Nonnutritive Sucking at the Mother's Breast Facilitates Oral Feeding Skills in Premature Infants: A Pilot Study.

BACKGROUND: Premature infants have difficulties in transitioning from gavage to breastfeeding. Targeted interventions to support breastfeeding in premature infants in the neonatal intensive care unit are scarce. PURPOSE: This pilot study evaluates the effectiveness of nonnutritive sucking at the mother's breast in premature infants to facilitate breastfeeding performance and exclusive breastfeeding. METHODS: The study design constituted a single-blinded randomized control trial, with 9 participants randomly allocated into experimental (n = 4) and control (n = 5) groups. The intervention, nonnutritive sucking at the mother's breast thrice a day for 5 minutes, till nutritive breastfeeding was started, was done in addition to standard care, which was nonnutritive sucking on a finger during gavage feeds. The control group received only standard care. Nonnutritive sucking was assessed using "Stages of Nonnutritive Sucking Scale," and breastfeeding performance was assessed using the "Preterm Infant Breastfeeding Behavior Scale" by a blinded assessor unaware of the infants' allocation. RESULTS: Five infants in the control arm and 4 in the intervention arm completed the study. The infants in the intervention group showed faster transition to mature stages of nonnutritive sucking (P = .05) and had longer sucking bursts during breastfeeding (P = .06) than those in the control group. There was no difference in the rates of exclusive breastfeeding at 6 months in the intervention and control groups. IMPLICATIONS FOR PRACTICE: Early initiation of nonnutritive sucking at the mother's breast in very preterm infants is a safe and effective intervention to facilitate maturation of oral feeding and breastfeeding behavior. IMPLICATIONS FOR RESEARCH: Nonnutritive sucking at the mother's breast can be explored as an intervention, with a larger sample, to facilitate exclusive breastfeeding and to establish intervention fidelity.

Activity based group therapy reduces maternal anxiety in the Neonatal Intensive Care Unit - a prospective cohort study.

BACKGROUND: A large proportion of mothers in the Neonatal Intensive Care Unit (NICU) experience psychological distress, which is associated with adverse infant and parenting outcomes. Interventions addressing maternal anxiety in the NICU are scarce. AIMS: To assess the effect of activity based group therapy on maternal anxiety in the NICU when compared to a control group. STUDY DESIGN: The study was a prospective phase lag cohort study. In Phase 1 the control group was recruited and assessed using the State-Trait Anxiety Inventory (STAI-S) once at recruitment and again 4 weeks later. In phase 2, mothers were invited to take part in activity-based groups of 1 h duration once a week for 4 weeks. The STAI-S was administered before and after every group session. SUBJECTS: Mothers of babies admitted in the NICU who consented to participate, had a working knowledge of Tamil or English and were likely to stay for 4 weeks for the treatment were included. OUTCOME MEASURES: State anxiety assessed using the STAI-S. RESULTS: Seventeen mothers each in the control and experimental groups completed the study. In the experimental group, there was a significant reduction in the post-test anxiety scores when compared to the pre-test in the first (p = 0.005), third (p = 0.07) and fourth (p = 0.009) sessions. The post-test anxiety scores of the intervention group was significantly lower than that of the control group (p = 0.009). CONCLUSION: Activity based group therapy is effective as an intervention in reducing maternal anxiety in the NICU. SUMMARY: Anxiety in mothers of infants admitted in the NICU has been associated with adverse infant and parenting outcomes. This study evaluated the feasibility and effectiveness of an activity based group intervention to reduce anxiety levels in mothers in the NICU. The study was a prospective phase lag cohort study. Anxiety levels were assessed in mothers in the control group at recruitment and then 4 weeks later. In the intervention group, activity based group sessions were conducted once a week for 4 weeks. State anxiety was assessed before and after every group session. In the intervention group the anxiety levels were significantly lower in the post-test, when compared to the pre-test. Also the number of mothers suffering from moderate to severe anxiety and the anxiety scores in the post-test were significantly lower in the intervention group when compared to the control group. We conclude that activity based group sessions are effective in reducing the state anxiety in mothers in the NICU. Improving maternal psychological wellbeing may indirectly contribute to better infant outcomes.

Comparison of burden among primary care-givers of children with autism and intellectual disability against children with intellectual disability only in a hospital population in India.

OBJECTIVE: To compare the burden among the primary caregivers (PCG) of children with autism and intellectual disability (ASD + ID) against intellectual disability (ID) only, and identify the factors that predict high caregiver burden. METHODS: Children with either ASD + ID (N = 41) or ID (N = 56) and their PCG were recruited and assessed using the Family Burden Interview Schedule, Binet Kamat Scale of Intelligence or Gesell's Developmental Schedule and Vineland Social Maturity Scale, Childhood Autism Rating Scale, Sensory Profile and Brief Autism Mealtime Behavior Inventory after collecting the socio-demographic details. Appropriate bivariate and multivariate statistical test were used. RESULTS: The total burden and level of burden was similar among PCG of children with ASD + ID and ID (P = 0.8). However, financial burden (P = 0.03) and burden due to the effects on the physical health of other family members (P = 0.03) was more among the ID group. The burden due to the effects on family interaction was more (P = 0.009) in the ASD + ID group. The socio-economic status (OR = 3.60; P = 0.03) and the kinship of the primary care-giver (OR = 0.37; P = 0.008) were significantly associated with high level of burden. In addition, the diagnosis, and gender of the child contributed to the prediction model for high level of burden. CONCLUSIONS: The interventions for children with ASD + ID and ID should have modules to address burden among PCG. Disability specific burden alleviating strategies should be used among PCG who are at risk of having high burden.

Feeding problems among children with autism in a clinical population in India.

OBJECTIVES: To compare the prevalence and profile of feeding problems (FP) and their relationship with sensory processing in children with autism and intellectual disability (ID). METHODS: Children between ages 3 to 10 y with autism (N = 41) and ID (N = 56) were recruited and assessed with Brief Autism Mealtime Behavior Inventory, Sensory Profile Questionnaire, Childhood Autism Rating Scale and Binet-Kamat Scale of Intelligence or Gesell's Developmental Schedule. Assessments were done by independent raters. Bivariate and multivariate analyses were used appropriately. RESULTS: The prevalence of FP were 61 and 46.4% among children with autism and ID respectively. Feeding problems were severe among children with autism (P 0.001), especially in young children with autism (P 0.05), and gender was not related to FP. Disruptive meal-time behaviors (P 0.001) and food over-selectivity (P 0.02) were significantly more among children with autism in the bivariate and multivariate analysis. Feeding problems and various dimensions of sensory processing were significantly associated after controlling the confounders. CONCLUSIONS: These findings underscore the need for mandatory assessment of FP in children with developmental disabilities, and if present, they need to be addressed with multimodal-multidisciplinary interventions.

Sensory Profile Caregiver Questionnaire: a measure for sensory impairment among children with developmental disabilities in India.

OBJECTIVE: There is no validated measure for assessing sensory processing among children with Developmental Disorders (DD) in India, and therefore, the authors validated the Sensory Profile Caregiver Questionnaire (SPCQ). METHODS: Parents of 119 children with DD or typical development completed the SPCQ. The diagnosis of DD was confirmed by psychologists using standardized measures. Two experienced occupational therapists independently diagnosed sensory processing dysfunction by consensus as reference standard diagnosis. The convergent and divergent validity were assessed by another rater. The data was analyzed for diagnostic accuracy, reliability and validity appropriately. RESULTS: A total SPCQ score of ≤ 481 (Sn = 81.58%, Sp = 85.19%; AUC = 0.90, z = 14.95; P 0.0001) is appropriate for the diagnosis of sensory processing dysfunction. The inter-rater reliability (ICC = 0.87), test- retest reliability (ICC = 0.90), internal consistency (Cronbach's α = 0.86), section-total correlation, face and content validity for the SPCQ were good. Convergent validity with the Sensory Processing Measure (r = -0.76, P 0.001), and divergent validity with the subscale scores for social skills/ oppositional behavior of ADD-H Comprehensive Teacher Rating Scale (r = 0.32; P 0.1/ r = 0.08; P 0.6) was established. CONCLUSIONS: The SPCQ has adequate psychometric properties for use in the Indian population for identifying sensory processing dysfunction.

Re-emphasising the efficacy of the multi-purpose, self-adjustable, aeroplane splint for the splinting of axillary burns.

This article re-emphasises the efficacy of the previously described multi-purpose, self-adjustable, aeroplane splint for the splinting of axillary burns. This superior to the commonly used contoured splint for various reasons namely (i) its usability during the acute burn care rehabilitation, (ii) its cost effectiveness, (iii) its durability, and (iv) its strength. Above all due to its easy maneuverability this splint provides easy accessibility around environmental barriers. Though we acknowledge that there is a possibility of 'chord of circle' development due to the use of this splint, we have been successful in preventing such a complication simply by prescribing pressure garment concomitantly with this splint. Thus this article highlights the efficacy of earlier described multi-purpose, self-adjustable, aeroplane splint for the splinting of axillary burns.

Adjustable aesthetic aeroplane splint for axillary burn contractures.

Managing axillary burns with an Aeroplane Splint has been known for its effectiveness for years. However, poor compliance in using the various models of currently available aeroplane splints leads to an inadequate outcome, because of the discomfort produced not only in wearing but also while ambulating within the community. In developing countries like India the biggest barrier to environmental accessibility is the presence of multiple permanent structures like narrow thoroughfares, entry/exit sites of public transport, and narrow aisles. These pose a challenge to rehabilitation professionals while prescribing large splints. An attempt to target these problems was made by Manigandan et al, but aeroplane splints, even the one described by them does not deal with the major problem of aesthetic appeal as identified by many of our patients. Accordingly this article presents a new model of the aeroplane splint with innovative changes, focussing on aesthetic appeal while maintaining all the benefits of the splint described by Manigandan et al.