Demographic and Clinical Parameters Are Comparable Across Different Types of Pediatric Feeding Disorders

Background: Knowledge and understanding of risk mechanisms associated with pediatric feeding disorders (PFD) remain limited. We aimed to investigate causative factors associated with PFD and their relation to specific PFD types according to the recent consensus WHO-based definition. Methods: We retrospectively reviewed the medical records of children with PFD and retrieved their demographic and clinical characteristics. Healthy age- and sex-matched children served as controls. Results: Included were 254 children with PFD [median (interquartile range) age 16.4 (9.5-33) months at diagnosis] and 108 children in the control group [median age 24.85 (14.5-28.5) months]. According to the WHO-based definition, disturbances in oral intake were predominantly related to nutritional dysfunction in 118 (46.6%), feeding skill dysfunction in 83 (32.3%), medical conditions in 42 (16.7%) and psychosocial dysfunction in 11 (4.4%). In multivariate analysis, children with PFD had a higher risk for lower socioeconomic background (P<0.01) and low birth weight (26.8% compared to 7.4% ,P<0.001). Moreover, significantly fewer children in the PFD group were breastfed (75% versus 89%, P=0.003). There were no significant differences in any of those variables between PFD types. Conclusions: Low socioeconomic status, lack of breastfeeding, and low birth weight were significantly more frequent in children with PFD. PDF manifest as multiple dysfunctions, thus highlighting the need to offer these children and their families multidisciplinary care.

Texture Consumption Patterns of 8- to 12-Month-Old Infants: A Reflection of Typical Feeding Development

Purpose The lack of age-appropriate expectations for the acquisition of feeding skills and consumption of textured food in early childhood inhibits early and accurate identification of developmental delay in feeding and pediatric feeding disorder. The objective of this study was to describe texture intake patterns in a cohort of typically developing infants between 8 and 12 months of age, with the aim of informing future research to establish targets for feeding skill acquisition. Method Using cross-sectional methodology, we studied the presence of liquid and solid textures and drinking methods in the diet, consumption patterns by texture and drinking methods, and caloric intake by texture via caregiver questionnaire and 3-day dietary intake record in 63 healthy infants between 8 and 12 months of age. Descriptive statistics and a one-way analysis of variance were conducted to compare the effect of age on texture intake patterns. Results Findings reveal rapid advancement of intake patterns for texture overall and for energy intake by texture between 8 and 12 months of age. Whereas liquids continue to provide a large proportion of total energy through this time, solids contribute an equal proportion of energy by 12 months of age. Conclusions This study describes texture intake patterns in a cohort of typically developing infants between 8 and 12 months of age by examining the presence of texture and drinking methods, liquid and solid consumption patterns, and energy intake by texture. When applied to data from a future population sample, findings will provide a threshold for age expectations for typical and disordered feeding development to aid in the detection of developmental delay in feeding and pediatric feeding disorder. What Is Known: Expectations regarding early feeding development have been focused on nutrition parameters. Lack of standardized, age-appropriate expectations for texture progression in infancy and early childhood inhibits early and accurate identification and treatment of pediatric feeding disorder. What Is New: We have described changes in dietary composition by texture and drinking method in healthy infants. Together with nutritional composition, this study describes a more comprehensive assessment of infant feeding, particularly to clinicians who need to diagnose feeding skill deficits. Supplemental Material https://doi.org/10.23641/asha.16879615

Machine Learning to Support Visual Inspection of Data: A Clinical Application

Practitioners in pediatric feeding programs often rely on single-case experimental designs and visual inspection to make treatment decisions (e.g., whether to change or keep a treatment in place). However, researchers have shown that this practice remains subjective, and there is no consensus yet on the best approach to support visual inspection results. To address this issue, we present the first application of a pediatric feeding treatment evaluation using machine learning to analyze treatment effects. A 5-year-old male with autism spectrum disorder participated in a 2-week home-based, behavior-analytic treatment program. We compared interrater agreement between machine learning and expert visual analysts on the effects of a pediatric feeding treatment within a modified reversal design. Both the visual analyst and the machine learning model generally agreed about the effectiveness of the treatment while overall agreement remained high. Overall, the results suggest that machine learning may provide additional support for the analysis of single-case experimental designs implemented in pediatric feeding treatment evaluations.

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.

Qualitative Exploration of Mealtime Routines and Parental Stress of Children with Pediatric Feeding Disorders: Analysis of Occupational Performance

Pediatric feeding disorders (PFD) affect approximately 25-35% of children with typical development, 40-80% of children with developmental disabilities, and 90% of children with autism spectrum disorder (ASD). Feeding disorders affect families by disrupting mealtime routines, changing family dynamics, and increasing parental stress. Occupational therapy (OT) focuses on client-centered care that facilitates independence in meaningful occupations, including feeding and eating. OTs also play an essential role in assisting, training, and educating parents on effective mealtime strategies that can be implemented and carried over into the home environment. Few research studies show how parents manage behaviors and stress during mealtime routines, and little attention has been placed on how PFD can affect parental stress. This study reinforces the value of OT services that focus on family-based interventions and family-based training, considering rituals, routines, and environment to help decrease parental stress during mealtime routines. Data was collected during face-to-face interviews with parents of children diagnosed with PFD. The data gathered was used to identify and analyze how parents of children with PFD manage behaviors and stress during mealtimes. This study benefits families of children with PFD because it will provide additional resources and advocacy for parents. The benefit of having more resources available for parents regarding mealtime stress and mealtime behaviors is that parents will have more opportunities to find a strategy that will benefit the family routine and dynamic. This study will benefit OT practitioners because it will help guide OT family-based interventions reinforcing the importance of carry-over strategies for parents. Analysis of the data suggested that parents of children with PFD perceive mealtime behaviors as highly stressful. The analysis also showed that parents tend to ignore maladaptive mealtime behaviors during mealtime. However, when this was not successful, they would soothe the child or use punishment such as taking away electronic devices. To relieve stress, parents reported getting outdoors and talking to family or friends as the primary way of reducing stress. The findings from this qualitative study support the need for OTs to incorporate families’ unique habits, routines, and cultural and social norms into parent training to ensure the carry-over of strategies into the respective home environment.