Eating behaviors in children with down syndrome: Results of a home-use test

In Vivo Behavior of Transitional Foods as Compared to Purees: A Videofluoroscopic Analysis

PURPOSE

Medically tailored transitional foods (TFs) may be a clinically viable alternative to pureed consistency for individuals requiring texture-modified foods. However, little remains known about the performance of TFs during the swallow. The purpose of this investigation was to describe oropharyngeal swallowing physiology in patients with dysphagia during consumption of TFs as compared to pureed solids.

METHOD

Retrospective chart reviews were conducted on 31 long-term acute care hospital inpatients (23 males; Mage = 57.5 years), who all had a primary medical diagnosis of acute respiratory failure. All patients received a videofluoroscopic swallow study that included both pureed and transitional solid (Savorease Therapeutic Foods) trials. Swallow function was assessed and described following the Modified Barium Swallow Impairment Profile (MBSImP) interpretation approach.

RESULTS

No statistically significant differences in scores were observed between pureed and transitional solids for any of the MBSImP component scores. Similarly, no statistically significant differences were observed in overall oral or pharyngeal composite scores. Although a majority of the individual patients performed similarly on both consistencies across the components scores, there was some variability across a few scores, with a subset of patients performing better with transitional solids for oral and pharyngeal residue and a subset of patients performing better with pureed solids for bolus preparation and initiation of the pharyngeal swallow. No instances of airway invasion were present across any of the solids trialed.

CONCLUSIONS

The findings of this pilot study revealed that high-dissolving transitional solids did not increase apparent risk as compared to pureed textures, as there were no significant differences in swallowing safety and only some differences were observed in performance between the two textures. These findings may support the use of transitional solids as a "bridge" and safe consistency to facilitate progression to higher, more challenging textures in medically complex persons with dysphagia based on individual performance. This work represents an important initial step toward the integration of transitional solids into evaluation protocols, texture recommendations, and, potentially, into treatment.

Tube weaning in children with Down's syndrome-"Waiting is no option"

Down syndrome (DS) is one of the most common genetic disorders and often associated with feeding problems and tube feeding. Although feeding tubes have a life sustaining function, tube dependency can occur including adverse effects such as frequent vomiting, poor appetite and oral aversion. Although various tube weaning programs exist, their effectiveness in children with DS has been studied only to a limited extent. This study investigated outcomes and growth parameters in tube-dependent children (TDC) with DS who participated in a program based on the "Graz Model of tube weaning". The current international prospective cohort study included 33 TDC with DS treated between April 2013 and July 2023 (median age: 1.67 years; IQR: 1.00-4.35). Growth data (weight-for-age z scores [WAZ], height-for-age z scores [HAZ], and BMI z scores [zBMI]) were evaluated before and after weaning. The study assessed treatment duration and predictors of weaning success. Overall success rate was 91.67% with an average treatment duration of 79 days. Duration of weaning for younger children (<3 years) tended to be shorter. Post treatment, significant reductions in WAZ (p = .001) and zBMI (p < .001) occurred. HAZ remained constant. The only significant predictor of treatment duration was the degree of change in zBMI and HAZ (p = .001). This study demonstrated that the "Graz model of tube weaning" is effective in the great majority of TDC with DS. Results showed moderate weight loss but that this did not affect overall growth. Future studies should evaluate long-term nutritional and developmental outcomes post-weaning.

Dietary pattern, physical activity and body composition of Children with and without Down Syndrome - A case control study

Background: Down syndrome (DS) is a known chromosomal disorder that results in changes in physical and clinical characteristics. Subjects with DS are more likely to be obese or overweight and have some recognized nutrition related problems. The objectives of this study are to compare body composition, food consumption pattern and physical activity level of children with and without DS. Methods: A case-control study of 82 participants (32 cases and 50 controls) was done. Anthropometric data related to weight, height, waist circumference, fat mass and fat free mass were obtained from the subjects. Food frequency questionnaire and survey were used to evaluate the dietary intake from 8 food groups and physical activity, respectively. Results: Children with DS exhibited significantly less intake of fruits and leafy vegetables (P < 0.05) compared to controls. There was no significant difference in the average number of sport activities that both children with DS and NDS were involved in, male with DS preferred dancing (P = 0.028) while NDS preferred football (P = 0.008). Statistically significant difference between the cases and controls was found in female fat mass (P = 0.043), waist circumference (P = 0.024, 0.007), hip circumference (P = 0.05, 0.011) and waist to height ratio (P < 0.001) of both male and female children with and without DS. Conclusion: Abdominal obesity is a major health concern among children with DS, indicating their increased risk of comorbidities associated with abdominal obesity such as insulin resistance. Their tendency to consume simple carbohydrate instead of fiber rich food, fruits and vegetables might further increase their risk of obesity. Perception of the dietary and physical activity preferences could help in the development of a life style program for higher quality of life.

Breastfeeding Experiences of Mothers of Children with Down Syndrome: A Qualitative Study

Purpose: It is known that despite the benefits of breast milk and breastfeeding, children with Down syndrome (DS) are breastfed less than other children are. More information is needed to reveal the problems experienced regarding breastfeeding in this group of children and take precautions. The purpose of this study was to learn about the breastfeeding experiences of mothers of children with DS. Methods: The study was carried out by conducting in-depth interviews with 17 women who met the inclusion criteria in Turkey between September 1 and December 1, 2023. Content analysis was used to analyze the data. Results: As a result of the content analysis, five themes emerged. These themes were changing of body and emotions, why doesn't my baby suck?, I have to breastfeed my baby, I am not alone, and experiences should be shared. Conclusions: It was determined that mothers of children with DS experienced problems/difficulties due to individual, baby-related, and environmental factors. The positive effects of breastfeeding children with DS can be made prevalent in society by supporting these mothers.

Complementary feeding practices of caregivers of infants with Down syndrome as compared to caregivers of typically developing infants

Caregiver feeding practices during the complementary feeding period (6 months-2 years) may be particularly important for infants with Down syndrome (DS) as they are at higher risk for later health conditions (e.g., obesity, diabetes) that can be influenced by early feeding practices. However, how well caregivers of infants with DS are meeting infant feeding evidence-based practices is relatively unknown. Caregivers of infants with DS (N = 75) and caregivers of typically developing (TD) infants (N = 66) aged 0-2 years completed an online survey about their infant feeding practices and information sources. Caregiver practices and information sources were statistically compared between groups. Results indicated that there are significant differences in the feeding practices of caregivers of infants with DS when compared to caregivers of TD infants. Caregivers of infants with DS were less likely to meet infant feeding evidence-based practices than caregivers of TD infants. Caregivers of infants with DS were also more concerned about their infant's food intake and later weight status. Some individual feeding practices also significantly differed between groups, with caregivers of infants with DS more likely to meet evidence-based practices of purchasing iron rich foods and avoiding added salt, but less likely to use responsive feeding practices than caregivers of TD infants. Caregivers of infants with DS were also less likely to receive information about how to navigate the complementary feeding period than caregivers of TD infants. Coupled with existing research, the results of the present study suggest that infant feeding evidence-based practices should be reviewed for their appropriateness for this population and additional support for caregivers of infants with DS should be implemented to help them navigate this important period.

The olfactory bulb: A neuroendocrine spotlight on feeding and metabolism

Olfaction is the most ancient sense and is needed for food-seeking, danger protection, mating and survival. It is often the first sensory modality to perceive changes in the external environment, before sight, taste or sound. Odour molecules activate olfactory sensory neurons that reside on the olfactory epithelium in the nasal cavity, which transmits this odour-specific information to the olfactory bulb (OB), where it is relayed to higher brain regions involved in olfactory perception and behaviour. Besides odour processing, recent studies suggest that the OB extends its function into the regulation of food intake and energy balance. Furthermore, numerous hormone receptors associated with appetite and metabolism are expressed within the OB, suggesting a neuroendocrine role outside the hypothalamus. Olfactory cues are important to promote food preparatory behaviours and consumption, such as enhancing appetite and salivation. In addition, altered metabolism or energy state (fasting, satiety and overnutrition) can change olfactory processing and perception. Similarly, various animal models and human pathologies indicate a strong link between olfactory impairment and metabolic dysfunction. Therefore, understanding the nature of this reciprocal relationship is critical to understand how olfactory or metabolic disorders arise. This present review elaborates on the connection between olfaction, feeding behaviour and metabolism and will shed light on the neuroendocrine role of the OB as an interface between the external and internal environments. Elucidating the specific mechanisms by which olfactory signals are integrated and translated into metabolic responses holds promise for the development of targeted therapeutic strategies and interventions aimed at modulating appetite and promoting metabolic health.

The influence of food sensory properties on eating behaviours in children with Down syndrome

Developing new food products for children is challenging, particularly in vulnerable groups including children with Down syndrome (DS). Focusing on children with DS, the aim of this study was to study the influence of parent liking on acceptance of food products by children with DS and demonstrate the influence of food sensory properties on indicators of food acceptance, food rejection, and challenging eating behaviours. Children (ages 1158 months) with DS (n = 111) participated in a home use test evaluating snack products with varying sensory properties as profiled by a trained sensory panel. Parents recorded their children's reactions to each food product; trained coders coded videos for eating behaviours. To understand the influence of each sensory modality on eating behaviour, ordered probit regression models were run. Results found a significant correlation between the parent liking and overall child disposition to the food (p < 0.05). From the regression analysis, the inclusion of all food sensory properties, including texture, flavour, taste, product shape and size, improved the percentage of variance explained in child mealtime behaviours and overall disposition over the base model (containing no sensory modalities), with texture having the largest influence. Overstuffing the mouth, a challenging eating behaviour, was most influenced by product texture (children ≥ 30 months), and product texture and size (children < 30 months). In both age groups, coughing/choking/gagging was most influenced by food texture and was associated with a product that was grainy and angular (sharp corners). In both age groups, product acceptance was associated with a product that was dissolvable, crispy, and savoury while rejection was associated with a dense, gummy and fruity product. These results suggest that a dissolvable, crispy texture, with a cheesy or buttery flavour are the sensory properties important in a desirable flavoured commercial snack product for children with DS; however, overall disposition must be balanced against mouth overstuffing.

Feeding Stressors and Resources Used by Caregivers of Children With Down Syndrome: A Qualitative Analysis

BACKGROUND

Challenging eating behaviors or feeding difficulties, commonly displayed in children with Down syndrome (DS), may amplify perceived stress in caregivers. If caregivers lack resources on how to accommodate the needs of the child with DS, they may find feeding the child stressful and resort to negative coping strategies.

OBJECTIVE

The aim of this study was to understand the feeding stressors, resources, and coping strategies used by caregivers of children with DS.

DESIGN

A qualitative analysis of interview transcripts was undertaken, framed around the Transactional Model of Stress and Coping.

PARTICIPANTS/SETTING

Between September to November 2021, 15 caregivers of children (aged 2 through 6 years) with DS, were recruited from 5 states located in the Southeast, Southwest, and West regions of the United States.

ANALYSIS

Interviews were audio-recorded, transcribed verbatim, and analyzed using deductive thematic analysis and content analysis approaches.

RESULTS

Thirteen caregivers reported increased stress around feeding the child with DS. Stressors identified included concern about adequacy of intake and challenges associated with feeding difficulties. Stress related to feeding was higher among caregivers whose child was learning a new feeding skill or in a transitional phase of feeding. Caregivers used both professional and interpersonal resources in addition to problem- and emotion-based coping strategies.

CONCLUSIONS

Caregivers identified feeding as a stressful event with higher stress reported during transitional phases of feeding. Caregivers reported that speech, occupational, and physical therapists were beneficial resources to provide support for optimizing nutrition and skill development. These findings suggest that caregiver access to therapists and registered dietitian nutritionists is warranted.

A Scoping Review of the Complementary Feeding Practices and Early Eating Experiences of Children With Down Syndrome

OBJECTIVE

Children with Down syndrome may experience more challenges in their early feeding and may be introduced to complementary foods comparatively later than typically developing (TD) children. This scoping review aimed to identify and synthesize the existing literature that describes feeding problems and early eating experiences relating to the period of complementary feeding for children with Down syndrome.

METHODS

Scopus, PubMed, Medline, Web of Science, and PsycInfo were searched. Journal articles published between January 1991 and June 2022 that reported on the complementary feeding period with children with Down syndrome were included.

RESULTS

Eighteen journal articles met the inclusion criteria. Children with Down syndrome were introduced to complementary foods later than TD children and progressed to more challenging food textures at a slower rate. Gross and fine motor skill delays and sensory difficulties contributed to secondary feeding problems such as difficulties chewing, biting, and reduced awareness of food on lips and tongue. Parents of children with Down syndrome reported exercising more caution and employing more controlling feeding practices compared to TD and had higher levels of concern regarding their child's weight.

CONCLUSIONS

Guidelines and early feeding support specific to children with Down syndrome should be available before the first complementary foods are introduced and throughout this period. Feeding support should aim to address parental concerns and provide assistance when feeding problems occur, to minimize delays and encourage the optimum development of eating abilities. Future research should address the development of feeding problems during this period and explore possible interventions.

Hypovitaminosis D in persons with Down syndrome and autism spectrum disorder

BACKGROUND

Plasma levels of vitamin D have been reported to be low in persons with Down syndrome (DS) and existing data is limited to small and homogenous cohorts. This is of particular importance in persons with DS given the high rates of autoimmune disease in this population and the known relationship between vitamin D and immune function. This study sought to investigate vitamin D status in a multi-center cohort of individuals with DS and compare them to individuals with autism spectrum disorder (ASD) and neurotypical (NT) controls.

METHODS

A retrospective, multi-center review was performed. The three sites were located at latitudes of 42.361145, 37.44466, and 34.05349. Patients were identified by the International Classification of Diseases (ICD)-9 or ICD-10 codes for DS, ASD, or well-child check visits for NT individuals. The first vitamin D 25-OH level recorded in the electronic medical record (EMR) was used in this study as it was felt to be the most reflective of a natural and non-supplemented state. Vitamin D 25-OH levels below 30 ng/mL were considered deficient.

RESULTS

In total, 1624 individuals with DS, 5208 with ASD, and 30,775 NT controls were identified. Individuals with DS had the lowest mean level of vitamin D 25-OH at 20.67 ng/mL, compared to those with ASD (23.48 ng/mL) and NT controls (29.20 ng/mL) (p < 0.001, 95% CI: -8.97 to -6.44). A total of 399 (24.6%) individuals with DS were considered vitamin D deficient compared to 1472 (28.3%) with ASD and 12,397 (40.3%) NT controls (p < 0.001, 95% CI: -5.43 to -2.36). Individuals with DS with higher body mass index (BMI) were found to be more likely to have lower levels of vitamin D (p < 0.001, 95% CI: -0.3849 to -0.1509). Additionally, having both DS and a neurologic diagnosis increased the likelihood of having lower vitamin D levels (p < 0.001, 95% CI: -5.02 to -1.28). Individuals with DS and autoimmune disease were much more likely to have lower vitamin D levels (p < 0.001, 95% CI: -6.22 to -1.55). Similarly, a history of autoimmunity in a first-degree relative also increased the likelihood of having lower levels of vitamin D in persons with DS (p = 0.01, 95% CI: -2.45 to -0.63).

CONCLUSIONS

Individuals with DS were noted to have hypovitaminosis D in comparison to individuals with ASD and NT controls. Associations between vitamin D deficiency and high BMI, personal autoimmunity, and familial autoimmunity were present in individuals with DS.

Observations of feeding practices of US parents of young children with Down syndrome

Parental behaviours influence food acceptance in young children, but few studies have measured these behaviours using observational methods, especially among children with Down syndrome (CWDS). The overall goal of this study was to understand parent feeding practices used during snack time with young CWDS (N = 111, aged 11-58 months). A coding scheme was developed to focus on feeding practices used by parents of CWDS from a structured home-use test involving tasting variously textured snack products. Behavioural coding was used to categorise parental feeding practices and quantify their frequencies (N = 212 video feeding sessions). A feeding prompt was coded as successful if the child ate the target food product or completed the prompt within 20 s of the prompt being given without a refusal behaviour. CWDS more frequently consumed the test foods and completed tasks in response to Autonomy-Supportive Prompts to Eat (49.3%), than to Coercive-Controlling Prompts to Eat (24.2%). By exploring the parent-CWDS relationship during feeding, we can identify potentially desirable parent practices to encourage successful feeding for CWDS. Future research should build upon the knowledge gained from this study to confirm longitudinal associations of parent practices with child behaviours during feeding.

Associations between parenting strategies and BMI percentile among Latino children and youth with intellectual and developmental disabilities

Introduction

Maintaining healthy weight is a challenge for all children, and particularly for children with IDD compared to nondisabled children and for Latino children compared to non-Latino White children. Parenting practices related to food intake and physical activity have been found to be important in maintaining children's weight. In this study, we describe the prevalence of overweight and obesity status among Latino children with IDD and their maternal caregivers and determine the relationship between food and physical activity parenting practices and childhood obesity among Latino children with IDD.

Methods

We interviewed 94 Latino parent/child dyads and collected information about parenting practices, home environment, and parent and child height and weight using standardized measures. Parent body mass index (BMI) and child BMI percentile were calculated from height and weight.

Results

The combined overweight/obesity status for children in our sample was high (60.3%) compared to national rates among nondisabled Latino children (56%) and non-Latino White children with autism (37%). Contrary to research on nondisabled children, we found that greater parental use of controlling dietary strategies was associated with lower BMI percentile in Latino children with IDD. These findings may be indicative of the fact that children with IDD tend to have unique dietary behaviors that warrant more disability and culturally sensitive strategies.

Discussion

Our findings suggest that overweight and obesity is especially prevalent for Latino children with IDD and that more research is needed on family factors that promote health in Latino families of children with IDD.