada día. El pico de sinaptogénesis sucede entre 34 y 36 semanas de edad gestacional, que es el tiempo donde la succión nutritiva es segura. El ritmo de la succión se establece a las 32 semanas. El proceso de alimentarse sufre encefalización cuando los reflejos son integrados, entonces pasa de un ritmo de alimentación reflejo, a tener la capacidad de alterar voluntaria y cualitativamente la estrategia de alimentación. Este proceso se consolida debido a la integración sensoriomotora de la deglución con la respiración, la coordinación ojo-mano, el tono muscular normal, la postura y un apropiado ambiente psicosocial. Alimentarse, especialmente en los primeros años de vida, es un proceso mutuo, se necesitan dos personas para lograrlo, y por eso, si alguna de las dos carece de las habilidades necesarias, esto puede generar problemas de la alimentación. Nada sustituye la valoración realizada con una historia clínica y un examen físico dirigidos a valorar cuán efectiva es la fase oral y faríngea mientras el bebé es alimentado. Cuando se presenten dificultades, la intervención debe ser activa, eso incluye la toma de decisiones médicas y quirúrgicas, protección de la vía aérea, suministro del aporte calórico idóneo para las necesidades del infante. Se deben además brindar estrategias maduracionales para su nivel de desarrollo alimentario actual y para ir adquiriendo las habilidades esperadas en elfuturo cercano y tardío

Uma intervenção cognitivo-comportamental com uma criança com dificuldades alimentares: Pedro descobriu que gostava de comer / A cognitive-behavioural intervention in a child with feeding problems: Peter discovered that he enjoys eating

Este artigo visa descrever a intervenção com uma criança de 7 anos de idade com problemas alimentares: Pedro recusava-se a comer alimentos sólidos desde bebê. A intervenção baseou-se nos princípios cognitivo-comportamentais, incluindo treino parental e exposição gradual aos alimentos evitados, seguida de reforço positivo. Contudo, na fase final, seguiu-se uma orientação narrativa, no sentido de promover a consolidação da mudança, por meio da elaboração de resultados únicos e validação social da mudança. O comportamento alimentar de Pedro melhorou ao longo das 13 sessões. Vale destacar que os ganhos se mantiveram até a última consulta de follow-up que aconteceu 6 meses depois da finalização.

This case study aims to describe an intervention with a 7-years-old child with feeding problems: Pedro refused to eat any solid food since he was a baby. The intervention was based on cognitive-behavioural principles and included parental training and exposure to the avoided aliments followed by positive reinforcement. In the final stage, however, the intervention was inspired by the narrative therapy, in order to consolidate the change. This phase included elaboration of unique outcomes and social validation of the change. The child's feeding behaviour considerably improved throughout the 13 sessions. The positive changes have been maintained until the last follow-up session, 6 months after de finalization.