A Multidisciplinary Approach to Pediatric Feeding Disorders: Roles of the Speech-Language Pathologist and Behavioral Psychologist

Experiences of Allied Health Clinicians Accessing a Pilot Project ECHO® Program to Support Learning in Pediatric Feeding

INTRODUCTION

Pediatric feeding disorder is increasing in prevalence, yet low clinician confidence regarding its management is a barrier to care. Targeted clinician training is needed as traditional didactic training programs are limited in both their accessibility and capacity to provide opportunities for the application of theory-based learning.

METHODS

This study examined the experiences of a group of clinicians involved in a multidisciplinary PedFeed ECHO® network, a virtual community of practice established to support speech pathologists, occupational therapists, dieticians, and psychologists in Queensland, Australia, working with children with pediatric feeding disorder. Sixteen clinicians (34% of the total PedFeed ECHO network) from different professional backgrounds, clinical settings, and locations participated in semistructured interviews three months post completion of eight ECHO sessions.

RESULTS

Inductive thematic analysis revealed three themes: (1) broad-ranging outcomes of PedFeed ECHO, (2) participant experiences of PedFeed ECHO, and (3) facilitators for future success. PedFeed ECHO was viewed very positively and provided participants with a valuable opportunity for information sharing and collaboration as a multidisciplinary team. Participants described impacts on their professional practice, knowledge, confidence, and professional isolation, as well as service and patient-level impacts. Several facilitators for the success of future PedFeed ECHO cohorts were provided.

DISCUSSION

Insights from participants will serve to improve the design and delivery of ECHO training for future cohorts. Monitoring clinical skill development over a longer period of time and exploring clinician perceptions regarding direct impact on patient care are needed to further validate the impact of ECHO.

What School-Based Speech-Language Pathologists Need to Know About Pediatric Swallowing and Feeding Development and Disorders

PURPOSE

School-based speech-language pathologists are at the frontline for treating children with pediatric feeding disorders (PFDs). Often, speech-language pathologists are the primary allied health professionals who are charged with maximizing safety, supporting nutrition and neurodevelopmental growth. Due to the increasing need for assessment and treatment of PFDs in schools, it is fundamental that PFDs and dysphagia are detected, differentially diagnosed, and addressed to support developing children. This tutorial addresses the anatomy, physiology, and development of functional feeding and swallowing patterns across the spectrum of childhood for both PFDs and dysphagia.

METHOD

A clinical expert review of the anatomy, physiology, and development of functional feeding and swallowing patterns in children across the spectrum of childhood will be completed.

CONCLUSIONS

The aim of this tutorial is to support school-based speech-language pathologists in their understanding of the anatomy and physiology of feeding and swallowing. School-based speech-language pathologists should complete this tutorial with an increased understanding and breadth of knowledge related to typical anatomy and physiology versus atypical or disordered presentations. This tutorial would support school-based speech-language pathologists in determining whether a child presents with characteristics of oropharyngeal dysphagia and/or a PFD.

Treating Pediatric Feeding Disorders and Dysphagia: Evidence-Based Interventions for School-Based Clinicians

PURPOSE

Children with pediatric feeding disorder (PFD) and dysphagia are increasingly prevalent in school-based caseloads. This tutorial discusses the current best practices for treating children with PFD and dysphagia as well as considerations for service delivery in educational settings.

METHOD

The rationale for treating PFD and dysphagia in an educational setting is discussed. A review of various interventions for PFD and dysphagia and a discussion of the available evidence are provided. The principles of experience-dependent neuroplasticity and theory-driven practice are discussed in light of the need for additional empirical research. Practical considerations to enhance evidence-based practice for PFD and dysphagia in educational settings are explored.

RESULTS

The reader will be able to identify evidence-based interventions for students with PFD and dysphagia and plan for the implementation of these approaches in the school setting.

CONCLUSIONS

Students with PFD and dysphagia require skilled interventions to support their participation in educationally relevant activities and to promote continued development of feeding and swallowing skills while at school. A discussion of the current evidence for various interventions is provided to promote the utilization of evidence-based interventions in school-based settings.

Who Helps Children With Communication Disorders Access Sex Education? Practice Patterns of Speech-Language Pathologists and Psychologists

PURPOSE

Children with communication disorders are often systematically excluded from sex education curricula. They may also have difficulty accessing the curricula because of the materials' linguistic and pragmatic complexity. Even curricula written for children with intellectual disabilities do not typically include considerations for communication disorders. This places them at risk for sexually transmitted infections, sexual health misinformation, and sexual assault. Yet, it is unclear which professionals are assisting children with communication disorders to access sex education.

METHOD

North American speech-language pathologists (SLPs) and clinical psychologists (N = 112) completed a survey that asked about their practice patterns in helping children access sex education, as well as their beliefs about the importance of sex education, how disabilities affect sex education, perceived barriers, and their self-efficacy and role in addressing sex education.

RESULTS

Although SLPs and clinical psychologists believed that communication disorders could affect sex education and consent and felt they had some responsibility for helping their clients in accessing sex education, they did not regularly assist their clients in this area. Both groups of clinicians were divided in their views of their own roles and responsibility. SLPs were especially polarized; every question about their role in addressing sex education included SLPs who fully agreed and some who fully disagreed with the statement.

CONCLUSIONS

Children with communication disorders do not consistently receive assistance accessing sex education curricula from either SLPs or clinical psychologists. Clinicians need education to support them addressing sex education and clear guidance about their roles in this area.

The Effectiveness of Slightly Thick Liquids for Improving Swallowing in Bottle-Fed Children With Aerodigestive Concerns

Purpose

Strategies for facilitating safe and functional bottle feeding in children with dysphagia include selecting nipples that reduce flow rate, pacing, altered positioning, and thickening liquid consistencies. We aimed to determine the impact of slightly thick liquids on swallowing through retrospective review of a convenience sample of clinical videofluoroscopic swallowing studies (VFSS) from 60 bottle-fed children (21 boys and 39 girls, mean age of 9.9 months) referred due to suspected aspiration.

Method

Eligible VFSS exams were those in which the child swallowed both thin and slightly thick barium (40% w/v Varibar barium) using the same nipple. VFSS sequences (i.e., uninterrupted portions of the VFSS recording) were randomly assigned in duplicate for rating by trained raters; discrepancies were resolved by consensus. Parameters measured included number of swallows/sequence, sucks/swallow, swallow and sequence duration, number and timing of penetration or aspiration events, laryngeal vestibule closure integrity, and pharyngeal residue. Chi-square tests, linear mixed-model analyses of variance, and Wilcoxon signed-ranks tests identified consistency effects.

Results

There were no aspiration events in these recordings. Slightly thick liquids resulted in significantly fewer penetration events (p < .05), increased sucks/swallow, fewer swallows/sequence, and longer swallow and sequence durations. The number of children with ≥ 1 sequence showing pyriform sinus residue was significantly higher with slightly thick liquids.

Conclusions

Slightly thick liquids can be effective in reducing penetration in bottle-fed children with dysphagia. However, slightly thick liquids may also lead to a safety-efficiency trade-off, with increased risk of pyriform sinus residue. Thickening for children with dysphagia should be considered only when other approaches are not effective. Overthickening should be avoided to limit negative impact on swallowing efficiency.

A position statement on the post gene-therapy rehabilitation of aromatic I-amino acid decarboxylase deficiency patients

Aromatic L-amino acid decarboxylase (AADC) deficiency is a rare genetic disorder of monoamine neurotransmitter synthesis that presents with a range of symptoms, including motor dysfunction and limited attainment of developmental motor milestones. The approval of eladocagene exuparvovec, a gene therapy for AADC deficiency with demonstrated efficacy for motor improvements, now expands the range of motor outcomes possible for patients with this disorder. However, recommendations and guidelines for therapy following treatment with gene therapy are lacking. To ensure patients can reach their full potential following treatment with gene therapy, it is essential they receive rehabilitation therapies designed specifically with their impairments and goals in mind. Therefore, we highlight specific rehabilitative needs of patients following gene therapy and propose a set of recommendations for the post-treatment period based on collective experiences of therapists, physicians, and caregivers treating and caring for patients with AADC deficiency who have been treated with gene therapy. These recommendations include a focus on periods of intensive therapy, facilitating active movements, training for functional abilities, cognitive and communication training, parent/caregiver empowerment, collaboration between therapists and caregivers to develop in-home programs, and the incorporation of supplemental forms of therapy that patients and their families may find more enjoyable and engaging. Many of these rehabilitative strategies may be employed prior to gene therapy. However, these recommendations will be valuable for therapists, caregivers, and wider treatment teams as they prepare for the post-treatment journey with these patients. Furthermore, the considerations and recommendations presented here may prove beneficial outside the AADC deficiency community as gene therapies and other treatments are developed and approved for other rare diseases.

Feeding Characteristics in Children With Food Allergies: A Scoping Review

BACKGROUND

Food allergy (FA) affects approximately 8% of children and may be immunoglobulin E (IgE)-mediated or non-IgE-mediated. It is recognized clinically that children with both subtypes of FA may present with features of pediatric feeding disorder (PFD); however, there is currently a limited detail of presenting characteristics.

OBJECTIVE

The objective of this study was to synthesize the current evidence regarding the feeding characteristics of children with FA, with a focus on the feeding skills and psychosocial domains of PFD.

METHOD

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Papers published between 2001 and 2022 describing feeding characteristics in the feeding skills and psychosocial domains in children with FA/history of FA were included. Papers that focused solely on characteristics from the medical or nutritional domains were excluded. Descriptive information regarding demographics, methodology, allergy profile and history, and the characteristics of PFD observed was extracted using a preconceived data extraction form.

RESULTS

Overall, 40 papers contained descriptions of feeding characteristics of children with non-IgE-mediated FA (n = 22) and IgE-mediated FA (n = 11), while four were nonspecific. In the psychosocial domain, food refusal/aversion, anxiety with eating, and poor intake were the most frequently reported, regardless of FA subtype. Less information was reported regarding feeding skills, although slowness in eating, immature diet, and delays in oral sensory-motor skills were described.

CONCLUSIONS

Children with FA/history of FA may present with a range of characteristics that map across the feeding skill and psychosocial domains of PFD. Systematic research is needed to fully describe the feeding characteristics of children with FA.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24562732.

Characteristics and health service utilization of children most at risk for prolonged temporary tube feeding

BACKGROUND

This study aimed to describe children at risk of prolonged temporary tube feeding and evaluate associations between tube feeding duration and child and health service variables.

METHODS

A prospective medical hospital records audit was conducted between November 1, 2018, and November 30, 2019. Children at risk of prolonged temporary tube feeding were identified as having a tube feeding duration of >5 days. Information was collected on patient characteristics (eg, age) and service delivery provision (eg, tube exit plans). Data were collected from the pretube decision-making phase until tube removal (if applicable) or until 4 months after tube insertion.

RESULTS

Descriptively, 211 at-risk children (median, 3.7 years; interquartile range [IQR], 0.4-7.7) differed from 283 not-at-risk children (median age, 0.9 years; IQR, 0.4-1.8) in terms of age, geographical location of residence, and tube exit planning. Medical diagnoses of neoplasms, congenital abnormalities, perinatal problems, and digestive system diseases in the at-risk group were individually associated with longer than average tube feeding duration, as were the primary reasons for tube feeding of nonorganic growth faltering and inadequate oral intake related to neoplasms. Yet, variables independently associated with greater odds of lengthier tube feeding durations were consultations with a dietitian, speech pathologist, or interdisciplinary feeding team.

CONCLUSION

Children at risk of prolonged temporary tube feeding access interdisciplinary management because of their complexity. Identified descriptive differences between at-risk and not-at-risk children may be useful when selecting patients for tube exit planning and developing tube feeding management education programs for health professionals.

Impact of diet on sensory processing in early childhood: summary of an interactive webconference / expert roundtable discussion

Pediatric feeding disorders can be seen in up to 45% of normally developing children aged under 5 years old, mainly during the first three years of life when the child has inadequate food intake and/or difficulty maintaining adequate growth, and/or lack of age-appropriate eating habit. This article describes the opinion of a group of experts on children eating patterns and how to manage pediatric feeding disorders, with the aim to improve the quality of life of children and their caregivers.

Teaching the Skill of Chewing From a Behavior Analytic Approach: A Systematic Review

Relatively few empirical studies of pediatric chewing interventions have been published in the psychology literature. The purpose of this paper was to systematically review chewing interventions within the applied behavior analysis literature. We identified a small, but growing, behavior analytic literature demonstrating the effectiveness of various multicomponent treatment packages to teach and improve chewing skills. Future researchers should consider a range of participant characteristics, including results of oral motor assessments, explore a more extensive definition of chewing to target the complex nature of chewing as well as component skills, and examine the necessary and sufficient components of chewing interventions along with the potential benefits of multidisciplinary interventions.

Caregivers' Experiences of Infant Feeding Problems: The Role of Self-Compassion and Stress Management

Introduction Infant feeding problems are strongly associated with caregiver stress, which in turn is linked to poorer outcomes for children. Self-compassion is a modifiable trait strongly associated with improved mental health and greater resilience. The purpose of this study was to investigate the relationships among self-compassion, stress management practices, and caregiver stress in a sample of parents who identified feeding problems in their infants. Method Parents who identified feeding problems in their infants completed an online survey. They described the feeding problems, completed the Self-Compassion Scale and the Perceived Stress Scale, and detailed their stress management practices. Results Higher self-compassion was strongly associated with lower overall stress and more modestly associated with lower feeding-related distress. More severe feeding problems were significantly more stressful for caregivers. Participants reported a wide variety of stress management approaches. Discussion These findings indicate that higher self-compassion is associated with lower caregiver stress for parents whose infants experience feeding problems. Implications for service providers are reviewed. Supplemental Material https://doi.org/10.23641/asha.14831028.