nursing perspective on feeding evaluation and...
TRANSCRIPT
Nursing Perspective on
Feeding Evaluation and
Treatment
Cyndi Chapman, APRN,MSN,MHCL
August 2017
Nursing Perspective on Feeding Evaluation and
Treatment
• OBJECTIVES:
• Participant will understand the nursing assessment regarding feeding issues
• Participant will be able to verbalize the nurse’s role in the interdisciplinary
team for feeding plans
• Participant will learn different tools from a nursing perspective for feeding
evaluation.
Nursing Perspective on Feeding Evaluation and
Treatment
• Different stages of newborn/pediatrics
• Prematurity
• Newborn
• Specific diagnosis
• Developmental disabilities
• Infant
• Toddlers
• Adolescents
• Pre teen
• Teenager
Nursing Perspective on Feeding Evaluation and
Treatment
• Prematurity
• Assessment
• Gestational age
• Specific diagnosis
• Breast feeding strengthening
• Feeding readiness
• Feeding cues
Nursing Perspective on Feeding Evaluation and
Treatment
• Feeding Cues
Nursing Perspective on Feeding Evaluation and
Treatment
Nursing Perspective on Feeding Evaluation and
Treatment
• Categories
• Structural Abnormalities-anatomic abnormalities of the structures associated with eating and feeding. Examples: defects associate with Pierre-Robin syndrome, retrognathic jaw, cleft palate, posterior tongue placement, macroglossia, tracheotomy, esophageal strictures or stenosis.
• Neurological conditions- feeding problems associated with central nervous systems insult or musculoskeletal disorders. Example, CP, muscular dystrophies, cranial nerve dysfunctions, mental retardation/develo0pmental disabilities, brain stem injury, pervasive developmental disorders
• Behavioral Issues-feeding difficulties resulting from psychosocial difficulties (poor environmental stimulation, dysfunctional feeder-child interaction), negative feeding behaviors shaped and maintained by internal and/or external reinforcement (selective food refusal, rumination) and/or emotionally based difficulties (phobias, conditioned emotional reactions, depression).
Nursing Perspective on Feeding Evaluation and
Treatment
• Categories, cont.
• Cardiorespiratory Problems-feeding difficulties associated with diseases and
symptoms which compromise the cardiovascular and respiratory systems,
complicating the coordination of sucking, swallowing and breathing during feeding.
Ex tachypnea associated with bronchopulmonary dysplasia
• Metabolic dysfunctions-feeding difficulties associate with metabolic diseases and
syndromes which interfere with the development and/or maintenance of normal
feeding patterns. Ex hereditary fructose intolerance, dumping syndrome.
Nursing Perspective on Feeding Evaluation and
Treatment
• Complex pediatric feeding problems
• Normal development
• Pediatric difficulties either medical or developmental
• 25-35%of normal developing have issues
• 33-80% of development delay
• 50-70% of premature infants born before 36 weeks require significan feeding support
• Biobehavioral conditions
• Need to assess biological aspects
• Need to assess behavioral aspects
• Nonorganic vs organic origins
• Non-disruptive social and environmental emotional antecedents and consequences for feeding
• Organic-structural, neuromuscular,or other physiologic reasons
Nursing Perspective on Feeding Evaluation and
Treatment
• Feeding observations are best done in natural environments*
• Assessments should include:
• Manifestation of problem Thorough medical/developmental history
• Data on growth and weight Emotional climate during meals
• Family Stressors Motor skills, posture and tone
• Antenatal and perinatal history Feeding routines and environments
• Oral motor skills and swallowing Sensory processing
• Feeding routines/environments Child behavior prior to and during meals
• Self-regulation/level of alertness Strategies previously used
Nursing Perspective on Feeding Evaluation and
Treatment
• Quality and timing of oral motor skills
• •Strength
• •Coordination
• •Sensory function
• •Tone
• •Asymmetry
• •Cranial nerve function
• •Motor planning
• •Gag, cough, quality of voice, watery eyes/nose –may be indicators of aspiration
• 6/
Nursing Perspective on Feeding Evaluation and
Treatment
• After Assessment
• Oral Motor Stimulation and Exercise
• Positioning
• Behavioral Strategies
• Medications
• Altered Diets
• Sensory Strategies
• Feeding Tubes
• Vital Stim
Nursing Perspective on Feeding Evaluation and
Treatment
• Team discipline
• Pediatric Gastroenterology
• Nursing
• Nutrition
• Occupational Therapy
• Psychology
• Speech pathology
• Pediatricians
• Case Management
Nursing Perspective on Feeding Evaluation and
Treatment
Nursing Perspective on Feeding Evaluation and
Treatment
• Nursing as a part of the interdisciplinary team
• Assessing family situation
• Assessing current situation
• Assessing patient- age dependent
• Social situation
• Eating is learned, not instinctual
• •History of negative experiences
• •Gastrointestinal issues
• •Neurological problems
Nursing Perspective on Feeding Evaluation and
Treatment
• •Congenital malformation
• •Allergies
• •Cardiac and/or respiratory problems
• •Abnormal muscle tone
• •Disordered child-caregiver relationships
• •KIDS DON’T EAT IF THEY DON’T FEEL WELL
Nursing Perspective on Feeding Evaluation and
Treatment
• Feeding is a science
• Feeding is evidence based
• Studies are done based on everything we talk about
• Physiology plays a part
• Breast feeding
• Textures or something else
• It’s all about the baby/child
Nursing Perspective on Feeding Evaluation and
Treatment
• Persistent problem with eating, feeding, and/or swallowing*
• •Chronic food refusal
• •Feeding tube dependence
• •Food selectivity
• •Poor oral intake
• •Swallowing disorder
• TPN
• Oral Aversion
• Hirschsprungs etc
Nursing Perspective on Feeding Evaluation and
Treatment
• Positioning Infants
Key factors for positioning infants*(fair evidence)
•Positioning should be first intervention
•Overall ‘feeling of flexion”
•Head aligned with trunk, elevated
•Most feed optimally semi-upright, with side-tilt positioning
•May also position in front of you with head/neck supported to
facilitate eye contact
•Swaddling provides additional support
Nursing Perspective on Feeding Evaluation and
Treatment
• Position older children
Key factors for positioning older children***(good evidence)
•Goal –Most function with the least support/restriction
•Stable pelvis in neutral position
•Supported feet!
•Neutral or slightly flexed head
•Arms forward and free to move
Nursing Perspective on Feeding Evaluation and
Treatment
• Babbitt RL, Hoch TA, Coe DA, Cataldo MF, Kelly KJ, Stackhouse C, Perman JA. Behavioral assessment and treatment of pediatric feeding disorders. Developmental and Behavioral Pediatrics 1994;15(4):278-291.
• Troughton KE, Hill AE. Relation between objectively measured feeding competence and nutrition in children with cerebral palsy. Developmental Medicine and Child Neurology 2001;43(3):187-190.
• Sharp W G, Jaquess D L, Morton J F, Herzinger C V. Pediatric feeding disorders: A quantitative synthesis of treatment outcomes. Clinical Child and Family Psychology Review 2010.
• Burklow,KathleenA, Phelps, Anne N, Schultz, Janet R, McConnell, Keith, Rudolph, Colin. Classifying Complex Pediatric Feeding Disorders. Journal of Pediatric Gastroenterology& Nutrition 1998. Volume 27. Issue 2 pp143-147.
• Schwarz,Steven M, Corredor, Julissa, Fisher-Medina,Julie, Cohen, Jennifer and Rabinowitz, Simon. Diagnosis and Treatment of Feeding Disorders in Children with Developmental Disabilities. Pediatrics 2001: 108:671.
• Babbitt, Roberta L, Hoch, Theodore A., Coe, David A., Cataldo, Michael F., Kelly, Kevin J., Stackhouse, Claire, Perman, Jay A. Journal of Developmental and Behavioral Pediatrics. August 1994.
Nursing Perspective on Feeding Evaluation and
Treatment
THANK YOU
Questions??