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Feeding in Pediatric OTALLSJune 17th, 2015Melanie Shea, OTI

+Prevalence

20% of children struggle with some type of feeding issue during the first 5 years of life

5-10% of children with severe feeding disorders require medical intervention

1/3 of children with developmental disabilities have associated problems with feeding (Babbitt et al., 1994)

+Prevalence

Myth: Is it a behavioral or organic problem? Burklow et al. (1998) – 85% mixed Budd et al. (1992) – 64% mixed Rose PFC (2001) – 93% mixed

When normal early feeding experiences and interactions have been disrupted, children are at risk of chronic eating difficulties during early childhood. Poor appetite Food refusal and selectivity Delayed skill acquisition Disruptive mealtime behaviors (Babbitt et al., 1994)

+Effect on Parents 68% of mothers felt stressed out during

feeding time (Lewinsohn, 2005). 78% of parents identified the quality of the foods to be

the most important issue (Cerro, 2002) “The more worried a mother was about her child’s

weight, the more her interactions with her child at mealtimes were impacted” (Gueron-Sela et al., 2011).

Caring for these children increases the physical and psychological demands on parents because of balancing the tasks involved in managing the child’s medical care and nutrition, with other aspects of parenting and family life (Wolf & Glass, 1992; Mori, 1997).

Guilt, worry, and stress

+Family Meal Goals1. Volume of preferred foods

2. Exposure to non-preferred foods

3. Creating a mealtime structure and routine

+Negative Feeding Behaviors Crying Tantrums Refusal to accept food into the mouth Gagging Vomiting

+Parent-based Interventions

Have a schedule for meals & snacks Have a consistent seated location for mealtimes Avoid distractions at mealtimes Preparatory activities Use transitional activities Incorporate mealtime-related activities Positive reinforcement

* Reducing anxiety at mealtimes is critical for success

+Social Role Modeling At least one adult sits and eats with child Model good feeding behaviors Talk about the food Over-exaggerate how to eat the food Allow child to help with meal prep Do not punish child

+Steps to Successful Eating

1. Tolerate

2. Interacts with the food

3. Smells

4. Touches

5. Tastes

6. Eats

+Hindrances to OT

Feeding progress is often slow OTs might move to next level before it is appropriate Too many people working on feeding with the child Parents may be too busy/worried on basic needs that

they cannot add in new interventions

+OT Considerations

Safety * Work on spitting Work on more challenging foods in OT before having the

family work on them

Postural stability and proper positioning Sensory techniques prior to feeding Key phrases Parent education and training

+OT Considerations Auditory

Volume of voices Complexity of modeling

Visual Colors of food Clutter

Tactile Tools to interact with Use baggies or gloves Food textures

Taste and Smell Intensity

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+ReferencesClawson, E., & Elliott, C. (2014). Integrating Evidence-Based Treatment of Pediatric Feeding Disorders Into Clinical Practice: Challenges to Implementation. Clinical Practice in Pediatric Psychology, 2(3), 312-321.

Franklin, L., & Rodger, S. (2003). Parents’ perspectives on feeding medically compromised children: Implications for occupational therapy. Australian Occupational Therapy Journal, 50, 137-147.

Howe, T.-H., & Wang, T.-N. (2013). Systematic review of interventions used in or relevant to occupational therapy for children with feeding difficulties ages birth–5 years. American Journal of Occupational Therapy, 67, 405–412. http://dx.doi.org/10.5014/ajot.2013.004564

Maune, N. (2007, March). Pediatric Feeding Issues: Reexamining Assessment and Intervention Using the Sensory Integrative Frame of Reference. American Journal of Occupational Therapy, 30(1), 1-4.

Suarez, M. A., Atchison, B. J., & Lagerwey, M. (2014). Brief Report—Phenomenological examination of the mealtime experience for mothers of children with autism and food selectivity. American Journal of Occupational Therapy, 68, 102–107. http://dx.doi.org/10.5014/ajot.2014.008748

Toomey & Ross (2015). Picky Eaters vs. Problem Feeders – The SOS Approach to Feeding.