Family mealtime behaviors in children who are tube fed and preparing to transition to oral eating: A comparison to other pediatric populations

This study examined differences in observed mealtime behaviors between children preparing to transition to oral feeding and children with various other chronic illnesses using a standardized measure of mealtime beaviors. The parent-child mealtime relationship can become strained due to problematic mealtime behaviors that limit food intake, as well as inadvertent reinforcement of disruptive behavior by caregivers. Frequency/rate of behaviors were compared between children with tube feeding (CwTF) and from previous studies of children with chronic illnesses using the Dyadic Interactive Nomenclature for Eating (DINE). Parents of CwTF used more coaxing, physical prompts, and reinforcement during meals, while parents of children with chronic illnesses used more direct commands and engaged in more parent talk. Findings support differences in parent-child mealtime interactions and eating behaviors across pediatric illness subgroups.

Measuring Caregiver Person-Centered Communication for Persons With Dementia via Video Observations

Communication is fundamental for daily care activities in nursing homes (NHs). Second-by-second behavioral coding of video observations is an ideal approach to examine the interactive nature of communication but requires a reliable coding scheme. Recent studies have adapted the Peron-Centered Behavioral Inventory (PCBI) and Task-Centered Behavioral Inventory (TCBI) to analyze caregiver communication during mealtime interactions, but their use for coding general daily caregiving activities has not been widely evaluated. This pilot study adapted the PCBI and TCBI of video observations and determined their inter-rater reliability for measuring caregiver verbal communication with persons with dementia (PwD). We analyzed videos from a randomized controlled trial of an intervention to improve caregiver communication in NHs. We selected one 1-minute segment from 12 videos that included interactions of caregiver-resident dyads. One research assistant transcribed caregivers’ verbal communication and segmented the communication into utterances. Two other research assistants independently coded each utterance using the adapted PCBI and TCBI. The coding scheme was expanded by modifying the existing operational definitions, adding three new codes, and developing a coding decision guide. Residents were Caucasian (100%), mean age 86 years with dementia and resistive behaviors. The adapted PCBI and TCBI had an inter-rater reliability of Kappa=0.656 (p<.001) across the 12 videos. Overall, our adapted PCBI and TCBI showed substantial inter-rater reliability. The results support the use of our adapted PCBI and TCBI to distinguish between person-centered and task-centered communication in video observations, which, in turn, allows for sequential analysis to examine the impact of caregiver communication on PwD.

Characterizing Mealtime Verbal Interactions Among Nursing Home Staff and Residents With Dementia

Mealtime difficulties are common in residents with dementia, leading to negative outcomes. Interaction with staff are critical to engage residents in eating. This study characterized dyadic verbal interactions (descriptive statistics), and relationships among verbal behaviors and between verbal behaviors and individual characteristics (bivariate analyses). This secondary analysis of 110 videotaped mealtime observations involved 25 residents and 29 staff (42 unique dyads) in 9 nursing homes (NH). Verbal behaviors (utterances) were coded using the Cue Utilization and Engagement in Dementia mealtime video-coding scheme, addressing 8 positive behaviors and 4 negative behaviors. Staff spoke three times more frequently (76.5%) than residents (23.5%). Nearly all staff utterances were positive (99.2%). 85.1% of residents’ utterances were positive and 14.9% negative. Staff positive utterances were associated with staff negative utterances (p=.02), and resident positive (p<.001) and negative (p<.001) utterances. Staff negative utterances were associated with resident negative utterances (p=.02), but not with resident positive utterances (p=.39). Resident positive and negative utterances were associated (p<.001). Staff positive utterances were associated with staff race (p=.01), and resident age (p=.01), dementia stage (p<.001), and eating function (p<.001). Resident positive utterances were associated with years staff worked as caregivers (p=.02) and in the current NH (p=.01), resident age (p=.04), comorbidity (p=.04), dementia stage (p=.01), and eating function (p=.003). Resident negative utterances were associated with dementia stage (p=.01). Dyadic mealtime interactions were dynamic, interactive and complex. Multiple resident and staff characteristics were related to mealtime verbal interactions. Findings may inform development of individualized, person-centered mealtime care interventions.

Mealtimes in Head Start pre-k classrooms: examining language-promoting opportunities in a hybrid space

In this study we sought to identify profiles of talk during Head Start preschool mealtime conversations involving teachers and students. Videos of 44 Head Start classrooms’ lunch interactions were analyzed for the ratio of teacher–child talk and amount of academic vocabulary, and then coded for instances of academic/food, social/personal, and management talk to highlight the degree of hybridity of talk within this unique setting. Cluster analysis revealed four distinct patterns of teacher–child mealtime interactions in 44 Head Start preschool classrooms: classroom discourse, home discourse, hybrid-low, and hybrid-high. Multilevel models further demonstrated a relationship among these clusters of teacher–child interactions and children's end-of-year expressive vocabulary scores controlling for ratio of teacher–child talk and pre-test scores. Children in classrooms displaying a hybrid style of mealtime discourse made the greatest gains on measures of expressive vocabulary in contrast to their peers in classrooms displaying other discourse styles.