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

Repercussões da Pandemia de COVID-19 no Tratamento de Pacientes com Anorexia/Bulimia: Revisão de Escopo / Repercussions of the COVID-19 Pandemic on the Treatment of Patients with Anorexia and Bulimia: Scoping Review

A emergência sanitária deflagrada pela pandemia de COVID-19 exigiu que os serviços de saúde especializados na assistência aos Transtornos Alimentares se adaptassem às novas circunstâncias impostas pela necessidade de distanciamento social. Considerando essa perspectiva, delineou-se uma revisão de escopo com objetivo de analisar as estratégias de cuidado adotadas por profissionais da saúde para garantirem a continuidade do atendimento interdisciplinar aos pacientes em tempos de COVID-19. Foram consultadas as bases Web of Science, Scopus, PubMed/MEDLINE, CINAHL, PsycINFO, Embase, LILACS e SciELO entre 2020 e 2022. Identificaram-se 387 registros nas bases de dados, dos quais 11 preencheram os critérios de elegibilidade e foram selecionados. Os resultados foram organizados em três categorias temáticas: (1) a "não escolha" da escolha do formato online: prós e contras; (2) foco na comunicação e acolhimento: ressignificando o uso do dispositivo online; (3) intervenções online: adaptações, inovações e recursos alternativos. As principais estratégias utilizadas durante a transição do tratamento para o ambiente online foram: teleatendimento e psicoterapia online. Apesar de terem sido bem avaliadas, foram percebidas barreiras para superar as limitações do cuidado online, como a desconfiança dos pacientes e seus potenciais efeitos na qualidade do vínculo terapêutico.

The health emergency triggered by the COVID-19 pandemic demanded that health services specialized in treating Eating Disorders adapt to the new circumstances imposed by social distancing. Considering this perspective, a scoping review was designed with the objective of analyzing the care strategies adopted by health professionals to maintain continuity of interdisciplinary care to patients in times of COVID-19. The Web of Science, Scopus, PubMed/MEDLINE, CINAHL, PsycINFO, Embase, LILACS, and SciELO databases were queried. A total of 387 records were identified in the databases, of which 11 met the eligibility criteria and were selected. The results were organized into three thematic categories: (1) the "non-choice" of choosing the online format: pros and cons; (2) focus on communication and welcoming: resignifying the use of the online device; (3) online interventions: adaptations, innovations and alternative resources. The main strategies used during the transition of the treatment to the online environment were: telehealth and online psychotherapy. Although well evaluated, barriers to overcome the limitations of online care were perceived, such as patients' distrust and its potential effects on the quality of the therapeutic bond.

Exercise and Weight Management: The Role of Leptin-A Systematic Review and Update of Clinical Data from 2000-2022.

A well-balanced metabolism means a lower risk for metabolism-related neuropsychiatric disorders. Leptin is a secretory adipokine involved in the central control of appetite that appears to play a role in the etiology of feeding-related disorders. Additionally, the influence of exercise on feeding behaviors potentially modulates the circulation of metabolites that signal through the central nervous system. In this systematic review, we collected the recent clinical evidence on the effect of exercise on leptin concentrations in health individuals published from 2000 to 20 September 2022, according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA 2020 statement). Six hundred and thirty-eight papers were retrieved and forty-eight papers were included in the qualitative synthesis. Data supports that exercise positively influences appetite via enhancing peripheral and central leptin signaling (reuptake), especially during weight loss. Exercise modulation of leptin signaling through leptin receptors helps to stabilize increases in food intake during periods of negative energy balance, prior to a decrease in the body fat tissue content. At a high intensity, exercise appears to counteract leptin resistance.

Influence of eating with distractors on caloric intake of children and adolescents: a systematic review and meta-analysis of interventional controlled studies.

Eating habits developed during childhood can be perpetuated along life and contribute to the emergence of disorders. We aimed to investigate the influence of distractors during experimental meals on the energy intake of children and adolescents. We followed the PRISMA guidelines and the study was registered in PROSPERO (CRD42021259946). The PICOS strategy consisted of children and adolescents (P), exposed to distractors during meals (I), compared with no distraction (C) and the outcome was energy intake (Kcal) (O) evaluated in crossover and parallel randomized clinical trials (RCTs) (S). Searches were conducted in PubMed, Scopus, Web of Science, Cochrane, Proquest, Embase, and LILACs databases. We employed RoB 2 tool and NutriGrade. Databases searches returned 9,576 references. Thirteen articles were selected (five crossover and eight parallel RCTs). Volunteers aged 3 to 17 years-old. All studies evaluated TV as distractor. Most studies presented high/moderate risk of bias. Meta-analysis of parallel RCT indicated no significant difference in energy intake while eating with TV (MD = 0.05; 95% CI -0.13 - 0.23, P = 0.57), with moderate certainty level. In conclusion, under laboratory conditions, eating with distractors seems to barely alter energy intake for children and adolescents.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2022.2055525 .

Evolución y tratamiento de los trastornos de la conducta alimentaria en adolescentes: serie de casos / Treatment of eating disorders in adolescents: case series

Los trastornos de la conducta alimentaria son enfermedades de elevada prevalencia en la adolescencia y tienen repercusión en la salud integral. El objetivo fue describir su evolución y tratamiento en un grupo de adolescentes. Se estudiaron adolescentes menores de 18 años con al menos 6 meses de seguimiento y tratados por un equipo interdisciplinario. Se incluyeron 41 adolescentes: 23 presentaron anorexia nerviosa; 9, trastornos alimentarios no especificados; 7, bulimia nerviosa y 2, trastorno por atracones. El 35 % de pacientes con anorexia nerviosa requirió internación por complicaciones de la desnutrición. El 69 % de las pacientes con anorexia nerviosa, el 57 % de quienes tenían bulimia nerviosa y el 78 % de quienes tenían un trastorno alimentario no especificado presentaron remisión total o parcial, y no hubo pacientes fallecidos. La mayoría presentó una evolución favorable con el tratamiento.

Eating disorders are highly prevalent diseases in adolescence and have an impact on overall health. The objective was to describe the evolution and treatment of eating disorders in adolescents. Adolescents under 18 years of age with at least 6 months of follow-up and treated by an interdisciplinary team were studied. Forty one adolescents were included, 23 presented anorexia nervosa, 9 unspecified eating disorders, 7 bulimia nervosa and 2 binge eating disorders. Thirty five percent of patients with anorexia nervosa required hospitalization for complications of malnutrition. Sixty nine percent of the patients with anorexia nervosa, 57 % with bulimia nervosa, and 78 % with unspecified eating disorders had total or partial remission and there were no deceased patients. The majority presented a favorable evolution with the treatment.

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.

[Treatment of eating disorders in adolescents: case series]. / Evolución y tratamiento de los trastornos de la conducta alimentaria en adolescentes: serie de casos.

Eating disorders are highly prevalent diseases in adolescence and have an impact on overall health. The objective was to describe the evolution and treatment of eating disorders in adolescents. Adolescents under 18 years of age with at least 6 months of follow-up and treated by an interdisciplinary team were studied. Forty one adolescents were included, 23 presented anorexia nervosa, 9 unspecified eating disorders, 7 bulimia nervosa and 2 binge eating disorders. Thirty five percent of patients with anorexia nervosa required hospitalization for complications of malnutrition. Sixty nine percent of the patients with anorexia nervosa, 57 % with bulimia nervosa, and 78 % with unspecified eating disorders had total or partial remission and there were no deceased patients. The majority presented a favorable evolution with the treatment.

Los trastornos de la conducta alimentaria son enfermedades de elevada prevalencia en la adolescencia y tienen repercusión en la salud integral. El objetivo fue describir su evolución y tratamiento en un grupo de adolescentes. Se estudiaron adolescentes menores de 18 años con al menos 6 meses de seguimiento y tratados por un equipo interdisciplinario. Se incluyeron 41 adolescentes: 23 presentaron anorexia nerviosa; 9, trastornos alimentarios no especificados; 7, bulimia nerviosa y 2, trastorno por atracones. El 35 % de pacientes con anorexia nerviosa requirió internación por complicaciones de la desnutrición. El 69 % de las pacientes con anorexia nerviosa, el 57 % de quienes tenían bulimia nerviosa y el 78 % de quienes tenían un trastorno alimentario no especificado presentaron remisión total o parcial, y no hubo pacientes fallecidos. La mayoría presentó una evolución favorable con el tratamiento.

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

Acompanhamento fonoaudiológico nas dificuldades alimentares no câncer infanto-juvenil: uma série de casos / Speech therapy follow-up for eating difficulties with juvenile child cancer: a series of cases / Seguimiento fonoaudiológico en las dificultades de alimentación en el cáncer infantojuvenil: una serie de casos

Objetivo: Este estudo teve como objetivo relatar o acompanhamento fonoaudiológico nas dificuldades alimentares no câncer infanto-juvenil. Métodos: O estudo de série de casos retrospectivo e descritivo-qualitativo teve amostra composta por 3 indivíduos com idade variando entre 8 e 14 anos, em acompanhamento com a equipe do Serviço de Oncologia Pediátrica do Hospital da Criança Santo Antônio - Irmandade Santa Casa de Misericórdia de Porto Alegre, com solicitação de avaliação fonoaudiológica para investigação de deglutição/alimentação. A coleta foi realizada por meio de dados extraídos de prontuário eletrônico da instituição, onde constavam as evoluções dos casos dos pacientes internados e atendidos em ambulatório, de março de 2018 a agosto de 2019. Resultados: Nos 3 casos relatados, os pacientes apresentaram deglutição normal, com indicação de via alternativa para alimentação pelo prejuízo na ingestão oral de alimentos durante e/ou após o tratamento oncológico. As queixas alimentares devido aos efeitos colaterais do tratamento foram inapetência, alteração de paladar, náusea e vômitos. Os casos foram acompanhados durante a internação e em ambulatório de fonoaudiologia. Dois dos pacientes permaneceram com a via alternativa por tempo prolongado e um deles reestabeleceu a alimentação por via oral exclusiva. Conclusão: O fonoaudiólogo inserido na equipe multidisciplinar de cuidados ao paciente com câncer infanto-juvenil é um dos responsáveis pelo acompanhamento das dificuldades alimentares provocadas pela doença e tratamentos, com olhar além da disfagia orofaríngea. A sua atuação deve envolver estratégias que promovam a nutrição adequada, seja por via alternativa ou via oral, visando segurança e conforto, com respeito à autonomia do paciente.

Objective: This study was aimed to report speech therapy follow-up for eating difficulties with childhood cancer. Methods: The retrospective and descriptive-qualitative case series study was sampled composed of patients aged between 8 and 14 years, under follow-up with the Pediatric Oncology Service of the Hospital da Criança Santo Antônio - Irmandade Santa Casa de Misericórdia de Porto Alegre, with a request for speech therapy evaluation for swallowing/feeding research. The collection was performed through data extracted from the institution's electronic medical records, with the evolution of the cases of patients hospitalized and attended in an outpatient clinic, from March 2018 to August 2019. Results: In the 3 reported cases, the patients presented normal swallowing, with indication of feeding tubes by impairment in oral food intake during and/or after cancer treatment. The dietary complaints due to the side effects of treatment were inapetence, taste change, nausea and vomiting. The cases were followed during hospitalization and in the speech therapy outpatient clinic. Two of the patients remained on a feeding tube for a long time and one of them reestablished exclusive oral feeding. Conclusion: The speech therapist inserted in the multidisciplinary team of care for patients with childhood cancer is one of those responsible for follow-up of eating difficulties caused by the disease and treatments, with a look beyond oropharyngeal dysphagia. Its performance should involve strategies that promote adequate nutrition, either alternatively or orally, aiming at safety and comfort, with respect to the patient's autonomy.

Objetivo: Este estudio tenía como objetivo de relatar el seguimiento fonoaudiológico en las dificultades de alimentación en el cáncer infantil. Métodos: El estudio retrospectivo y descriptivo-cualitativo de la serie de casos estaba compuesto por 3 individuos de entre 8 y 14 años, bajo seguimiento con el equipo de Servicio de Oncología Pediátrica del Hospital da Criança Santo Antônio - Irmandade Santa Casa de Misericórdia de Porto Alegre, con solicitud de evaluación fonoaudiológica para la investigación de la deglutición/alimentación. La recopilación se realizó a través de datos extraídos de la historia clínica digitalizada institucional con la evolución de los casos de pacientes hospitalizados y atendidos en un servicio de consulta externa, de marzo de 2018 a agosto de 2019. Resultados: En los 3 casos reportados, los pacientes presentaron deglución normal, con indicación de vía alterna de alimentación por presentar dificultad en la ingesta oral de alimentos durante y/o después del tratamiento oncológico. Las quejas alimenticias asociadas a los efectos secundarios del tratamiento fueron la pérdida del apetito, alteración en el sentido del gusto, náuseas y vómito. Los casos fueron acompañados por el fonoaudiólogo durante la hospitalización y el servicio de consulta externa. Dos de los pacientes permanecieron con via alterna de alimentación durante un tiempo prolongado y uno de ellos restableció la alimentación por vía oral por completo. Conclusión: El fonoaudiólogo como parte del equipo multidisciplinario de atención en pacientes con cáncer infantil, es uno de los responsables del seguimiento de las dificultades de alimentación causadas por la enfermedad y los tratamientos, con una mirada más allá de la disfagia orofaríngea. Su actuación debe incluir estrategias que promuevan una nutrición adecuada, ya sea por vía alterna o vía oral, con el objetivo de garantizar la seguridad y comodidad del paciente y respetando su autonomía.

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.

Adult avoidant/restrictive food intake disorder: a case report / Transtorno alimentar evitativo/restritivo em uma adulta: um relato de caso

ABSTRACT The aim this report is to present an adult case of avoidant/restrictive food intake disorder (ARFID) in a patient with atypical development. To emphasize the diagnostic and behavioral characteristics of this new nosological category included in the Feeding and Eating Disorders (FED) section of DSM-5. A woman with Down Syndrome in early adulthood who developed restriction and avoidance symptoms of food until the total eating refusal with weight loss, malnutrition and dependence exclusively on enteral feeding by gastrostomy tube. This case exemplified how ARFID may remain a hidden diagnosis and even be misdiagnosed as other eating disorders, such as anorexia nervosa. The increase in diagnostic suspicion for this nosological entity with neurobiological/behavioral mechanisms involved in its clinical presentations in mind, might increase knowledge about this serious eating disorder, aiming the development of evidence-based interventions.

RESUMO O objetivo deste relato é apresentar um caso de transtorno alimentar evitativo/restritivo (TARE) em uma paciente adulta com desenvolvimento atípico e salientar as características diagnósticas e comportamentais dessa nova categoria nosológica incluída na seção de Transtornos Alimentares da DSM-5. Mulher com síndrome de Down que, no início da vida adulta, evoluiu com sintomas de restrição e evitação alimentar até a recusa total da alimentação, com perda de peso, desnutrição e dependência total de alimentação enteral por gastrostomia. Este caso elucida como o diagnóstico de TARE pode permanecer oculto e ser confundindo com outras condições patológicas alimentares, como a anorexia nervosa. O aumento da suspeição diagnóstica para essa entidade nosológica, tendo em mente os mecanismos neurobiológicos/comportamentais envolvidos em suas apresentações clínicas, possibilitará o aumento do conhecimento sobre esse grave transtorno alimentar, visando ao desenvolvimento de intervenções eficazes baseadas em evidências.

Evaluación y manejo de dificultades de succión-deglución en recién nacidos y lactantes sin compromiso neuromuscular / Assessment and management of sucking-swallowing difficulties in newborns and infants without neuromuscular disease

The difficulties of sucking, swallowing and feeding have been extensively studied in pediatric population with congenital or acquired condition. The severity and variety of signs and symptoms guide the evaluation and treatment with relatively low complexity, if the necessary specialists and equipment are available. The confrontation of swallowing and feeding disorders in newborns and infants who do not have neurological, genetic or metabolic conditions becomes a major challenge. Difficulties are related to failures in the safety, efficiency and behavior of the child when feeding. This article reviews the development of feeding, the relationship with the digestive air tract and the impact on speech acquisition. Assessment and treatment criteria are also detailed, with emphasis on the management of multidisciplinary teams and active family incorporation.

Las dificultades de succión, deglución y alimentación han sido ampliamente estudiadas en población pediátrica portadora de alguna condición congénita o adquirida. La severidad y variedad de signos y síntomas, orientan a la evaluación y tratamiento con relativa baja complejidad, si se cuenta con los especialistas y equipamiento necesario. Se transforma en un desafío mayor el enfrentamiento de alteraciones de deglución y alimentación en recién nacidos y lactantes que no presentan condiciones neurológicas, genéticas o metabólicas. Las dificultades se relacionan con fallas en la seguridad, eficiencia y la conducta del niño al alimentarse. En este artículo se revisa el desarrollo de la alimentación, su relación con el tracto aéreo digestivo y el impacto en la adquisición del habla. También se detallan criterios de evaluación e intervención, con énfasis en el manejo de equipos multidisciplinarios e incorporación activa de la familia.

The classification of feeding and eating disorders in the ICD-11: results of a field study comparing proposed ICD-11 guidelines with existing ICD-10 guidelines.

BACKGROUND: The World Health Organization (WHO) International Classification of Diseases and Related Health Problems (ICD) is used globally by 194 WHO member nations. It is used for assigning clinical diagnoses, providing the framework for reporting public health data, and to inform the organization and reimbursement of health services. Guided by overarching principles of increasing clinical utility and global applicability, the 11th revision of the ICD proposes major changes that incorporate empirical advances since the previous revision in 1992. To test recommended changes in the Mental, Behavioral, and Neurodevelopmental Disorders chapter, multiple vignette-based case-controlled field studies have been conducted which examine clinicians' ability to accurately and consistently use the new guidelines and assess their overall clinical utility. This manuscript reports on the results from the study of the proposed ICD-11 guidelines for feeding and eating disorders (FEDs). METHOD: Participants were 2288 mental health professionals registered with WHO's Global Clinical Practice Network. The study was conducted in Chinese, English, French, Japanese, and Spanish. Clinicians were randomly assigned to apply either the ICD-11 or ICD-10 diagnostic guidelines for FEDs to a pair of case vignettes designed to test specific clinical questions. Clinicians selected the diagnosis they thought was correct for each vignette, evaluated the presence of each essential feature of the selected diagnosis, and the clinical utility of the diagnostic guidelines. RESULTS: The proposed ICD-11 diagnostic guidelines significantly improved accuracy for all FEDs tested relative to ICD-10 and attained higher clinical utility ratings; similar results were obtained across all five languages. The inclusion of binge eating disorder and avoidant-restrictive food intake disorder reduced the use of residual diagnoses. Areas needing further refinement were identified. CONCLUSIONS: The proposed ICD-11 diagnostic guidelines consistently outperformed ICD-10 in distinguishing cases of eating disorders and showed global applicability and appropriate clinical utility. These results suggest that the proposed ICD-11 guidelines for FEDs will help increase accuracy of public health data, improve clinical diagnosis, and enhance health service organization and provision. This is the first time in the revision of the ICD that data from large-scale, empirical research examining proposed guidelines is completed in time to inform the final diagnostic guidelines.

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.

Narratives of mothers of children with autism spectrum disorders: focus on eating behavior / Narrativa de mães de crianças com transtorno do espectro do autismo: foco no comportamento alimentar

Abstract Objective To investigate the eating behavior of individuals with autism through their mothers' narratives. Methods The study of narratives was used to report on the narrators' experiences. Data on the eating habits of individuals with autism were collected using semi-structured interviews held individually with the mothers. The interviews were recorded, transcribed and codified using the NVivo software program. Results Eighteen mothers of boys/young men with autism participated in the study. Analysis yielded three major categories: eating patterns, the family's attitudes to the child's eating habits, and food-related behavior. Conclusion Results show that autism-related factors may affect the child's food choices. Environmental factors, particularly the parents' behavior, may also play a decisive role, both in reinforcing the child's food choices and in encouraging a healthier and more diversified diet. Professionals should instruct parents regarding their decisive role in reinforcing or discouraging inappropriate mealtime behavior in children with autism.

Resumo Objetivo Investigar o comportamento alimentar de indivíduos com transtorno do espectro do autismo (TEA) através das narrativas de suas mães. Métodos Os dados sobre os hábitos alimentares dos indivíduos com TEA foram coletados utilizando entrevistas semiestruturadas realizadas individualmente com as mães. As entrevistas foram gravadas, transcritas e codificadas usando o programa NVivo. Resultados Dezoito mães de meninos/jovens homens com autismo participaram do estudo. A análise produziu três categorias principais: padrões alimentares, a atitude da família em relação aos hábitos alimentares da criança e comportamentos relacionados à alimentação. Conclusão Os resultados mostram que os fatores relacionados ao autismo podem afetar as escolhas alimentares da criança. Os fatores ambientais, particularmente o comportamento dos pais, também podem desempenhar um papel decisivo, tanto no reforço das escolhas alimentares da criança quanto no incentivo a uma dieta mais saudável e diversificada. Os profissionais devem instruir os pais sobre o seu papel decisivo no reforço ou desencorajamento do comportamento inapropriado nas refeições em crianças com TEA.

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.

[Obesity and metabolic syndrome in children and adolescents]. / Obesidad y síndrome metabólico en niños y adolescentes.

Obesity and the metabolic syndrome are closely related to the cases of cardiovascular disease; they are usually regarded as belonging to the adult population but are seen with increasing frequency in children and adolescents. There is evidence that atherosclerotic lesions occur most often in young people with obesity. The factors involved in this pandemic are manifold and range from genetic-biological to cultural changes. The family and the environment in which the child develops play a key role in the adoption of habits related to diet and physical activity. This problem does not respect borders and cultures but all countries are being affected, even more those of middle-income. State and Society as a whole can play a role oriented to modify this environment. The restriction on sales of unhealthy food and the fight against the sedentary lifestyle are urgently needed to be applied. The impact that these disorders will have in terms of cardiovascular disease, has not yet reached its true dimension.

Obesidad y síndrome metabólico en niños y adolescentes / Obesity and metabolic syndrome in children and adolescents

La obesidad y el síndrome metabólico se encuentran íntimamente relacionados con los casos de enfermedad cardiovascular; son considerados habitualmente como propios de la población adulta aunque se observan con una frecuencia creciente en niños y adolescentes. Existe evidencia de que las lesiones ateroescleróticas se presentan con más frecuencia en jóvenes obesos. Los factores involucrados en esta pandemia son múltiples e incluyen desde variables genético-biológicas hasta cambios culturales. La familia y el entorno en el que el niño se desarrolla juegan un papel fundamental en la adopción de los hábitos relacionados con la alimentación y la actividad física. Esta problemática no respeta fronteras ni culturas sino que todos los países están siendo afectados, más aún aquellos de ingresos medios. El papel que le cabe al Estado y a la sociedad en su conjunto se orienta a modificar este medio ambiente. La restricción en las ventas de alimentos poco saludables y la lucha contra el sedentarismo son políticas que urgen ser aplicadas. El impacto que estos trastornos tendrán en términos de enfermedad cardiovascular, no ha cobrado aún su verdadera dimensión.

Obesity and the metabolic syndrome are closely related to the cases of cardiovascular disease; they are usually regarded as belonging to the adult population but are seen with increasing frequency in children and adolescents. There is evidence that atherosclerotic lesions occur most often in young people with obesity. The factors involved in this pandemic are manifold and range from genetic-biological to cultural changes. The family and the environment in which the child develops play a key role in the adoption of habits related to diet and physical activity. This problem does not respect borders and cultures but all countries are being affected, even more those of middle-income. State and Society as a whole can play a role oriented to modify this environment. The restriction on sales of unhealthy food and the fight against the sedentary lifestyle are urgently needed to be applied. The impact that these disorders will have in terms of cardiovascular disease, has not yet reached its true dimension.