Tools available to screen for child feeding dysfunction: A systematic review.

INTRODUCTION: The aim of this systematic review is to identify existing pediatric feeding screening tools that have been shown to be valid and reliable in identifying feeding dysfunction in children. METHOD: A database search produced 5862 relevant articles to be screened based on pre-determined inclusion/exclusion criteria. After full text review of 183 articles, 64 articles were included in the review. RESULTS: Forty-four studies detailed development and validation of unique feeding screening tools for the pediatric population. The remaining twenty studies were validations studies of already developed screening tools. DISCUSSION: Multiple screening tools identified were effective in determining feeding dysfunction in children. Several tools employed excellent techniques to measure reliability and validity for diverse pediatric populations. Careful consideration of the tools listed in this review will help practitioners determine the best method for feeding screening in their facility.

Influence of fathers on the feeding practices and behaviors of children: A systematic review.

INTRODUCTION: This systematic review will identify and summarize current research concerning the influence of fathers on the feeding behaviors of their children. Outcomes specific to child health, development of eating habits, relationships between paternal weight and child weight, and paternal dietary habits and child dietary habits were specifically targeted. METHODS: A systematic review was conducted based on protocols outlined by PRISMA. A database search produced 851 relevant articles to be screened based on pre-determined inclusion criteria. Twenty-three studies met inclusion criteria for full review including two papers based on a single randomized control trial, 3 longitudinal studies, and 18 cross-sectional studies. RESULTS: The most consistent findings across studies include the following. Father's BMI was positively correlated with child's BMI, father's dietary intake was predictive of child's dietary intake, food availability in the home influenced child intake, father's food parenting style predicted their children's eating behaviors and congruent parenting by mothers and fathers produced the best child food choices. CONCLUSIONS: A growing body of research indicates that fathers play a key role in influencing child eating behaviors. Further research, including randomized control trials, will help strengthen current conclusions and better inform education and interventions designed for fathers.

Assessment of clinical practice procedures among Registered Dietitian Nutritionists for identifying feeding dysfunction in the pediatric population.

BACKGROUND & AIMS: Feeding dysfunction is common in children. Efficient processes to identify and treat feeding dysfunction are not commonly known or used among healthcare practitioners. The aim of this study was to develop and validate a survey tool to assess current practice procedures used by Registered Dietitian Nutritionists (RDN) in identifying, diagnosing, and treating feeding dysfunction in children 0-18 years of age. METHODS: A survey was developed and distributed to gather information on RDN practice procedures, prevalence of pediatric feeding dysfunction, identification of pediatric feeding dysfunction, and method of treatment used to address pediatric feeding dysfunction. Emails were sent to 4449 RDNs in United States. All participants were classified by the Commission on Dietetic Registration (CDR) as clinical dietitians. Distribution and frequency of survey responses were assessed, and in the case of qualitative questions, were categorized according to themes identified. RESULTS: Responses of RDNs from 41 states completed 341 total surveys, 179 surveys were included in data analysis. Eighty percent of participants do not use a specific screening tool to identify feeding dysfunction. Results concerning feeding therapy strategies and terms used by RDNs to describe feeding dysfunction were highly varied or lacking. Increased inclusion of RDNs on interdisciplinary teams was indicated by 80% of participants. The majority of participants indicated they refer patients with feeding dysfunction to other practitioners instead of providing feeding therapy themselves. CONCLUSIONS: Standardized screening, diagnostic, and treatment protocols regarding feeding dysfunction are needed to provide consistent and comprehensive care for the pediatric population. Use of these protocols among RDNs would enable them to improve feeding abilities in more patients earlier in individual child development.

A Pilot Project Using Pediatricians as Initial Diagnosticians in Multidisciplinary Autism Evaluations for Young Children.

OBJECTIVES: Wait times for autism spectrum disorder (ASD) evaluations are long, thereby delaying access to ASD-specific services. We asked how our traditional care model (requiring all patients to see psychologists for ASD diagnostic decisions) compared to an alternative model that better utilizes the available clinicians, including initial evaluation by speech, audiology, and pediatrics (trained in Level 2 autism screening tools). Pediatricians could diagnose immediately if certain about diagnosis but could refer uncertain cases to psychology. Accuracy and time to diagnosis, charges, and parent satisfaction were our main outcome measures. METHODS: Data were gathered through record extraction (n = 244) and parent questionnaire (n = 57). We compared time to diagnosis, charges, and parent satisfaction between traditional and alternative models. Agreement between pediatrician and psychologist diagnoses was examined for a subset (n = 18). RESULTS: The alternative model's time to diagnosis was 44% faster (85 vs 152 d) and 33% less costly overall. Diagnostic agreement was 93% for children with ASD diagnoses and 100% for children without ASD diagnoses. Pediatricians expressed higher diagnostic certainty about children with higher levels of ASD symptoms. Parents reported no differences in high satisfaction with experiences, family-centered care, and shared decision making. CONCLUSION: Efficient use of available clinicians with additional training in Level 2 autism screening resulted in improvements in time to diagnosis and reduced charges for families. Coordination of multidisciplinary teams makes this possible, with strategic sequencing of patients through workflow. Flexibility was key to not only allowing pediatricians to refer uncertain cases to psychology for diagnosis but also allowing for diagnosis by a pediatrician when symptomatic presentation clearly met diagnostic criteria.