Feeding Problems and Long-Term Outcomes in Preterm Infants—A Systematic Approach to Evaluation and Management

Preterm infants are known to have long-term healthcare needs. With advances in neonatal medical care, younger and more preterm infants are surviving, placing a subset of the general population at risk of long-term healthcare needs. Oral feeding problems in this population often play a substantial yet under-appreciated role. Oral feeding competency in preterm infants is deemed an essential requirement for hospital discharge. Despite achieving discharge readiness, feeding problems persist into childhood and can have a residual impact into adulthood. The early diagnosis and management of feeding problems are essential requisites to mitigate any potential long-term challenges in preterm-born adults. This review provides an overview of the physiology of swallowing and oral feeding skills, disruptions to oral feeding in preterm infants, the outcomes of preterm infants with feeding problems, and an algorithmic approach to the evaluation and management of neonatal feeding problems.

Orangutan mothers adjust their behaviour during food solicitations in a way that likely facilitates feeding skill acquisition in their offspring

Immature orangutans acquire their feeding skills over several years, via social and independent learning. So far, it has remained uninvestigated to what extent orangutan mothers are actively involved in this learning process. From a fitness point of view, it may be adaptive for mothers to facilitate their offspring’s skill acquisition to make them reach nutritional independence faster. Food solicitations are potential means to social learning which, because of their interactive nature, allow to investigate the degree of active involvement of the mother. To investigate the role of food solicitation and the role of the mother in immatures’ foraging skill acquisition, we analysed 1390 food solicitation events between 21 immature Sumatran orangutans (Pongo abelii) and their mothers, collected over 13 years at the Suaq Balimbing orangutan population. We found that solicitation rates decreased with increasing age of the immatures and increased with increasing processing complexity of the food item. Mothers were more likely to share complex items and showed the highest likelihoods of sharing around the age at which immatures are learning most of their feeding skills. Our results indicate that immature Sumatran orangutans use food solicitation to acquire feeding skills. Furthermore, mothers flexibly adjust their behaviour in a way that likely facilitates their offspring’s skill acquisition. We conclude that orangutan mothers have a more active role in the skill acquisition of their offspring than previously thought.

Evaluating the Use of Telepractice for Bottle-Feeding Assessments

There is currently limited evidence supporting the use of telepractice to conduct bottle-feeding assessments. This study aimed to investigate the inter-rater reliability of bottle-feeding assessments conducted via synchronous telepractice (real-time videoconferencing). Secondary aims were to investigate parent and clinician satisfaction. Bottle-feeding skills of 30 children (aged 1 month–2 years) were simultaneously assessed by a telepractice SP (T-SP) at a remote location and an in-person SP (IP-SP) at the family home. A purpose-designed assessment form was used to evaluate: (1) developmental level (screen only), (2) state, color, and respiration, (3) oral motor skills, (4), infant oral reflexes, (5) tongue tie (screen only), (6) non-nutritive suck, (7) bottle-feeding, (8) overall feeding skills and (9) recommendations. Results of the T-SP and IP-SP assessments were compared using agreement statistics. Parents reported perceptions of telepractice pre and post session, and also rated post-session satisfaction. The telepractice SP completed a satisfaction questionnaire post-appointment. The majority of assessment components (45/53, 85%) met the agreement criteria (≥80% exact agreement). Difficulties were noted for the assessment of palate integrity, gagging during non-nutritive suck assessment, and 6 components of the tongue tie screen. Parent and clinician satisfaction was high; SPs reported that they would offer telepractice services to 93% of families again in the future. Overall, the results demonstrated that most components of a bottle-feeding assessment could be reliably completed via synchronous telepractice in family homes. However, further research is required to improve the reliability of some intra-oral assessment components.

Oral Motor Treatment Efficacy: Feeding and Swallowing Skills in Children with Cerebral Palsy

This study is aimed at identifying the relationship between oral motor treatment and the improvement of abilities for feeding and swallowing in boys and girls with CP residing in the state of Yucatán. The sample consisted of 30 patients with a diagnosis of CP and the presence of ADT, with gross motor function levels from II to V, between 3 and 14 years old, of which 50% received oral motor treatment. The predominant diagnosis was spastic CP and tetraplegia. An interview was carried out with the tutor, the application of the gross motor skills scale, and an assessment of feeding skills. The feeding and swallowing skills that improved significantly with the oral motor treatment were mandibular mobility, tongue activity, abnormal reflexes, control of breathing, and general oral motor skills ( p ≤ 0.05 ). Within the sample that did not receive oral motor treatment, 46% presented low or very low weight and 40% referred recurrent respiratory diseases. In the end, it was concluded that feeding skills improve significantly with oral motor treatment, regardless of the severity of gross motor involvement. Likewise, oral motor treatment was associated with a lower presence of respiratory diseases and nutritional compromise.

Build Independent Self-feeding Function: A Pilot Study on a Child with Autism and Feeding Disorder

The high occurrence of feeding disorders among children with autism spectrum disorder has caught the attention of professionals from different disciplines. When taking an insight into their feeding problems, mixed physical, behavioral and psychological difficulties were encountered, such as oral skill deficits (e.g., chew, swallow, and coordination), fine motor skill deficits, food selectivity (e.g., texture aversion), food neophobia, and so on. However, the traditional non-oral tube feeding method for maintaining their nutrition consumption is criticized as too intrusive and inadequate for training self-feeding skills. Therefore, to target both establishing independent self-feeding function and food consumption variety (nutrition) while using less intrusive intervention method, the present study tested the effectiveness of a multicomponent behavioral intervention protocol on a child with autism and feeding disorder, setting across physical, behavioral and psychological background. A task analysis on self-feeding function resulted in a backward-chain training procedure on swallowing, chewing, and fine motor skills, separately and then combined. The training procedure consisted of 3 key components: 1) swallowing training, 2) chewing training starting with using a chew facilitator tube, 3) fine motor training targeting on self-feeding; and 4) fine motor-chewing-swallowing coordination training with multiple types of food. The results showed the present multicomponent behavioral intervention protocol successfully established the participant’s self-feeding skills: ameliorated his oral and fine motor skills, cultivated his independent self-feeding function, and increased his food consumption volume and variety.

Build Independent Self-feeding Function: A Pilot Study on a Child with Autism and Feeding Disorders

The high occurrence of feeding disorders among children with autism spectrum disorder has caught the attention of professionals from different disciplines. When taking an insight into their feeding problems, mixed physical, behavioral and psychological difficulties were encountered, such as oral skill deficits (e.g., chew, swallow, and coordination), fine motor skill deficits, food selectivity (e.g., texture aversion), food neophobia, and so on. However, the traditional non-oral tube feeding method for maintaining their nutrition consumption is criticized as too intrusive and inadequate for training self-feeding skills. Therefore, to target both establishing independent self-feeding function and food consumption variety (nutrition) while using a less intrusive intervention method, the present study tested the effectiveness of a multicomponent behavioral intervention protocol on a child with autism and feeding disorder, setting across physical, behavioral and psychological background. A task analysis on self-feeding function resulted in a backward-chain training procedure on swallowing, chewing, and fine motor skills, separately and then combined. The training procedure consisted of 3 key components: 1) swallowing training, 2) chewing training starting with using a chew facilitator tube, 3) fine motor training targeting on self-feeding; and 4) fine motor-chewing-swallowing coordination training with multiple types of food. The results showed the present multi-component behavioral intervention protocol successfully established the participant’s self-feeding skills: ameliorated his oral and fine motor skills, cultivated his independent self-feeding function, and increased his food consumption volume and variety.

Children with Feeding Difficulties Present Changes in the Development of Feeding Skills: A Study with a Control Group

Introduction Feeding skills (FS) are important to child development, as the delay in their presence could suggest feeding difficulties (FD) symptoms. The aim of the present study was to compare the development of three types of FS (autonomy to eat, posture at meals, and adequate use of cutleries) among children with FD and without FD. Methods This was a case-control retrospective observational study. The sample consisted of 316 children from case and control groups in accordance with the presence (or not) of FD. The control group was recruited by convenience (verbal approaching at the emergency care unit), and the case group was based on the medical records collected at the reference center. A same-structured questionnaire was used for both groups. Results Children with FD (63.2%) used baby-bottles in an inadequate way with a higher frequency after 24 months of age. Inadequate posture at meals was observed with higher frequency in children with FD (78.1%). Children without FD (89.1%) had more autonomy to eat. In children > 18 months old, this frequency was higher (90.6%). Conclusion Children with FD showed changes on the development of FS. Inadequate posture at meals was associated with a 36-fold higher risk of having FD. Not eating alone after the age of 18 months was associated with a 6-fold higher risk of having FD, while not using baby bottles was associated with a lower risk (52%) of FD complaints. Delays in FS can be predictors of FD during childhood.

The Validity and Reliability of Early Feeding Skills Assessment and Cue-Based Feeding Scales for Preterm Infants

Background: One of the fundamental factors in infants’ readiness to discharge from the Neonatal Intensive Care Unit (NICU) is attaining full oral feeding. Determining the infants’ development requires instruments to comprehensively assess the infants’ oral skills and the process of feeding. Objectives: This study aimed to measure the validity and reliability of Early Feeding Skill assessment (EFS) and the subscales of the cue-based feeding (Oral Feeding Readiness scale (OFRS) and Oral Feeding Quality scale (OFQS)). Methods: Participants consisted of 30 preterm infants born at gestational age (GA) ≤ 34 weeks in Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Infants were enrolled by convenience sampling. Intraclass correlation coefficients (ICC) and Weighted Kappa were used to measure reliability, and Spearman and Pearson’s correlation coefficient were used to test convergent and discriminant validity. Results: The inter- and intra-rater reliability of all dimensions of EFS were good (ICC ranged from 0.77 to 0.95) except intra-rater reliabiltiy for the ability to maintain physiologic stability and ability to coordinate swallowing was moderate. The inter-rater reliability of the cue-based feeding scales was excellent (Weighted Kappa of > 0.74). The intra-rater reliablity indicated good agreement for OFRS (Weighted Kappa = 0.73) and excellent agreement for OFQS (Weighted Kappa = 0.75). There was an inverse correlation between most subscales of EFS and cue-based feeding scales (P < 0.05), except the ability to maintain physiologic stability and ability to coordinate swallowing dimensions (P > 0.05). There was a significant correlation between the ability to maintain physiologic stability dimension and post menstrual age (PMA) (r = 38, (P < 0.05) and between the oral feeding recovery assessment and GA (r = 0.37, (P < 0.05). OFQS was inversely correlated with GA and PMA (P < 0.05). Conclusions: EFS and cue-based feeding scales are valid and reliable scales to assess the oral feeding skills of preterm infants; however, using only one of these scales solely to evaluate infants’ feeding process is not enough.