Intensive Multidisciplinary Feeding Day Programs in the United States: A Report Regarding the Treatment Landscape.

Intensive multidisciplinary intervention is increasingly recognized as the standard of care for children with complex feeding problems. Much, however, remains unknown about this treatment model. This current qualitative, prospective study sought to identify intensive multidisciplinary day hospital programs operating in the US, describe the treatment approach, and summarize current capacity.

Trastornos alimentarios pediátricos con impacto nutricional severo / Pediatric feeding disorders with severe nutritional impact

Las dificultades en la alimentación tienen una prevalencia significativa en niños/as con desarrollo típico y aumentan, significativamente, cuando existen condiciones de salud comórbidas, siendo ésta una de las preocupaciones más frecuentes en la consulta pediátrica. La falta de una detección oportuna puede impactar de forma negativa en la salud integral de las niñeces. El objetivo de este trabajo es describir el abordaje que se realizó en niños/as que presentaron trastornos alimentarios pediátricos con impacto nutricional severo en el contexto de la "Clínica interdisciplinaria de deglución y conducta alimentaria" que funciona en un hospital público en la Ciudad Autónoma de Buenos Aires, Argentina. Se llevó a cabo un estudio de carácter descriptivo y retrospectivo. Se incluyeron en la muestra final a 16 familias. Los niños/as comprendían una franja etaria de 2 a 13 años. Los motivos de internación más prevalentes fueron impotencia funcional de miembros inferiores y alteraciones visuales. Un 93,75% de la población presentaba desafíos en su desarrollo. La edad promedio de aparición de las dificultades en la alimentación fue entre los 12 y 18 meses de edad. Un 56,25% había consultado, anteriormente, con algún profesional de la salud. El 56,25% no contaba con los apoyos terapéuticos adecuados. El 100% tenía dificultades en la conformación de rutinas. Los trastornos alimentarios pediátricos constituyen un fuerte desafío para el equipo de salud. La detección precoz, las intervenciones oportunas y el enfoque centrado en la familia son fundamentales para evitar complicaciones severas y propiciar un vínculo placentero a la hora de comer.

Pediatric feeding disorders (PFD) have a significant prevalence in typical development children and increase drastically when there are comorbilities health conditions. PFD are one of the most frequent concerns in pediatric consultant. The lack of accured detection can negatively impact the comprehensive health of children. The objective of this article is to describe the approach that was carried out in children and adolescents who presented pediatric feeding disorders with severe nutritional impact in the context of the "Interdisciplinary Swallowing and feeding team" that operates in a public hospital in the City from Buenos Aires, Argentina. A descriptive and retrospectivestudy was carried out. 16 families were included in the final sample. The children included an age range of 2 to 13 years. The most prevalentreasons for hospitalization were functional impotence of the lower limbs and visual alterations. 93.75% of the population presented challenges in their development. The average age of onset of feeding difficulties was between 12 and 18 months of age. 56.25% had previously consulted with a health professional. 56.25% did not have adequate therapeutic support. 100% had difficulties in forming routines. Pediatric Feeding Disorders (PFD) constitute a strong challenge for the health team, so awareness and training on this topic is essential. Early detection, timely interventions, and a family-centered approach are essential to avoid severe complications and promote a pleasant mealtime for all

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.

El fonoaudiólogo en los trastornos de alimentación Más allá de la alimentación / The speech language pathologist in pediatric feeding disorders Beyond swallowing

Este articulo surge a partir de la necesidad de generar espacios de reflexión sobre el rol del fonoaudiólogo en las dificultades de alimentación infantil. Se debe tener en cuenta que la alimentación es un proceso natural que trasciende a la cultura. En el ámbito pediátrico son cada vez más frecuentes las consultas por dificultades de esta índole. La fonoaudiología, estudia e interviene las alteraciones de la deglución y alimentación en diferentes rangos etarios. Particularmente, en bebés y niños pequeños, estas problemáticas pueden deberse a múltiples condicionantes que alteren o dificulten la seguridad y eficacia deglutoria; como también el confort durante la alimentación. A lo largo del manuscrito se intentan revisar ejes centrales en estrecha relación a este tema que posee múltiples aristas y como parte final en la discusión se aborda la complejidad que plantean los desafíos de la alimentación con especial énfasis en la necesidad del trabajo interdisciplinario. Por lo que se busca como meta final dar a conocer el rol del fonoaudiólogo en los trastornos de alimentación a la comunidad científica a través de un artículo de reflexión

This article arises from the need to generate reflection spaces of the (SLP) speech and language pathology ́s role in pediatric feeding disorders. It should be taken into account that feeding is a natural process that transcends culture. In the pediatric field, consultations for difficulties of this nature are frequent increasingly. SLP assess and rehab feeding and swallowing disorders in all range age. Particularly in babies and young children, these problems may be due to multiple conditions that alter or hinder swallowing safety and efficacy, as well as comfort during feeding. Throughout the manuscript, an attempt is made to review central themes closely related to this topic, which has multiple edges, and as a final part of the discussion, the complexity posed by the challenges of nutrition is addressed with special emphasis on the need for interdisciplinary work. Therefore, the final goal is to make the role of the speech

Intensive Multidisciplinary Intervention for Young Children with Feeding Tube Dependence and Chronic Food Refusal: An Electronic Health Record Review.

OBJECTIVE: To assess characteristics and outcomes of young children receiving intensive multidisciplinary intervention for chronic food refusal and feeding tube dependence. STUDY DESIGN: We conducted a retrospective study of consecutive patients (birth to age 21 years) admitted to an intensive multidisciplinary intervention program over a 5-year period (June 2014-June 2019). Inclusion criteria required dependence on enteral feeding, inadequate oral intake, and medical stability to permit tube weaning. Treatment combined behavioral intervention and parent training with nutrition therapy, oral-motor therapy, and medical oversight. Data extraction followed a systematic protocol; outcomes included anthropometric measures, changes in oral intake, and percentage of patients fully weaned from tube feeding. RESULTS: Of 229 patients admitted during the 5-year period, 83 met the entry criteria; 81 completed intervention (98%) and provided outcome data (46 males, 35 females; age range, 10-230 months). All patients had complex medical, behavioral, and/or developmental histories with longstanding feeding problems (median duration, 33 months). At discharge, oral intake improved by 70.5%, and 27 patients (33%) completely weaned from tube feeding. Weight gain (mean, 0.39 ± 1 kg) was observed. Treatment gains continued following discharge, with 58 patients (72%) weaned from tube feeding at follow-up. CONCLUSIONS: Our findings support the effectiveness of our intensive multidisciplinary intervention model in promoting oral intake and reducing dependence on tube feeding in young children with chronic food refusal. Further research on the generalizability of this intensive multidisciplinary intervention approach to other specialized treatment settings and/or feeding/eating disorder subtypes is warranted.

The Autism Managing Eating Aversions and Limited Variety Plan vs Parent Education: A Randomized Clinical Trial.

OBJECTIVE: To assess the feasibility and initial efficacy of a structured parent training program for children with autism spectrum disorder and moderate food selectivity. STUDY DESIGN: This 16-week randomized trial compared the Managing Eating Aversions and Limited variety (MEAL) Plan with parent education. MEAL Plan (10 core and 3 booster sessions) provided parents with nutrition education and strategies to structure meals and expand the child's diet. Parent education (10 sessions) provided information about autism without guidance on nutrition, meal structure, or diet. In addition to feasibility outcomes, primary efficacy outcomes included the Clinical Global Impression - Improvement scale and the Brief Autism Mealtime Behaviors Inventory. Grams consumed during a meal observation served as a secondary outcome. RESULTS: There were 38 eligible children (19 per group, 32 males). For MEAL Plan, attrition was <10% and attendance >80%. Therapists achieved >90% fidelity. At week 16, positive response rates on the Clinical Global Impression - Improvement scale were 47.4% for the MEAL Plan and 5.3% for parent education (P < .05). The adjusted mean difference (SE) on Brief Autism Mealtime Behaviors Inventory at week 16 was 7.04 (2.71) points (P = .01) in favor of MEAL Plan. For grams consumed, the adjusted standard mean difference (SE) was 30.76 (6.75), also in favor of MEAL Plan (P = .001). CONCLUSIONS: The MEAL Plan seems to be feasible, and preliminary efficacy results are encouraging. If further study replicates these results, the MEAL Plan could expand treatment options for children with autism spectrum disorder and moderate food selectivity. TRIAL REGISTRATION: Clinicaltrials.gov: NCT02712281.

A Systematic Review and Meta-Analysis of Intensive Multidisciplinary Intervention for Pediatric Feeding Disorders: How Standard Is the Standard of Care?

OBJECTIVE: To assess models of care and conduct a meta-analysis of program outcomes for children receiving intensive, multidisciplinary intervention for pediatric feeding disorders. STUDY DESIGN: We searched Medline, PsycINFO, and PubMed databases (2000-2015) in peer-reviewed journals for studies that examined the treatment of children with chronic food refusal receiving intervention at day treatment or inpatient hospital programs. Inclusion criteria required the presentation of quantitative data on food consumption, feeding behavior, and/or growth status before and after intervention. Effect size estimates were calculated based on a meta-analysis of proportions. RESULTS: The systematic search yielded 11 studies involving 593 patients. Nine articles presented outcomes based on retrospective (nonrandomized) chart reviews; 2 studies involved randomized controlled trials. All samples involved children with complex medical and/or developmental histories who displayed persistent feeding concerns requiring formula supplementation. Behavioral intervention and tube weaning represented the most common treatment approaches. Core disciplines overseeing care included psychology, nutrition, medicine, and speech-language pathology/occupational therapy. The overall effect size for percentage of patients successfully weaned from tube feeding was 71% (95% CI 54%-83%). Treatment gains endured following discharge, with 80% of patients (95% CI 66%-89%) weaned from tube feeding at last follow-up. Treatment also was associated with increased oral intake, improved mealtime behaviors, and reduced parenting stress. CONCLUSIONS: Results indicate intensive, multidisciplinary treatment holds benefits for children with severe feeding difficulties. Future research must address key methodological limitations to the extant literature, including improved measurement, more comprehensive case definitions, and standardization/examination of treatment approach.