RESUMEN
BACKGROUND: Feeding problems in children with autism jeopardize the well-being of both children with autism and their families. Mixed findings were reported from previous interventions, which were mostly evaluated by single subject research design (SSRD) studies. Moreover, feasibility assessment and social validity measurement were unaddressed by these SSRD studies. To fill this substantial knowledge gap, the present review systematically summarized and evaluated feeding interventions implemented in children with autism, which were assessed by studies employing group designs. METHOD: An extensive literature search in eight established online databases was conducted, and a total of 17 eligible studies published in 2009-2021 were included for further analysis. A descriptive account of the features of the investigations is provided, including assessment of study quality. RESULTS: A total of 449 children with autism and 203 parents/caregivers participated in the included studies. The multiple use of five strategic intervention components were highlighted in this review, including nutrition education/consultations, environmental modifications, sensory exposure, cognitive components, and behaviour interventions. The reviewed interventions showed a preliminarily positive effect for modifying feeding problems in children with autism. Furthermore, the evaluation based on the RE-AIM framework (reach, efficacy, adoption, implementation, and maintenance) demonstrated that an interdisciplinary multi-component intervention strategy may achieve high effectiveness and feasibility in improving feeding problems in a wide range of children with autism. CONCLUSIONS: This review found that interventions achieved and maintained a positive effect on modification of feeding problems in groups of children with autism. Information and gaps identified and summarized in the implementation process may assist both researchers and stakeholders to further support these vulnerable children.
Asunto(s)
Trastorno Autístico , Humanos , Niño , Trastorno Autístico/terapia , Trastorno Autístico/psicología , Proyectos de Investigación , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Trastornos de Ingestión y Alimentación en la Niñez/etiología , Conducta Alimentaria/psicología , PreescolarRESUMEN
AIM: The aim of this study was to scrutinize how online occupational therapy group training for mothers influenced their attitudes and stress levels relating to feeding their children and the eating behaviours of the children. The secondary purpose of the study is to evaluate the satisfaction of the participants of this program. Twenty-nine mothers of children aged 3-6 years, experiencing feeding issues, were randomly allocated to either an intervention or control group. BACKGROUND: Feeding problems including selective eating, loss of appetite, and mealtime behaviour problems are prevalent during childhood. Parents play a fundamental role in acquiring knowledge about feeding. Problems in the feeding process may lead to parental stress, feelings of despair, and incorrect attitudes. RESULTS: The mothers in the research group participated in the 4-week training. Results indicated positive effects on both maternal attitudes and their children's eating behaviours (p < 0.05). No significant change was found in mothers' state and trait anxiety levels (p > 0.05). Participants were asked to score their satisfaction level with the program between 1 and 10, and the average of the scores was 9.78 ± 0.42. CONCLUSION: This study shows that online group education for mothers can support existing treatments and guide clinicians working with children with feeding problems.
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Madres , Terapia Ocupacional , Humanos , Femenino , Madres/psicología , Madres/educación , Preescolar , Niño , Masculino , Adulto , Conducta Alimentaria/psicología , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Trastornos de Ingestión y Alimentación en la Niñez/psicología , Psicoterapia de Grupo/métodos , Estrés Psicológico , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Relaciones Madre-Hijo , Intervención basada en la InternetRESUMEN
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.
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Terapia Conductista/métodos , Nutrición Enteral/efectos adversos , Conducta Alimentaria/psicología , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Niño , Preescolar , Nutrición Enteral/psicología , Trastornos de Ingestión y Alimentación en la Niñez/psicología , Femenino , Humanos , Masculino , Padres/psicología , Estudios RetrospectivosRESUMEN
Objective: Many children with autism spectrum disorder (ASD) have feeding and mealtime problems. To address these, we conducted a pilot randomized trial of a new 11-session, individually delivered parent training program that integrated behavioral strategies and nutritional guidance (PT-F). Methods: Forty-two young children (age: 2 to 7-11 years) with ASD and feeding problems were assigned to 11 sessions of PT-F intervention over 20 weeks or a waitlist control. Outcomes included attendance, parent satisfaction, therapist fidelity, and preliminary assessments of child and parent outcomes. Results: Of the 21 PT-F families, attendance was high (85%) as was parent satisfaction (94% would recommend to others). Treatment fidelity was also high (97%-therapist integrity; 94%-parent adherence). Compared with waitlist, children whose parents participated in PT-F showed significantly greater reductions on the two parent-completed primary outcomes (Brief Autism Mealtime Behavior Inventory-Revised; Twald = -2.79; p = .003; About Your Child's Eating; Twald = -3.58; p = .001). On the independent evaluator-completed secondary eating outcome, the Clinical Global Impression-Improvement, 48.8% of the participants in PT-F were rated as "responders" compared with 0% in waitlist (p = .006). General child disruptive behavior outcomes decreased more in PT-F but not significantly. Parent outcomes of caregiver stress showed nonsignificant trends favoring PT-F with moderate to small effect sizes. Conclusions: This trial provides evidence for feasibility, satisfaction, and fidelity of implementation of PT-F for feeding problems in young children with ASD. Feeding outcomes also appeared favorable and lends support for conducting a larger efficacy trial.
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Trastorno del Espectro Autista/complicaciones , Trastorno del Espectro Autista/psicología , Educación no Profesional/métodos , Conducta Alimentaria/psicología , Trastornos de Ingestión y Alimentación en la Niñez/complicaciones , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Padres/educación , Trastorno del Espectro Autista/rehabilitación , Niño , Preescolar , Trastornos de Ingestión y Alimentación en la Niñez/psicología , Femenino , Humanos , Masculino , Proyectos PilotoRESUMEN
OBJECTIVE: Family therapy has long been advocated as an effective intervention for eating disorders. A specific form of family therapy, one that utilizes family resources, has proven especially effective for adolescents with anorexia or bulimia nervosa (AN and BN). First developed in London, a behaviorally focused adaptation, called family-based treatment (FBT), has been manualized and systematically studied in six randomized clinical trials for adolescent AN and two for adolescent BN. METHOD: This Commentary focuses on manualized FBT; what we know, what we do not know (yet), and what we hope for. RESULTS: We do know that efficacy data for FBT, especially adolescent AN, are quite robust, even though remission rates remain elusive for more than half of all cases. While preliminary, moderators of FBT for adolescent AN have been identified and could aid us in determining the most (or least) responsive patient groups. And weight gain (â¼2.5kg) by week four has been confirmed as an early predictor of remission at end-of-treatment. What we do not know, yet, is whether specific adaptations to manualized FBT will confer improved remission rates. DISCUSSION: Finally, and in terms of what is hoped for, we highlight the promise of improved access, dissemination, and implementation of FBT.
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Terapia Familiar/métodos , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Adolescente , Niño , Femenino , Humanos , Masculino , Resultado del TratamientoRESUMEN
OBJECTIVE: Avoidant/restrictive food intake disorder (ARFID), pica, and rumination disorder (RD) were added to the revised DSM-5 Feeding and Eating Disorders chapter in 2013. We developed a structured interview-the Pica, ARFID, and Rumination Disorder Interview (PARDI)-to assess the presence and severity of these diagnoses for evaluation and treatment planning in clinical and research settings. Here, we describe the development of the PARDI and provide a preliminary report on feasibility, acceptability, reliability, and validity in relation to ARFID. METHOD: We created an initial item pool from existing measures of similar constructs and clinical experience. The PARDI includes items assessing the level of endorsement and overall severity of common ARFID features organized into profiles (i.e., sensory sensitivity, lack of interest in eating, and fear of aversive consequences) and algorithms for diagnosing ARFID, pica, and RD. We collected initial psychometric data from participants (10-22 years) with ARFID (n = 39), clinically significant avoidant/restrictive eating (n = 8), and healthy controls (n = 10). RESULTS: On average, the PARDI took 39 min to complete and was acceptable to participants. All subscales achieved internal consistency greater ≥0.77, and inter-rater reliability for the ARFID diagnosis was moderate (κ = 0.75). Individuals with ARFID scored significantly higher than healthy controls on ARFID severity and ARFID profiles. DISCUSSION: The PARDI appears acceptable to respondents and preliminary evidence of reliability and validity has been demonstrated in an initial sample. Larger-scale validation studies are currently underway. The PARDI is freely available to clinicians and researchers.
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Trastornos de Ingestión y Alimentación en la Niñez/psicología , Pica/psicología , Adolescente , Adulto , Niño , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Femenino , Humanos , Entrevistas como Asunto , Masculino , Proyectos Piloto , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
Feeding difficulties are common and significant issues for children with autism spectrum disorder and their families. Key features of autism are intrinsically linked with factors contributing to these children's feeding difficulties. Following a multidisciplinary assessment to exclude non-behavioural reasons for the feeding difficulty, there are two mainstay modalities of treatment: operant conditioning and systematic desensitisation. Currently, evidence points towards operant conditioning as the most efficacious psychotherapy. However, recent research into cognitive behavioural therapy for older children with feeding difficulties has shown promising results and will be an area to monitor in the coming years. This review outlines the causes and health impacts and evaluates current evidence supporting the available psychotherapeutic interventions for children with autism spectrum disorder experiencing feeding difficulties.
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Trastorno del Espectro Autista/complicaciones , Trastornos de Ingestión y Alimentación en la Niñez/etiología , Adolescente , Niño , Terapia Cognitivo-Conductual , Conducta Alimentaria , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Femenino , Humanos , MasculinoRESUMEN
OBJECTIVES: Although several studies have demonstrated the short-term benefit of the behavioral treatment of rumination syndrome, few have investigated the long-term outcomes. Studies reporting long-term benefit have involved combined pediatric and adult samples or have examined outcomes of patients involved in various types of treatment. The purpose of the present study was to examine several aspects of long-term outcome in adolescent patients who took part in the same intensive, interdisciplinary, inpatient behavioral treatment approach. METHODS: Self-report measures were completed by 47 adolescent patients (mean ageâ=â15.9) around 1 year or more from discharge from our inpatient program. Measures indexed changes in rumination, medical outcomes (eg, use of supplemental nutrition), somatic symptoms, and quality of life. RESULTS: Most patients reported continued improvement in their rumination over time, with 20% reporting cessation of rumination for at least 6 months. The majority of patients no longer required supplemental nutrition and reported improvements in somatic symptoms and quality of life. Patients who reported greater improvement in rumination also reported more significant improvements in their somatic symptoms and quality of life. CONCLUSIONS: Intensive behavioral treatment of rumination syndrome leads to long-term improvement in rumination as well as other related factors, including somatic symptoms and quality of life.
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Terapia Conductista/métodos , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Hospitalización , Adolescente , Trastornos de Ingestión y Alimentación en la Niñez/diagnóstico , Trastornos de Ingestión y Alimentación en la Niñez/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Síntomas sin Explicación Médica , Calidad de Vida , Autoinforme , Síndrome , Resultado del TratamientoRESUMEN
OBJECTIVE: This study aimed to compare outcomes of different multidisciplinary feeding therapy approaches in children with feeding difficulties. METHODS: Children aged 2 to 6 years with feeding difficulties and a medically complex history (MC) were recruited. Children with feeding difficulties and a nonmedically complex history (NMC) were included as a comparison group. Participants attended a clinical assessment, and eligible participants were randomized to receive targeted feeding intervention incorporating either operant conditioning or systematic desensitization. Parents could elect to receive intervention in an intensive (10 sessions in a week) or weekly (10 sessions during 10 weeks) format. Both groups received immersive parent training. A review was completed 3 months post-intervention. RESULTS: In total, 98 participants were eligible to participate (MC, nâ=â43; NMC, nâ=â55). Data from 20 children from the MC group (47%) and 41 children from the NMC group (75%) were included in the final analysis. Clinically significant improvements were observed following both arms of therapy, consistent with previous research. Parents of children in the MC arm were significantly more likely to elect for intensive intervention than weekly (MCâ=â12/20, 60%; 12/41, 29%; Pâ=â0.02). CONCLUSIONS: Both therapy protocols were considered clinically effective. The difference in attrition rates between the etiological groups suggests primary differences in how service delivery should be managed. Progress for the medically complex child may be slower while medical issues are stabilized, or while the focus for parents shifts to other developmental areas. In planning services for a medically complex group, therefore, it is essential that consideration be given to medical and family needs.
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Terapia Conductista/métodos , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Apoyo Nutricional/métodos , Niño , Preescolar , Condicionamiento Operante , Desensibilización Psicológica , Trastornos de Ingestión y Alimentación en la Niñez/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Resultado del TratamientoRESUMEN
BACKGROUND: Admissions of infants in England have increased substantially but there is little evidence whether this is across the first year or predominately in neonates; and for all or for specific causes. We aimed to characterise this increase, especially those admissions that may be avoidable in the context of postnatal care provision. METHODS: A cross sectional analysis of 1,387,677 infants up to age one admitted to English hospitals between April 2008 and April 2014 using Hospital Episode Statistics and live birth denominators for England from Office for National Statistics. Potentially avoidable conditions were defined through a staged process with a panel. RESULTS: The rate of hospital admission in the first year of life for physiological jaundice, feeding difficulties and gastroenteritis, the three conditions identified as potentially preventable in the context of postnatal care provision, increased by 39% (39.55 to 55.33 per 1000 live births) relative to an overall increase of 6% (334.97 to 354.55 per 1000 live births). Over the first year the biggest increase in admissions occurred in the first 0-6 days (RR 1.26, 95% CI 1.24 to 1.29) and 85% of the increase (12.36 to 18.23 per 1000 live births) in this period was for the three potentially preventable conditions. CONCLUSIONS: Most of the increase in infant hospital admissions was in the early neonatal period, the great majority being accounted for by three potentially avoidable conditions especially jaundice and feeding difficulties. This may indicate missed opportunities within the postnatal care pathway and given the enormous NHS cost and parental distress from hospital admission of infants, requires urgent attention.
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Hospitalización/estadística & datos numéricos , Enfermedades del Recién Nacido/terapia , Parto , Estudios Transversales , Inglaterra/epidemiología , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Femenino , Gastroenteritis/terapia , Costos de Hospital , Hospitalización/economía , Humanos , Lactante , Recién Nacido , Ictericia Neonatal/terapia , Atención Posnatal/normas , EmbarazoRESUMEN
PURPOSE OF REVIEW: The prevalence of feeding disorders in medically complex children is estimated to be as high as 80%. Enteral tube nutrition (ETN) is commonly used for nutritional support in children with feeding disorders. Adverse consequences of ETN include medical complications, psychosocial problems, and higher healthcare costs. We used a retrospective cohort controlled study design to compare outcomes of our outpatient multidisciplinary intensive feeding therapy (IFT) program to our traditional therapy (TT) of single-discipline, once weekly feeding therapy to reduce ETN dependence in medically complex young children. RECENT FINDINGS: Children in the IFT cohort experienced a median reduction in ETN dependence of 49% (34.5-58.5%) compared with a median reduction of 0% (0-25%) for TT (p > 0.0001). Almost half of the IFT cohort no longer required ETN by the conclusion of the 5-week program. Medically complex young children (median age 26 months) successfully reduce or eliminate ETN in an outpatient multidisciplinary intensive feeding program.
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Atención Ambulatoria/métodos , Nutrición Enteral/estadística & datos numéricos , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Atención Ambulatoria/estadística & datos numéricos , Preescolar , Femenino , Humanos , Lactante , Masculino , Grupo de Atención al Paciente , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Enteral nutrition is effective in ensuring nutritional requirements and growth. However, when tube feeding lasts for a longer period, it can lead to tube dependency in the absence of medical reasons for continuation of tube feeding. Tube-dependent children are unable or refuse to start oral activities and they lack oral skills. Tube dependency has health-, psychosocial-, and economy-related consequences. Therefore, the transition to oral feeding is of great importance. However, this transition can be very difficult and needs a multidisciplinary approach. Most studies for treatment of tube dependency are based on behavioral interventions, such as family therapy, individual behavior therapy, neuro-linguistic programming, and parental anxiety reduction. Furthermore, oral motor therapy and nutritional adjustments can be helpful in tube weaning. The use of medication has been described in the literature. Although mostly chosen as the last resort, hunger-inducing methods, such as the Graz-model and the Dutch clinical hunger provocation program, are also successful in weaning children off tube feeding. CONCLUSION: The transition from tube to oral feeding is important in tube-dependent children but can be difficult. We present an overview for the prevention and treatment of tube dependency. What is known: ⢠Longer periods of tube feeding can lead to tube dependency. ⢠Tube weaning can be very difficult. What is new: ⢠Weaning as soon as possible and therefore referral to a multidisciplinary team are recommended. ⢠An overview of treatment options for tube dependency is presented in this article.
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Nutrición Enteral/efectos adversos , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Intubación Gastrointestinal/efectos adversos , Terapia Conductista , Niño , Terapia Combinada , Nutrición Enteral/métodos , Nutrición Enteral/psicología , Terapia Familiar , Conducta Alimentaria/psicología , Trastornos de Ingestión y Alimentación en la Niñez/etiología , Trastornos de Ingestión y Alimentación en la Niñez/psicología , Humanos , Intubación Gastrointestinal/psicología , Programación NeurolingüísticaRESUMEN
The requirements of evidence-based practice in 2017 are motivating new theoretical foundations and methodological tools for characterizing neonatal feeding behavior. Toward that end, this article offers a complex dynamical systems perspective. A set of critical concepts from this perspective frames challenges faced by speech-language pathologists and allied professionals: when to initiate oral feeds, how to determine the robustness of neonatal breathing during feeding and appropriate levels of respiratory support, what instrumental assessments of swallow function to use with preterm neonates, and whether or not to introduce thickened liquids. In the near future, we can expect vast amounts of new data to guide evidence-based practice. But unless practitioners are able to frame these issues in a systems context larger than the individual child, the availability of "big data" will not be effectively translated to clinical practice.
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Conducta Alimentaria/fisiología , Trastornos de Ingestión y Alimentación en la Niñez/diagnóstico , Trastornos de Ingestión y Alimentación en la Niñez/fisiopatología , Enfermedades del Prematuro/diagnóstico , Enfermedades del Prematuro/fisiopatología , Deglución/fisiología , Práctica Clínica Basada en la Evidencia , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Humanos , Alimentos Infantiles , Fórmulas Infantiles , Recién Nacido , Enfermedades del Prematuro/terapia , Comunicación Interdisciplinaria , Colaboración Intersectorial , Terapia Respiratoria , Patología del Habla y Lenguaje , Conducta en la Lactancia/fisiología , Viscosidad , Trabajo Respiratorio/fisiologíaRESUMEN
As the number of speech-language pathologists (SLPs) responsible for swallowing and feeding services in the educational setting increases, guidance informing this specialized practice continues to emerge. Although SLPs have provided dysphagia management for children in medical settings for many years, the extension of dysphagia services to the schools is comparatively new. This shift in care delivery for what was previously a hospital-based practice is now occurring more frequently, and in an environment void of extensive medical supports (i.e., the schools). With this transition, evidence-based approaches tailored to children with dysphagia receiving intervention in the school setting are paramount. Components that appear critical to this evolving specialty area include research, best practice guidelines, knowledge and skills training, and collaboration across professionals. This article addresses these pertinent issues by reflecting upon the past, reviewing the present, and planning for the future.
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Trastornos de Deglución/terapia , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Servicios de Salud Escolar , Niño , Atención a la Salud/tendencias , Predicción , Humanos , Comunicación Interdisciplinaria , Colaboración Intersectorial , Grupo de Atención al Paciente/tendencias , Servicios de Salud Escolar/tendencias , Patología del Habla y Lenguaje/tendencias , Estados UnidosRESUMEN
Feeding skills of preterm neonates in a neonatal intensive care unit are in an emergent phase of development and require careful support to minimize stress. The underpinnings that influence and enhance both neuroprotection and safety were discussed in Part I. An infant-guided, co-regulated approach to feeding can protect the vulnerable neonate's neurologic development, support the parent-infant relationship, and prevent feeding problems that may endure. Contingent interventions are used to maintain subsystem stability and enhance self-regulation, development, and coping skills. This co-regulation between caregiver and neonate forms the foundation for a positive infant-guided feeding experience. Caregivers select evidence-based interventions contingent to the newborn's communication. When these interventions are then titrated from moment to moment, neuroprotection and safety are fostered.
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Recien Nacido Extremadamente Prematuro/fisiología , Enfermedades del Prematuro/fisiopatología , Enfermedades del Prematuro/terapia , Recién Nacido de muy Bajo Peso/fisiología , Unidades de Cuidado Intensivo Neonatal , Neuroprotección/fisiología , Seguridad del Paciente , Señales (Psicología) , Práctica Clínica Basada en la Evidencia , Enfermería de la Familia , Trastornos de Ingestión y Alimentación en la Niñez/mortalidad , Trastornos de Ingestión y Alimentación en la Niñez/fisiopatología , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Humanos , Recién Nacido , Enfermedades del Prematuro/mortalidad , Alta del Paciente , Relaciones Profesional-Familia , Tasa de SupervivenciaRESUMEN
Neonatal feeding has been traditionally understudied so guidelines and evidence-based support for common feeding practices are limited. A major contributing factor to the paucity of evidence-based practice in this area has been the lack of simple-to-use, low-cost tools for monitoring sucking performance. We describe new methods for quantifying neonatal sucking performance that hold significant clinical and research promise. We present early results from an ongoing study investigating neonatal sucking as a marker of risk for adverse neurodevelopmental outcomes. We include quantitative measures of sucking performance to better understand how movement variability evolves during skill acquisition. Results showed the coefficient of variation of suck duration was significantly different between preterm neonates at high risk for developmental concerns (HRPT) and preterm neonates at low risk for developmental concerns (LRPT). For HRPT, results indicated the coefficient of variation of suck smoothness increased from initial feeding to discharge and remained significantly greater than healthy full-term newborns (FT) at discharge. There was no significant difference in our measures between FT and LRPT at discharge. Our findings highlight the need to include neonatal sucking assessment as part of routine clinical care in order to capture the relative risk of adverse neurodevelopmental outcomes at discharge.
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Práctica Clínica Basada en la Evidencia/métodos , Trastornos de Ingestión y Alimentación en la Niñez/diagnóstico , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Enfermedades del Prematuro/diagnóstico , Enfermedades del Prematuro/terapia , Conducta en la Lactancia/fisiología , Trastornos de Ingestión y Alimentación en la Niñez/fisiopatología , Humanos , Lactante , Recién Nacido , Enfermedades del Prematuro/fisiopatología , Monitoreo Fisiológico/métodos , Trastornos del Neurodesarrollo/diagnóstico , Trastornos del Neurodesarrollo/fisiopatología , Trastornos del Neurodesarrollo/terapia , Alta del Paciente , Pronóstico , Medición de RiesgoRESUMEN
Speech-language pathologists (SLPs) have fulfilled primary roles in the evaluation and management of children with feeding/swallowing disorders for more than five decades. The increased incidence and prevalence of newborns, infants, and children with feeding and swallowing disorders has resulted in increased use of instrumental swallowing evaluations. The videofluoroscopic swallow study and fiberoptic endoscopic evaluation of swallowing are the two most commonly used swallowing assessments by SLPs, with ultrasound used less frequently. This article focuses on updates over the past decade in the procedures and utility of instrumental assessments of swallowing function, and identifies future directions that may enable us to meet the needs of the children who are in our care to attain functional outcomes.
Asunto(s)
Trastornos de Deglución/diagnóstico , Trastornos de Ingestión y Alimentación en la Niñez/diagnóstico , Evaluación de Necesidades/tendencias , Patología del Habla y Lenguaje/tendencias , Niño , Preescolar , Estudios Transversales , Trastornos de Deglución/epidemiología , Trastornos de Deglución/terapia , Endoscopía/instrumentación , Endoscopía/tendencias , Trastornos de Ingestión y Alimentación en la Niñez/epidemiología , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Fluoroscopía/instrumentación , Fluoroscopía/tendencias , Predicción , Humanos , Lactante , Recién Nacido , Patología del Habla y Lenguaje/instrumentación , Grabación en Video/instrumentación , Grabación en Video/tendenciasRESUMEN
BACKGROUND: Upper gastrointestinal disorders typically present with common symptoms. The most relevant non-mucosal diseases are gastroparesis, functional dyspepsia and rumination syndrome. The literature pertaining to these 3 conditions was reviewed. KEY MESSAGES: Gastroparesis is characterized by delayed gastric emptying in the absence of mechanical obstruction of the stomach. The cardinal symptoms include postprandial fullness (early satiety), nausea, vomiting and bloating. The most frequently encountered causes of these symptoms are mechanical obstruction (pyloric stenosis), iatrogenic disease, gastroparesis, functional dyspepsia, cyclical vomiting and rumination syndrome. The most common causes of gastroparesis are neuropathic disorders such as diabetes, idiopathic, post-vagotomy and scleroderma among myopathic disorders. Principles of management of gastroparesis include exclusion of mechanical obstruction with imaging and iatrogenic causes with careful medication and past surgical history. Prokinetics and anti-emetics are the mainstays of treatment. Functional dyspepsia is characterized by the same symptoms as gastroparesis; in addition to delayed gastric emptying, pathophysiological abnormalities include accelerated gastric emptying, impaired gastric accommodation and gastric or duodenal hypersensitivity to distension and nutrients. Novel treatments include tricyclic antidepressants in patients with normal gastric emptying, acotiamide (acetyl cholinesterase inhibitor) and 5-HT1A receptor agonists such as buspirone. Rumination syndrome is characterized by repetitive regurgitation of gastric contents occurring within minutes after a meal. Episodes often persist for 1-2 h after the meal, and the regurgitant consists of partially digested food that is recognizable in its taste. Regurgitation is typically effortless or preceded by a sensation of belching. This has been summarized as a 'meal in, meal out, day in, day out' behavior for weeks or months, differentiating rumination from gastroparesis. Patients often have a background of psychological disorder or a prior eating disorder. Treatment is based on behavioral modification. CONCLUSION: Precise identification of the cause and pathophysiology of upper gastrointestinal symptoms is essential for optimal management.
Asunto(s)
Dispepsia/etiología , Trastornos de Ingestión y Alimentación en la Niñez/diagnóstico , Gastroparesia/etiología , Adolescente , Adulto , Diagnóstico Diferencial , Dispepsia/diagnóstico , Dispepsia/tratamiento farmacológico , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Femenino , Gastroparesia/diagnóstico , Gastroparesia/tratamiento farmacológico , Humanos , MasculinoRESUMEN
OBJECTIVES: The aim of this pilot study was to investigate feasibility and preliminary efficacy of an intensive, manual-based behavioral feeding intervention for children with chronic food refusal and dependence on enteral feeding or oral nutritional formula supplementation. METHODS: Twenty children ages 13 to 72 months (12 boys and 8 girls) meeting criteria for avoidant/restrictive food intake disorder were randomly assigned to receive treatment for 5 consecutive days in a day treatment program (nâ=â10) or waitlist (nâ=â10). A team of trained therapists implemented treatment under the guidance of a multidisciplinary team. Parent training was delivered to support generalization of treatment gains. We tracked parental attrition and attendance, as well as therapist fidelity. Primary outcome measures were bite acceptance, disruptions, and grams consumed during meals. RESULTS: Caregivers reported high satisfaction and acceptability of the intervention. Three participants (1 intervention; 2 waitlist) dropped out of the study before endpoint. Of the expected 140 treatment meals for the intervention group, 137 (97.8%) were actually attended. The intervention group showed significantly greater improvements (Pâ<â0.05) on all primary outcome measures (dâ=â1.03-2.11) compared with waitlist (dâ=â-1.13-0.24). A 1-month follow-up suggested stability in treatment gains. CONCLUSIONS: Results from this pilot study corroborate evidence from single-subject and nonrandomized studies on the positive effects of behavioral intervention. Findings support the feasibility and preliminary efficacy of this manual-based approach to intervention. These results warrant a large-scale randomized trial to test the safety and efficacy of this intervention.
Asunto(s)
Terapia Conductista , Conducta Infantil , Dieta Saludable , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Preferencias Alimentarias , Grupo de Atención al Paciente , Cooperación del Paciente , Preescolar , Terapia Combinada/efectos adversos , Estudios de Factibilidad , Trastornos de Ingestión y Alimentación en la Niñez/dietoterapia , Femenino , Estudios de Seguimiento , Georgia , Humanos , Lactante , Masculino , Manuales como Asunto , Comidas , Padres/educación , Aceptación de la Atención de Salud , Proyectos Piloto , Guías de Práctica Clínica como AsuntoRESUMEN
OBJECTIVES: Functional disorders of the upper gastrointestinal tract are frequently diagnosed in children. Four different clinical entities are addressed by the Rome III committee: functional dyspepsia (FD), cyclic vomiting syndrome (CVS), adolescent rumination syndrome (ARS), and aerophagia. Management of these disorders is often difficult leading to a wide variety in therapeutic interventions. We hypothesize that definitions and outcome measures in these studies are heterogeneous as well. Our aim is to systematically assess how these disorders and outcomes are defined in therapeutic randomized controlled trials (RCTs). STUDY DESIGN: CENTRAL, Embase, and MEDLINE/PubMed were searched from inception to February 25, 2015. Search terms were FD, CVS, ARS, and aerophagia. Therapeutic RCTs, or systematic reviews of RCTs, in English language including subjects ages 4 to 18 years (0-18 years for CVS) were evaluated. Quality was assessed using the Delphi list. RESULTS: A total of 1398 articles were found of which 8 articles were included. Seven concerned FD and 1 concerned CVS. In all of the studies, Rome criteria or similar definitions were used; all the studies however used different outcome measures. Seventy-five percent of the trials were of good methodological quality. Only 57% used validated pain scales. CONCLUSIONS: Different outcome measures are used in therapeutic trials on functional disorders of the upper gastrointestinal tract. There is a clear paucity of trials evaluating different treatment regimens regarding CVS, ARS, and aerophagia. Uniform definitions, outcome measures, and validated instruments are needed to make a comparison between intervention studies possible.