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Kaskie S, Horsley M, Marcuccio E. Experiences in Tube Weaning Children with Congenital Heart Disease and Oral Feeding Aversion. Pediatr Cardiol 2024:10.1007/s00246-024-03515-8. [PMID: 38744695 DOI: 10.1007/s00246-024-03515-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/29/2024] [Indexed: 05/16/2024]
Abstract
Infants and children with congenital heart disease (CHD) often require supplemental nutrition via tube feeding before and after surgery. Tube feeding may be required due to poor weight gain, inadequate oral-motor skills, and/or reduced endurance for oral feeding. Our team has described a successful approach to weaning this population (Horsley et al. (2022) Pediatr Cardiol 43:1429-1437). A subgroup of tube-fed patients with CHD who demonstrate oral feeding aversion (OA) presents unique challenges to the tube weaning process. We discuss our team's experience with tube weaning orally averse children with CHD. Of 36 patients enrolled in the Cincinnati Children's Heart Institute Cardiology Feeding Tube Wean Clinic, 11 (31%) were determined to have oral feeding aversion (OA) by a speech-language pathologist (SLP). Descriptive data comparing the OA group to the non-averse group was gathered prior to and during the wean. Both groups had the ability to tube wean successfully, although the OA group had lower median oral intake (9 vs 24%) and higher age at start of the wean (9 vs 4 months). Those with OA also had a longer median duration of wean in days (17 vs 12 days) and higher likelihood of return to tube feeds within six-month post-wean (22 vs 0%). Additionally, the OA group had a higher percentage of genetic syndromes (36 vs 16%), although this was not found to be statistically significant in this study. Children with OA present with unique challenges for tube weaning. The results of this study show that weaning children with CHD and OA is possible with a multidisciplinary team who is knowledgeable about this population.
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Affiliation(s)
- Sarah Kaskie
- Division of Speech-Language Pathology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
| | - Megan Horsley
- Division of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Elisa Marcuccio
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Yamamichi T, Imanishi Y, Sakai T, Yoshida M, Takayama K, Uga N, Umeda S, Usui N. Risk factors for and developmental relation of delayed oral nutrition in infants with congenital diaphragmatic hernia. Pediatr Surg Int 2023; 40:2. [PMID: 37991549 DOI: 10.1007/s00383-023-05595-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE To identify risk factors for delayed oral nutrition in infants with a congenital diaphragmatic hernia (CDH) and its impact on developmental delay at 18 months of age. METHODS This retrospective single-center cohort study compared the clinical parameters in patients with isolated CDH born and treated at our hospital between 2006 and 2020. We evaluated clinical features significantly related to delayed oral nutrition (defined as taking ≥ 30 days from weaning from mechanical ventilation to weaning from tube feeding). RESULTS Twenty-six of the 80 cases had delayed oral nutrition. Univariate analyses showed significant differences. Multivariate analyses were performed on the three items of preterm delivery, defect size (over 50% to nearly entire defect), and ventilation for ≥ 9 days. We identified the latter two items as independent risk factors. The adjusted odds ratios were 4.65 (95% confidence interval, 1.27-7.03) and 6.02 (1.65-21.90), respectively. Delayed oral nutrition was related to a significantly higher probability of developmental delay at 18 months (crude odds ratio 4.16, 1.19-14.5). CONCLUSION In patients with CDH, a large defect and ventilatory management over 9 days are independent risk factors for delayed oral nutrition, which is a potent predictor of developmental delay that requires active developmental care.
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Affiliation(s)
- Taku Yamamichi
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka, 594-1101, Japan.
| | - Yousuke Imanishi
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
| | - Takaaki Sakai
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka, 594-1101, Japan
| | - Mina Yoshida
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka, 594-1101, Japan
| | - Keita Takayama
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka, 594-1101, Japan
| | - Naoko Uga
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka, 594-1101, Japan
| | - Satoshi Umeda
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka, 594-1101, Japan
| | - Noriaki Usui
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo, Izumi, Osaka, 594-1101, Japan
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3
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Graham ME. Supporting Breastfeeding in Complex Pediatric Otolaryngology Dyads: Clinical Pathway With Illustrative Case Series. Ann Otol Rhinol Laryngol 2023; 132:1194-1199. [PMID: 36503275 PMCID: PMC10466998 DOI: 10.1177/00034894221140771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
OBJECTIVES The benefits of breastfeeding are well established, yet complex infants are less frequently supported to feed direct or pumped breastmilk. This article aims to provide an algorithm to support complex infants in meeting breastfeeding goals. METHODS Two cases are presented to illustrate the breastfeeding support pathway. Each involves early identification of motivated caregivers, consultation of allied health, and assessment of swallowing safety with modification of position or route as appropriate. RESULTS Two infants presented herein successfully continued to receive breastmilk despite airway complexity-1 with oral aversion secondary to prolonged nil per os period in the setting of tracheoesophageal fistula, and 1 with a tracheostomy secondary to subglottic stenosis. CONCLUSIONS It is both possible and imperative to support complex infants in continuing to breastfeed, either directly or via the safest possible route, for the benefits to both members of the dyad.
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Affiliation(s)
- M. Elise Graham
- Children’s Hospital at London Health Sciences Centre, London, ON, Canada
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4
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Chen CB. Nutritional and feeding challenges in aerodigestive patients. Curr Opin Pediatr 2023; 35:561-565. [PMID: 37489246 DOI: 10.1097/mop.0000000000001275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
PURPOSE OF REVIEW Aerodigestive disorders encompass conditions that affect both the airway and gastrointestinal tract. These include conditions such as acquired and congenital defects of the airway and esophagus as well as neuromuscular disorders. Patients often suffer from dysphagia, aspiration, and respiratory disorders. This article will provide a review of current practices in the management of feeding disorders, oropharyngeal dysphagia, and nutritional support in the aerodigestive population. RECENT FINDINGS Oral aversion, aspiration, and feeding-tube dependence are all commonly encountered problems in the aerodigestive population. Intensive inpatient and outpatient programs along with use of appetite stimulants and psychotropic medications may help to improve feeding-related disorders. Aspiration affects many patients and requires close monitoring of clinical symptoms along with routine assessment with video fluoroscopy. Developments in blenderized feeds and formula supplementation have also provided new options for patients with feeding intolerance. SUMMARY Patients with aerodigestive disorders require complex medical care, and multidisciplinary teams are the most effective in addressing their medical needs. Advances in feeding, occupational, and pharmacologic therapy have allowed healthcare providers to better address the needs of these patients.
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Affiliation(s)
- Charles B Chen
- Department of Child Health, University of Missouri School of Medicine, 400 N. Keene St., 65201, Columbia, Missouri, USA
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5
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Clinical Characteristics, Evaluation, and Management of Gastrointestinal Conditions in Pediatric Patients With Aerodigestive Disorders and Its Impact on the Airway. CURRENT PEDIATRICS REPORTS 2023. [DOI: 10.1007/s40124-023-00284-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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6
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Treatment of Food Aversion and Eating Problems in Children with Short Bowel Syndrome: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101582. [PMID: 36291518 PMCID: PMC9600729 DOI: 10.3390/children9101582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/10/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Food Aversion (FA) is a strong refusing behaviour to the oral assumption of food that can affect children with Short Bowel Syndrome (SBS). Management includes behavioural and Messy Play treatments, with few reports on systematic strategies to return the patient to enjoyable eating. We conducted a systematic review to better understand this complex and vital issue. (1) Materials and Methods: We investigated publications using MEDLINE, Embase, and the Web of Science to include articles published up to July 2022. The inclusion criteria were original articles including paediatric patients (aged < 18 years old) affected by SBS and Intestinal Failure (IF) who underwent treatment for FA. (2) Results: A total of 24 patients received treatment—15 (62.5%) patients were male and 9 (37.5%) were female. The age range was from 1 month to 16 years. Treatment of FA was carried out by behavioural therapy in 2 patients and Messy Play Therapy in 12 patients already surgically and pharmacologically managed for SBS. The treatment results showed complete weaning from Parenteral Nutrition in 9/14 cases (64%) using the behavioural treatment and 7/12 cases using Messy Play Therapy. (3) Conclusions: FA is a rare but disabling condition that often affects SBS patients, worsening their overall health and quality of life. This condition should be addressed in an Intestinal Rehabilitation Centre context. Our review sheds light on the literature gap regarding FA, and further studies are required to understand better which treatment options best suit SBS paediatric patients.
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Scott EM, Wenger OK, Robinson E, Colling K, Brown MF, Hershberger J, Radhakrishnan K. Glycogen storage disease type 1a in the Ohio Amish. JIMD Rep 2022; 63:453-461. [PMID: 36101819 PMCID: PMC9458600 DOI: 10.1002/jmd2.12310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/03/2022] [Accepted: 06/08/2022] [Indexed: 11/11/2022] Open
Abstract
Glycogen storage disease type 1a (GSD1a) is an inborn error of glucose metabolism characterized by fasting hypoglycemia, hepatomegaly, and growth failure. Late complications include nephropathy and hepatic adenomas. We conducted a retrospective observational study on a cohort of Amish patients with GSD1a. A total of 15 patients cared for at a single center, with a median age of 9.9 years (range 0.25–24 years) were included. All patients shared the same founder variant in GCPC c.1039 C > T. The phenotype of this cohort demonstrated good metabolic control with median cohort triglyceride level slightly above normal, no need for continuous overnight feeds, and a higher quality of life compared to a previous GSD cohort. The most frequent complications were oral aversion, gross motor delay, and renal hyperfiltration. We discuss our unique care delivery at a single center that cares for Amish patients with inherited disorders.
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Affiliation(s)
- Ethan M. Scott
- New Leaf Center Clinic for Special Children Ohio USA
- Department of Pediatrics Akron Children's Hospital Akron Ohio USA
| | - Olivia K. Wenger
- New Leaf Center Clinic for Special Children Ohio USA
- Department of Pediatrics Akron Children's Hospital Akron Ohio USA
| | - Elizabeth Robinson
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition Cleveland Clinic Foundation Cleveland Ohio USA
| | - Kristina Colling
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition Cleveland Clinic Foundation Cleveland Ohio USA
| | - Miraides F. Brown
- Akron Children's Hospital Rebecca D Considine Research Institute Akron Ohio USA
| | | | - Kadakkal Radhakrishnan
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition Cleveland Clinic Foundation Cleveland Ohio USA
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Abstract
Feeding difficulty is common in the pediatric population, particularly in at-risk infants, such as those born prematurely. Appropriate work-up should involve a multidisciplinary team and may commonly use modified barium swallow and flexible endoscopic evaluation of swallow, in addition to history and physical examination. Structural causes of dysphagia may involve surgical management, whereas nonstructural causes may invoke medical therapies. If symptoms do not resolve following intervention, it is important to revisit the interdisciplinary team, because dysphagia is commonly multifactorial in origin. Appropriate identification and early intervention are necessary for successful outcomes in growth and development for children.
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Affiliation(s)
- Annie E Moroco
- Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University Sidney Kimmel School of Medicine, 111 South 11th Street, Philadelphia, PA 19107, USA
| | - Nicole L Aaronson
- Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University Sidney Kimmel School of Medicine, 111 South 11th Street, Philadelphia, PA 19107, USA; Department of Surgery, Division of Pediatric Otolaryngology, Nemours Children's Hospital of Delaware, 1600 Rockland Road Wilmington, DE 19803, USA.
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9
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Goldstein SA, Watkins KJ, Lowery RE, Yu S, Knight RM, Drayton AK, Sayers L, Gaies M. Oral Aversion in Infants With Congenital Heart Disease: A Single-Center Retrospective Cohort Study. Pediatr Crit Care Med 2022; 23:e171-e179. [PMID: 34991136 DOI: 10.1097/pcc.0000000000002879] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Neonates undergoing cardiac surgery are at risk for oral aversion (OA). OA is not well described outside of the index hospitalization and impacts patients and families. We evaluated the prevalence of OA at 1 year old after neonatal cardiopulmonary bypass (CPB) surgery. DESIGN Retrospective cohort study. SETTING Single quaternary care hospital. SUBJECTS Our cohort included 157 neonates who underwent CPB surgery from 2014 to 2017 and had follow-up data available at 1 year old. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Three feeding experts reviewed the medical record to define children with OA; 30% of charts were evaluated in triplicate for validation. Neonates with and without OA were compared in univariate analysis, and risk factors for OA were explored in a limited multivariable analysis. OA was present at 1 year in 37 patients (23.6%) and other feeding difficulties were present in an additional 29 patients (18.5%). Thirty-eight patients (24.2%) had a feeding tube, including 12 (7.6%) with a gastrostomy tube. Factors associated with OA at 1 year included total ICU days, duration of mechanical ventilation, total number of nil per os days, and number of postoperative days (PODs) until oral feeding initiation (all p < 0.0001). Number of POD until oral feeding initiation remained independently associated with OA at 1 year in multivariable analysis (adjusted odds ratio, 1.08; 95% CI, 1.04-1.12; p < 0.0001). Infants with any oral intake at discharge had lower odds of OA at 1 year (0.21; 95% CI, 0.08-0.5; p = 0.0003). At hospital discharge, 132 patients (84.1%) were taking some oral feeds, and 128 patients (81.5%) received tube feeding. CONCLUSIONS OA and other feeding difficulties are common at 1 year old in neonates undergoing CPB surgery. Delayed exposure to oral intake may be a modifiable risk factor for OA and efforts to improve early oral feeding could lead to better functional outcomes.
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Affiliation(s)
- Stephanie A Goldstein
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Primary Children's Hospital, Salt Lake City, UT
| | - Kimberly J Watkins
- The Children's Heart Clinic, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN
| | - Ray E Lowery
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Sunkyung Yu
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI
| | - Rachel M Knight
- Department of Pediatric Feeding Disorders, University of Nebraska Medical Center, Munroe-Meyer Institute, Omaha, NE
| | - Amy K Drayton
- Department of Pediatric Feeding Disorders, University of Nebraska Medical Center, Munroe-Meyer Institute, Omaha, NE
| | | | - Michael Gaies
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI
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Pagnamenta E, Longhurst L, Breaks A, Chadd K, Kulkarni A, Bryant V, Tier K, Rogers V, Bangera S, Wallinger J, Leslie P, Palmer R, Joffe V. Research priorities to improve the health of children and adults with dysphagia: a National Institute of Health Research and Royal College of Speech and Language Therapists research priority setting partnership. BMJ Open 2022; 12:e049459. [PMID: 35078835 PMCID: PMC8796217 DOI: 10.1136/bmjopen-2021-049459] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To conduct the first UK-wide research priority setting project informing researchers and funders of critical knowledge gaps requiring investigation to improve the health and well-being of patients with eating, drinking and swallowing disorders (dysphagia) and their carers. DESIGN A priority setting partnership between the National Institute of Health Research (NIHR) and the Royal College of Speech and Language Therapists using a modified nominal group technique. A steering group and NIHR representatives oversaw four project phases: (1) survey gathering research suggestions, (2) verification and aggregation of suggestions with systematic review research recommendations, (3) multistakeholder workshop to develop research questions, (4) interim priority setting via an online ranking survey and (5) final priority setting. SETTING UK health services and community. PARTICIPANTS Patients with dysphagia, carers and professionals who work with children and adults with dysphagia from the UK. RESULTS One hundred and fifty-six speech and language therapists submitted 332 research suggestions related to dysphagia. These were mapped to 88 research recommendations from systematic reviews to form 24 'uncertainty topics' (knowledge gaps that are answerable by research). Four patients, 1 carer and 30 healthcare professionals collaboratively produced 77 research questions in relation to these topics. Thereafter, 387 patients, carers and professionals with experience of dysphagia prioritised 10 research questions using an interim prioritisation survey. Votes and feedback for each question were collated and reviewed by the steering and dysphagia reference groups. Nine further questions were added to the long-list and top 10 lists of priority questions were agreed. CONCLUSION Three top 10 lists of topics grouped as adults, neonates and children, and all ages, and a further long list of questions were identified by patients, carers and healthcare professionals as research priorities to improve the lives of those with dysphagia.
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Affiliation(s)
- Emma Pagnamenta
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Lauren Longhurst
- Child and Adolescent Mental Health Service, Whittington Health NHS Trust, London, UK
| | - Anne Breaks
- Acute Speech and Language Therapy Service, Evelina London Children's Hospital, London, UK
| | - Katie Chadd
- Research and Outcomes, Royal College of Speech and Language Therapists, London, UK
| | - Amit Kulkarni
- Research and Outcomes, Royal College of Speech and Language Therapists, London, UK
| | | | - Kathy Tier
- NIHR Evaluation, Trials and Studies Coordinating Centre, National Institute for Health Research, London, UK
| | | | - Sai Bangera
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Josephine Wallinger
- Division of Language and Communication Science, City University of London, London, UK
| | - Paula Leslie
- Center for Bioethics & Health Law, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rebecca Palmer
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Victoria Joffe
- School of Health and Social Care, University of Essex, Colchester, UK
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11
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Kunze M, Machalicek W. Interdisciplinary teams: A model to support students with autism. PSYCHOLOGY IN THE SCHOOLS 2021. [DOI: 10.1002/pits.22618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Megan Kunze
- Department of Special Education and Clinical Sciences University of Oregon Eugene Oregon USA
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12
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Luscombe GM, Hawthorn J, Wu A, Green B, Munro A. 'Empowering clinicians in smaller sites': A qualitative study of clinician's experiences with a rural Virtual Paediatric Feeding Clinic. Aust J Rural Health 2021; 29:742-752. [PMID: 34490941 DOI: 10.1111/ajr.12781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/17/2021] [Accepted: 06/25/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore the experiences of 'spoke site' allied health and child and family health clinicians in the provision of care through a pilot 'hub and spoke' model Virtual Paediatric Feeding Clinic (VPFC) outreach service. DESIGN The study was qualitative, with data from virtual interview transcripts analysed using thematic analysis. SETTING Orange Health Service ('hub site') and seven community health centres within the Western NSW Local Health District ('spoke sites'). PARTICIPANTS Nine 'spoke site' clinicians (from dietetics, speech pathology, occupational therapy and child and family health nursing), who had participated in the pilot clinic. INTERVENTIONS Participants took part in a semi-structured interview with a member of the research team. MAIN OUTCOME MEASURES Spoke site clinicians experiences and perceptions of the VPFC. RESULTS Four key themes emerged: (1) impact of the VPFC on 'spoke site' clinicians, (2) benefits for clients and families, (3) perceptions of the virtual model of care and (4) VPFC service challenges. CONCLUSION The expansion of an existing interdisciplinary Paediatric Feeding Clinic into a virtual service demonstrates the use of technology to bridge a gap in healthcare. Clinicians reported benefits not only for families, but for their own knowledge and confidence in provision of care and reduced professional isolation through connection with discipline-specific colleagues.
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Affiliation(s)
| | | | - Alison Wu
- Western NSW Local Health District, Orange, NSW, Australia
| | - Belinda Green
- Western NSW Local Health District, Orange, NSW, Australia
| | - Alice Munro
- Western NSW Local Health District, Orange, NSW, Australia
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13
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Selles RR, Wu MS, Carlos Novoa J, Zepeda-Burgos RM, Guttfreund D, McBride NM, McKay D, Storch EA. Prevalence, severity, and clinical correlates of food neophobia in Salvadorian youth. Bull Menninger Clin 2021; 85:42-58. [PMID: 33750202 DOI: 10.1521/bumc.2021.85.1.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Food neophobia (FN) describes problematic fear-based avoidance/restriction of novel foods. Using the novel parent-reported Measure of Food Neophobia (MFN), the authors examined FN symptoms and impairment in 305 Salvadorian children and explored clinical correlates. Factor analysis supported the MFN's designed structure to inquire about FN symptoms and FN impairment. At least one FN symptom was observed in 91% of the sample; however, only 9% were rated as having moderate or greater impairment. Demographic variables were not associated with FN; however, FN was positively correlated with internalizing, externalizing, inattention, health anxiety, and obsessive-compulsive symptoms. Inattention symptoms and health anxiety emerged as significant predictors of FN symptoms, while FN symptoms were the only significant predictor of FN impairment. The present study supports the MFN and provides information about FN in a general population, including the prevalence of clinically significant symptoms and association with psychological domains. Continued investigation of FN is still needed.
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Affiliation(s)
- Robert R Selles
- Postdoctoral fellow at the University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Monica S Wu
- Clinical Instructor at the UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Juan Carlos Novoa
- Executive Director of the Tin Marin Children's Museum, San Salvador, El Salvador
| | - Raquel Marina Zepeda-Burgos
- Professor in the Facultad de Posgrado y Educación Continua, Universidad José Matías Delgado, La Libertad, El Salvador
| | | | - Nicole M McBride
- Prevention Analyst at the Embedded Preventive Behavioral Health Capability, Marine Corps Community Services, United States Marine Corps
| | - Dean McKay
- Professor in the Department of Psychology, Fordham University, Bronx, New York
| | - Eric A Storch
- McIngvale Presidential Endowed Chair and Professor, Vice Chair and Head of Psychology, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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14
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Edwards S, Hyman PE, Mousa H, Bruce A, Cocjin J, Dean K, Fleming K, Romine RS, Davis AM. iKanEat: protocol for a randomized controlled trial of megestrol as a component of a pediatric tube weaning protocol. Trials 2021; 22:169. [PMID: 33640012 PMCID: PMC7913389 DOI: 10.1186/s13063-021-05131-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Although tube feeding routinely saves the lives of children who do not eat by mouth, chronic tube feeding can be a burden to patients, caregivers, and families. Very few randomized trials exist regarding the best methods for weaning children from their feeding tubes. Methods The current paper describes a randomized controlled trial of an empirically supported outpatient treatment protocol for moving children from tube to oral eating called iKanEat. Specifically, we describe the methods of randomized double-blind, placebo-controlled trial which includes a 4-week course of megestrol, the only medication used in the iKanEat protocol, to determine whether the addition of megestrol results in improved child outcomes. The primary and secondary aims are to assess the safety and efficacy of megestrol as part of the iKanEat protocol. The third aim is to provide critical information about the impact of the transition from tube to oral feeding on parent stress and parent and child quality of life. Discussion This trial will provide data regarding whether megestrol is a safe and effective component of the iKanEat tube weaning protocol, as well as important data on how the tube weaning process impacts parent stress and parent and child quality of life. Trial registration ClinicalTrials.gov NCT#03815019. Registered on January 17, 2019
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Affiliation(s)
- Sarah Edwards
- Pediatric Gastroenterology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Paul E Hyman
- Pediatric Gastroenterology, New Orleans Children's Hospital, New Orleans, LA, USA
| | - Hayat Mousa
- Pediatric Gastroenterology, Hepatology and Nutrition, University of California San Diego/Rady Children's Hospital, San Diego, CA, USA
| | - Amanda Bruce
- Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 4004, Kansas City, KS, 66160, USA.,Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA
| | - Jose Cocjin
- Pediatric Gastroenterology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Kelsey Dean
- Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 4004, Kansas City, KS, 66160, USA.,Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA
| | - Kandace Fleming
- Life Span Institute, University of Kansas, Lawrence, KS, USA
| | | | - Ann M Davis
- Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 4004, Kansas City, KS, 66160, USA. .,Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA.
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15
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Suluhan D, Yildiz D, Surer I, Fidanci Eren B, Balamtekin N. Effect of Gastrostomy Tube Feeding Education on Parents of Children with Gastrostomy. Nutr Clin Pract 2020; 36:1220-1229. [DOI: 10.1002/ncp.10586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Derya Suluhan
- Gulhane Faculty of Nursing Department of Pediatric Nursing, University of Health Sciences Turkey Ankara Turkey
| | - Dilek Yildiz
- Gulhane Faculty of Nursing Department of Pediatric Nursing, University of Health Sciences Turkey Ankara Turkey
| | - Ilhami Surer
- Department of Pediatric Surgery Gulhane Research and Training Hospital Ankara Turkey
| | - Berna Fidanci Eren
- Gulhane Faculty of Nursing Department of Pediatric Nursing, University of Health Sciences Turkey Ankara Turkey
| | - Necati Balamtekin
- Department of Pediatric Gastroenterology Gulhane Research and Training Hospital Ankara Turkey
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Tilyard R, Reilly C, Gallegos D, Syrmis M, Frederiksen N, Press C. Temporary feeding tube dependency in pediatric patients: A retrospective analysis of risk factors and preventative practices. Clin Nutr ESPEN 2020; 40:320-326. [PMID: 33183557 DOI: 10.1016/j.clnesp.2020.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 08/07/2020] [Accepted: 08/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Prolonged temporary tube feeding places pediatric patients at risk of tube dependency. This chart audit aimed to identify current temporary tube feeding practice within an Australian tertiary hospital, risk factors of prolonged temporary tube feeding, and the likelihood of high risk patients receiving tube dependency preventative practices. METHODS A retrospective chart audit was conducted of the medical records of 187 pediatric inpatients who had temporary feeding tubes placed in an Australian tertiary hospital between November 2014 and March 2017. Information was collected on patient demographics and tube feeding practices. The Kaplan Meier estimate, Cox regression and logistic regression were used to determine the median time until feeding tube removal, predictors of prolonged temporary tube feeding, and the relationship between these predictors and utilization of preventative practices. RESULTS The Kaplan Meier estimate of median tube feeding duration was 6.43 months (95% CI: 5.17-7.90). Predictors of prolonged tube feeding were prematurity (p = 0.003), feeding difficulties requiring speech pathology referral (p = 0.002), and referral for long-term feeding tubes (p = 0.002). There was a low prevalence of preventative clinical practices including documentation of tube exit plans (5.3%, n = 10) and referral for long-term feeding tubes (27.3%, n = 51). Exhibiting risk factors for prolonged tube feeding did not increase the likelihood of receiving preventative clinical practices. CONCLUSIONS The prolonged duration of temporary tube feeding within this sample highlights the need for improved utilization of tube dependency preventative practices within high risk groups.
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Affiliation(s)
- Regina Tilyard
- School of Nutrition and Exercise Sciences, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, Queensland 4059, Australia.
| | - Claire Reilly
- Department of Dietetics and Food Services, Queensland Children's Hospital, 501 Stanley Street, South Brisbane, Brisbane, Queensland 4101, Australia; Centre for Children's Health Research, Institute of Health and Biomedical Innovation. Graham Street, South Brisbane, Queensland 4101, Australia
| | - Danielle Gallegos
- School of Nutrition and Exercise Sciences, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, Queensland 4059, Australia; Centre for Children's Health Research, Institute of Health and Biomedical Innovation. Graham Street, South Brisbane, Queensland 4101, Australia
| | - Maryanne Syrmis
- Department of Dietetics and Food Services, Queensland Children's Hospital, 501 Stanley Street, South Brisbane, Brisbane, Queensland 4101, Australia
| | - Nadine Frederiksen
- Department of Dietetics and Food Services, Queensland Children's Hospital, 501 Stanley Street, South Brisbane, Brisbane, Queensland 4101, Australia
| | - Clare Press
- School of Human Movement and Nutrition Sciences, University of Queensland. St Lucia, Brisbane, Queensland 4072, Australia
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Long-term efficacy of clinical hunger provocation to wean feeding tube dependent children. Clin Nutr 2020; 39:2863-2871. [DOI: 10.1016/j.clnu.2019.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/19/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022]
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Social Determinants of Health and the Role of Routine Pediatric Care in a Medically Complex Toddler. J Dev Behav Pediatr 2020; 41:583-585. [PMID: 32649593 DOI: 10.1097/dbp.0000000000000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CASE Late on a Friday afternoon, a new family presents to your practice for urgent care. They come with their youngest child Mai, a 2-year-old girl, who, although born in the United States at 36 weeks gestation, has resided in Laos with her grandparents for the past 16 months. Your triage nurse tells you that she has a fever and was found to have profound anemia while at the WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) office earlier today.On walking into the room, you describe Mai as "listless" and "sickly." Her vitals were notable for fever (102°F), tachycardia (140 beats per minute), and tachypnea (35 breaths per minute). On physical examination, she was grunting with a systolic ejection murmur and without hepatosplenomegaly. Laboratory test results revealed hemoglobin of 2.2 g/dL, hematocrit of 12%, mean corpuscular volume of 50 fL, red cell distribution width of 27%, reticulocyte count of 3%, ferritin of <2 ng/mL, iron of 15 μg/dL, total iron binding count of 420 μg/dL, white blood cell count of 13.5 K/μL, and platelets of 605 K/μL. Her evaluation was consistent with severe iron deficiency anemia (IDA), which was further supported by reported restrictive diet and excessive cow milk intake of 35 ounces daily. She was admitted to the Pediatric Intensive Care Unit in high-output cardiac failure and was slowly transfused with 15 mL/kg of packed red blood cells over 2 days with careful monitoring. Once stabilized, she was transferred to the inpatient floor for further nutritional evaluation and supplementation. Additional workup, including hemoglobin electrophoresis, fecal occult blood test, celiac studies, and stool parasite testing were normal. The clinical picture was consistent with a viral infection in the setting of profound IDA and malnutrition.Although her clinical status had improved, she remained inpatient for nutritional optimization. Her height was at the 54th percentile (z-score: 0.11), weight was at the first percentile (z-score: -2.25), and body mass index was below the first percentile (z-score: -3.18), diagnostic of severe protein-calorie malnutrition. She was evaluated by an interdisciplinary growth and nutrition team, received multivitamin and mineral supplements, and was monitored for refeeding syndrome. She was noted to be "difficult to engage," "resistant to new faces," and made little progress on expanding her dietary choices. Concerns about a possible diagnosis of autism spectrum disorder were raised by her treating team. What would you do next? REFERENCE 1. Bouma S. Diagnosing pediatric malnutrition: paradigm shifts of etiology-related definitions and appraisal of the indicators. Nutr Clin Pract. 2017;32:52-67.
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Bandstra NF, Huston PL, Zvonek K, Heinz C, Piccione E. Outcomes for Feeding Tube-Dependent Children With Oral Aversion in an Intensive Interdisciplinary Treatment Program. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:2497-2507. [PMID: 32658602 DOI: 10.1044/2020_jslhr-19-00038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Feeding challenges in children are common, at times reaching a severity that requires the placement and long-term use of enteral feedings. A significant barrier to advancing the oral eating of some tube-dependent children is the presence of oral aversion. Although some research exists regarding the treatment of tube-dependent children who are averse to food or the process of eating, specifically, there has yet to be an examination of children who are truly "orally" averse-resisting not just the presentation of food or liquid but also nonnutritive stimuli presented extra- or intra-orally. Method Using a retrospective chart review, the current study aimed to examine the treatment outcomes of 18 feeding tube-dependent children with significant oral aversion (nine boys, nine girls; M age = 46.7 months, SD = 20.0 months, range: 11.4-89.3 months) as compared to 29 tube-dependent, but nonorally averse, clinical controls. Children completed approximately 6-8 weeks of intensive interdisciplinary feeding treatment. Results Analyses revealed significant improvements in all measured treatment outcomes for both patient groups, including children's rates of acceptance and maladaptive mealtime behavior. Significant reductions in tube use were also observed across both groups, with tube utilization decreasing, on average, by 76.2% for orally averse and by 64.3% for nonorally averse children by program discharge. Conclusion Results demonstrate the therapeutic benefits of intensive interdisciplinary intervention for both groups of tube-dependent children, highlighting that orally averse children, believed to be an especially challenging subset of pediatric feeding patients, demonstrate similarly positive treatment responses. Interestingly, in this preliminary examination, orally averse children demonstrated significantly greater reductions in tube utilization following discharge when compared with their nonorally averse clinical peers.
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Affiliation(s)
- Nancy F Bandstra
- Intensive Feeding Program, Helen DeVos Children's Hospital, Grand Rapids, MI
- Departments of Psychiatry and Pediatrics and Human Development, Michigan State University, East Lansing
| | - Parker L Huston
- Comprehensive Pediatric Feeding Program, Nationwide Children's Hospital, Columbus, OH
| | - Kate Zvonek
- Intensive Feeding Program, Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Carly Heinz
- Intensive Feeding Program, Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Emily Piccione
- Intensive Feeding Program, Helen DeVos Children's Hospital, Grand Rapids, MI
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Jones E, Southwood H, Cook C, Nicholson T. Insights into paediatric tube feeding dependence: A Speech-language pathology perspective. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 22:327-337. [PMID: 32366127 DOI: 10.1080/17549507.2020.1754910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose: To explore possible factors contributing to paediatric tube feeding dependency from the speech-language pathology perspective. Tube feeding dependency can have serious repercussions for children and their families with failed or slow weaning/transitioning from tube to oral feeding, more likely after the age of five.Method: A mixed methods approach was conducted. During the first quantitative phase, an online national survey of speech-language pathologists (SLPs) from the health and non-health sectors was carried out followed by interviews with a subset of the respondents. Forty-three SLPs completed the survey. In the second qualitative phase, 10 participants from the survey were interviewed in depth as to their opinions about why tube dependency occurs. Survey data from phase one were analysed using descriptive statistics and chi square comparisons. Interview data were categorised using thematic analysis. Findings from both methodologies were combined to report the results.Result: Two interlinking meta-themes were identified from the combined data sets. These were: (1) Medicalisation of tube fed children in infancy as a root cause of tube feeding dependency and (2) Fragmentation of the tube fed child's continuity of care. The specific results indicated several possible reasons for tube feeding dependency including medical emphasis on weight gain, prolonged nasogastric tube feeding and waiting too long for transition from tube to oral feeding. A lack of integrated care and clinician confidence in non-health settings also appeared to be a factor contributing to tube feeding dependency.Conclusion: Early and ongoing biomedical focus on weight gain affected long-term goals for transitioning leading, subsequently, to tube feeding becoming normalised by school age.
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Affiliation(s)
- Emily Jones
- Institute of Education, College of Humanities and Social Sciences, Massey University, Auckland, New Zealand
| | - Helen Southwood
- Institute of Education, College of Humanities and Social Sciences, Massey University, Auckland, New Zealand
| | - Catherine Cook
- School of Nursing, College of Health, Massey University, Auckland, New Zealand
| | - Tom Nicholson
- Institute of Education, College of Humanities and Social Sciences, Massey University, Auckland, New Zealand
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Mancell S, Meyer R, Hind J, Halter M. Factors Impacting on Eating in Pediatric Intestinal-Transplant Recipients: A Mixed-Methods Study. Nutr Clin Pract 2019; 35:919-926. [PMID: 31721302 DOI: 10.1002/ncp.10439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND No empirical data are found examining why eating may be difficult for some children and not others following intestinal transplant. This study aimed to describe the eating behaviors and nutrition intake of intestinal-transplant-recipient children and examine factors that may impact on their eating. METHODS Caregivers of all (n = 34) intestinal-transplant recipients <18 years of age in the United Kingdom were invited to participate in this mixed-methods study comprising questionnaires, a 3-day food diary and interviews. Questionnaires included the Children's Eating Behaviour Questionnaire and demographic/nutrition-related items. Analysis was by descriptive statistics using SPSS. Semistructured telephone interviews explored caregiver perceptions of their child's eating. Analysis was thematic. RESULTS Nine caregivers were recruited and completed the questionnaire and food diary. Eight of these were interviewed. Home tube feeding was required by 77% (n = 7) of children post transplant, 56% (n = 5) were "food avoidant", and median energy intake was 93% (range, 61%-137%) of requirements. The findings revealed complex, interrelated positive and negative medical, caregiver, and child-related influences on eating. Learning to eat at the recommended age and having positive and significant pretransplant eating experiences appeared protective, whereas receiving nothing by mouth and having aversive experiences were barriers. CONCLUSION This study provides the first empirical evidence of factors that may influence eating after intestinal transplant in children. The findings suggest promoting eating pretransplant, when the negative physical consequences can be managed, may be protective, and there may be eating-difficulty predictors that could be used to facilitate targeted interventions.
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Affiliation(s)
- Sara Mancell
- Nutrition & Dietetics Department, King's College Hospital, London, UK
| | - Rosan Meyer
- Department of Paediatrics, Imperial College, London, UK
| | - Jonathan Hind
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK
| | - Mary Halter
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
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22
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Gakenheimer-Smith L, Glotzbach K, Ou Z, Presson AP, Puchalski M, Jones C, Lambert L, Delgado-Corcoran C, Eckhauser A, Miller T. The Impact of Neurobehavior on Feeding Outcomes in Neonates with Congenital Heart Disease. J Pediatr 2019; 214:71-78.e2. [PMID: 31402138 PMCID: PMC6815703 DOI: 10.1016/j.jpeds.2019.06.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/22/2019] [Accepted: 06/21/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the association between neonatal neurobehavioral state and oral feeding outcomes following congenital heart disease (CHD) surgery. STUDY DESIGN This single center retrospective cohort study described neonates undergoing cardiac surgery evaluated perioperatively with the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS). We compared NNNS attention scores, which evaluates neonates' ability to orient and fixate on stimuli, with the feeding outcomes percentage of feeds taken orally at discharge and time to reach full oral feeds using regression analyses. Models were constructed for both preoperative and postoperative NNNS evaluations. RESULTS Between August 2015 and October 2017, 124 neonates underwent 89 preoperative and 97 postoperative NNNS evaluations. In multivariable Cox regression, higher preoperative NNNS attention scores were associated with a shorter time to achieve full oral feeds (hazard ratio 1.4; 95% CI 1.0‒2.0; P = .047). This relationship was not seen for post-operative NNNS attention scores or percentage of oral feeds at discharge. Depending on the model, younger age at surgery, increased ventilator days, increased length of stay, and single or 2-ventricle anatomy with aortic arch obstruction were associated with lower percentage of oral feeds at discharge and/or delay in full oral feeds. CONCLUSIONS Higher neonatal attention before cardiac surgery is associated with improved feeding outcomes. Prospective assessment of neonatal neurobehavioral state may be a novel approach to predict and target interventions to improve feeding outcomes in CHD. Future studies should examine the impact of intrinsic neurodevelopmental delay vs environmental adaptation on the neurobehavioral state of neonates with CHD.
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Affiliation(s)
| | - Kristi Glotzbach
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Zhining Ou
- Department of Pediatrics, University of Utah, Salt Lake City, UT; Division of Epidemiology, University of Utah, Salt Lake City, UT; Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Angela P Presson
- Department of Pediatrics, University of Utah, Salt Lake City, UT; Division of Epidemiology, University of Utah, Salt Lake City, UT
| | - Michael Puchalski
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | | | - Linda Lambert
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Claudia Delgado-Corcoran
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Aaron Eckhauser
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Thomas Miller
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT
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Hoffmeister J, Zaborek N, Thibeault SL. Postextubation Dysphagia in Pediatric Populations: Incidence, Risk Factors, and Outcomes. J Pediatr 2019; 211:126-133.e1. [PMID: 30954246 DOI: 10.1016/j.jpeds.2019.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/22/2019] [Accepted: 02/13/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess incidence, risk factors for, and impact on outcomes of postextubation dysphagia. We hypothesized that the incidence of postextubation dysphagia in pediatric patients would approximate or exceed that in adults, that age and duration of intubation would increase odds for postextubation dysphagia, and that the presence of postextubation dysphagia would negatively impact patient outcomes. STUDY DESIGN We performed a retrospective, observational cohort study of patients aged 0-16 years admitted between 2011 and 2017. Patients were included if they were extubated in the intensive care unit and fed orally within 72 hours. Records were reviewed to determine dysphagia status and assess the impact of patient factors on odds of postextubation dysphagia. The impact of postextubation dysphagia on patient outcomes was then assessed. RESULTS Following application of inclusion and exclusion criteria, the sample size was 372 patients. Postextubation dysphagia was observed in 29% of patients. For every hour of intubation, odds of postextubation dysphagia increased by 1.7% (P < .0001). Age of <25 months increased odds of postextubation dysphagia more than 2-fold (P < .05). When we controlled for age, diagnosis, number of complex chronic conditions, and dysphagia status, patients with dysphagia had an increase in total length of stay of 10.95 days (P < .0001). Postextubation dysphagia increased odds of gastrostomy or nasogastric tube at time of discharge (aOR 22.22, P < .0001). CONCLUSIONS This study found that postextubation dysphagia is associated with increased time between extubation and discharge and with odds of gastrostomy or nasogastric tube at time of discharge.
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Affiliation(s)
- Jesse Hoffmeister
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery; Department of Communication Sciences and Disorders
| | - Nicholas Zaborek
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Susan L Thibeault
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery; Department of Communication Sciences and Disorders.
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Budhan J, Scarborough D, Kuren MBV. The Impact of a Novel Gaming Reinforcement System on Oral Intake Outcomes in Pediatric Feeding Therapy: A Single Case Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:394-407. [PMID: 31136237 DOI: 10.1044/2018_ajslp-18-0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The aim of this study was to implement a novel reinforcement strategy into traditional dysphagia therapy with a school-age child diagnosed with a rare genetic syndrome, anxiety, and a hypersensitive gag reflex response. This clinical focus article evaluated the impact of a computer-based straw-drinking game on total liquid volume intake and the relationship between motivation and its role in feeding therapy. Method A longitudinal pilot study was used and required the development and implementation of a computer-based straw-drinking game as a novel reinforcement strategy. The gaming system was implemented to supplement ongoing dysphagia treatment in a single-subject case study design utilizing a client with pediatric dysphagia. Results The participant exhibited a trend of increased endurance during therapy sessions, allowing for increased volume per sip, increased trials per session, and decreased time between sequential trials. Average daily volume of oral intake remained less than 30 ml. Conclusions The gaming system maximized opportunities for orosensory desensitization of tactile input, resulting in increased comfort and endurance during therapy sessions, leading to more opportunities to practice the swallow. A novelty effect was observed as motivation and interest in the gaming system appeared greatest at the onset of the study. Generalized fatigue and anxiety continue to serve as barriers to more significant progress.
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Affiliation(s)
- Jamie Budhan
- Department of Speech Pathology and Audiology, Miami University, Oxford, OH
| | - Donna Scarborough
- Department of Speech Pathology and Audiology, Miami University, Oxford, OH
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Chiatto F, Coletta R, Aversano A, Warburton T, Forsythe L, Morabito A. Messy Play Therapy in the Treatment of Food Aversion in a Patient With Intestinal Failure: Our Experience. JPEN J Parenter Enteral Nutr 2018; 43:412-418. [DOI: 10.1002/jpen.1433] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/11/2018] [Indexed: 01/27/2023]
Affiliation(s)
- Fabrizia Chiatto
- Department of Translational Medical Sciences; Section of Paediatrics; University Federico II; Naples Italy
| | - Riccardo Coletta
- Department of Paediatric Surgery; Royal Manchester Children's Hospital; Manchester United Kingdom
- Paediatric Autologous Bowel Reconstruction and Rehabilitation Unit; Royal Manchester Children's Hospital; Manchester United Kingdom
| | | | - Tracy Warburton
- Department of Therapeutic and Specialised Play; Royal Manchester Children's Hospital; Manchester United Kingdom
| | - Lynette Forsythe
- Department of Dietetics and Nutrition; Royal Manchester Children's Hospital; Manchester United Kingdom
| | - Antonino Morabito
- Department of Pediatric Surgery; Meyer Children's Hospital; University of Florence; Florence Italy
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Feeding Difficulties and Orofacial Myofunctional Disorder in Patients with Hepatic Glycogen Storage Diseases. JIMD Rep 2018; 45:21-27. [PMID: 30242630 PMCID: PMC6336547 DOI: 10.1007/8904_2018_131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/26/2018] [Accepted: 07/27/2018] [Indexed: 01/25/2023] Open
Abstract
UNLABELLED Hepatic glycogen storage diseases (GSDs) are inborn errors of metabolism whose dietary treatment involves uncooked cornstarch administration and restriction of simple carbohydrate intake. The prevalence of feeding difficulties (FDs) and orofacial myofunctional disorders (OMDs) in these patients is unknown. OBJECTIVE To ascertain the prevalence of FDs and OMDs in GSD. METHODS This was a cross-sectional, prospective study of 36 patients (19 males; median age, 12.0 years; range, 8.0-18.7 years) with confirmed diagnoses of GSD (type Ia = 22; Ib = 8; III = 2; IXa = 3; IXc = 1). All patients were being treated by medical geneticists and dietitians. Evaluation included a questionnaire for evaluation of feeding behavior, the orofacial myofunctional evaluation (AMIOFE), olfactory and taste performance (Sniffin' Sticks and Taste Strips tests), and facial anthropometry. RESULTS Nine (25%) patients had decreased olfactory perception, and four (11%) had decreased taste perception for all flavours. Eight patients (22.2%) had decreased perception for sour taste. Twenty-six patients (72.2%) had FD, and 18 (50%) had OMD. OMD was significantly associated with FD, tube feeding, selective intake, preference for fluid and semisolid foods, and mealtime stress (p < 0.05). Thirteen patients (36.1%) exhibited mouth or oronasal breathing, which was significantly associated with selective intake (p = 0.011) and not eating together with the rest of the family (p = 0.041). Lower swallowing and chewing scores were associated with FD and with specific issues related to eating behavior (p < 0.05). CONCLUSION There is a high prevalence of FDs and OMDs in patients with GSD. Eating behavior, decreased taste and smell perception, and orofacial myofunctional issues are associated with GSD.
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Abstract
Feeding disorders often present in children with complex medical histories as well as those with neurodevelopmental disabilities. If untreated, feeding problems will likely persist and may lead to additional developmental and medical complications. Treatment of pediatric feeding disorders should involve an interdisciplinary team, but the core intervention should include behavioral feeding techniques as they are the only empirically supported therapy for feeding disorders.
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Hopkins J, Cermak SA, Merritt RJ. Oral Feeding Difficulties in Children With Short Bowel Syndrome: A Narrative Review. Nutr Clin Pract 2017; 33:99-106. [DOI: 10.1177/0884533617707493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Judy Hopkins
- Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Sharon A. Cermak
- Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
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Krom H, de Winter JP, Kindermann A. Development, prevention, and treatment of feeding tube dependency. Eur J Pediatr 2017; 176:683-688. [PMID: 28409284 PMCID: PMC5432583 DOI: 10.1007/s00431-017-2908-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 04/04/2017] [Indexed: 11/29/2022]
Abstract
UNLABELLED 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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Affiliation(s)
- Hilde Krom
- Emma Children's Hospital, Box 22666, 1100 DD, Amsterdam, The Netherlands.
| | - J. Peter de Winter
- 0000 0004 0568 6419grid.416219.9Spaarne Hospital, Box 770, 2130 AT Hoofddorp, The Netherlands
| | - Angelika Kindermann
- 0000 0004 0529 2508grid.414503.7Emma Children’s Hospital, Box 22666, 1100 DD Amsterdam, The Netherlands
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Boullata JI, Carrera AL, Harvey L, Escuro AA, Hudson L, Mays A, McGinnis C, Wessel JJ, Bajpai S, Beebe ML, Kinn TJ, Klang MG, Lord L, Martin K, Pompeii-Wolfe C, Sullivan J, Wood A, Malone A, Guenter P. ASPEN Safe Practices for Enteral Nutrition Therapy [Formula: see text]. JPEN J Parenter Enteral Nutr 2016; 41:15-103. [PMID: 27815525 DOI: 10.1177/0148607116673053] [Citation(s) in RCA: 226] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Enteral nutrition (EN) is a valuable clinical intervention for patients of all ages in a variety of care settings. Along with its many outcome benefits come the potential for adverse effects. These safety issues are the result of clinical complications and of process-related errors. The latter can occur at any step from patient assessment, prescribing, and order review, to product selection, labeling, and administration. To maximize the benefits of EN while minimizing adverse events requires that a systematic approach of care be in place. This includes open communication, standardization, and incorporation of best practices into the EN process. This document provides recommendations based on the available evidence and expert consensus for safe practices, across each step of the process, for all those involved in caring for patients receiving EN.
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Affiliation(s)
- Joseph I Boullata
- 1 Clinical Nutrition Support Services, Hospital of the University of Pennsylvania and Department of Nutrition, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Lillian Harvey
- 3 Northshore University Hospital, Manhasset, New York, and Hofstra University NorthWell School of Medicine, Garden City, New York, USA
| | - Arlene A Escuro
- 4 Digestive Disease Institute Cleveland Clinic Cleveland, Ohio, USA
| | - Lauren Hudson
- 5 Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew Mays
- 6 Baptist Health Systems and University of Mississippi School of Pharmacy, Jackson, Mississippi, USA
| | - Carol McGinnis
- 7 Sanford University of South Dakota Medical Center, Sioux Falls, South Dakota, USA
| | | | - Sarita Bajpai
- 9 Indiana University Health, Indianapolis, Indiana, USA
| | | | - Tamara J Kinn
- 11 Loyola University Medical Center, Maywood, Illinois, USA
| | - Mark G Klang
- 12 Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Linda Lord
- 13 University of Rochester Medical Center, Rochester, New York, USA
| | - Karen Martin
- 14 University of Texas Center for Health Sciences at San Antonio, San Antonio, Texas, USA
| | - Cecelia Pompeii-Wolfe
- 15 University of Chicago, Medicine Comer Children's Hospital, Chicago, Illinois, USA
| | | | - Abby Wood
- 17 Baylor University Medical Center, Dallas, Texas, USA
| | - Ainsley Malone
- 18 American Society for Enteral and Parenteral Nutrition, Silver Spring, Maryland, USA
| | - Peggi Guenter
- 18 American Society for Enteral and Parenteral Nutrition, Silver Spring, Maryland, USA
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31
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Abdelhadi RA, Rahe K, Lyman B. Pediatric Enteral Access Device Management. Nutr Clin Pract 2016; 31:748-761. [DOI: 10.1177/0884533616670640] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Ruba A. Abdelhadi
- Enteral Access Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Katina Rahe
- Enteral Access Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Beth Lyman
- Nutrition Support Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
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32
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Abstract
Intestinal failure is a recognized complication of surgically-managed necrotizing enterocolitis (NEC). Functional adaptation of remaining bowel means that many children are eventually able to achieve enteral autonomy. Integrated multidisciplinary care in the early post-operative phase is key to long-term success. The objective of this review is to outline a clinical approach to management of intestinal and nutritional complications experienced by children following intestinal resection for NEC.
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Affiliation(s)
- Kelsey D J Jones
- Department of Paediatric Gastroenterology and Nutrition, Oxford Childrens' Hospital, Oxford University Hospitals NHS Foundation Trust, United Kingdom
| | - Lucy J Howarth
- Department of Paediatric Gastroenterology and Nutrition, Oxford Childrens' Hospital, Oxford University Hospitals NHS Foundation Trust, United Kingdom
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33
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Davis AM, Dean K, Mousa H, Edwards S, Cocjin J, Almadhoun O, He J, Bruce A, Hyman PE. A Randomized Controlled Trial of an Outpatient Protocol for Transitioning Children from Tube to Oral Feeding: No Need for Amitriptyline. J Pediatr 2016; 172:136-141.e2. [PMID: 26947568 PMCID: PMC4846510 DOI: 10.1016/j.jpeds.2016.02.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/20/2016] [Accepted: 02/03/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the role of amitriptyline in the effectiveness of an outpatient protocol for weaning medically complicated children from tube to oral feeding. STUDY DESIGN Twenty-one children seen in multidisciplinary outpatient feeding teams across 4 sites were recruited to a randomized placebo-controlled trial of a 6-month outpatient treatment protocol with behavioral, oral-motor, nutrition, and medication components. RESULTS All of the children who completed the 6-month program (73%) were weaned to receive only oral feeding, regardless of group assignment. The transition from tube to oral feeding resulted in decreases in body mass index percentile and pain, some improvements in quality of life, and no statistically significant changes in cost. CONCLUSIONS Amitriptyline is not a key component of this otherwise effective outpatient, interdisciplinary protocol for weaning children from tube to oral feeding. TRIAL REGISTRATION ClinicalTrials.gov: NCT01206478.
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Affiliation(s)
- Ann M. Davis
- Department of Pediatrics, University of Kansas Medical Center,Center for Children’s Healthy Lifestyles & Nutrition
| | - Kelsey Dean
- Center for Children’s Healthy Lifestyles & Nutrition
| | - Hayat Mousa
- Pediatric Gastroenterology, Hepatology and Nutrition Department, University of California San Diego / Rady Children’s Hospital
| | - Sarah Edwards
- Pediatric Gastroenterology, Children’s Mercy Kansas City
| | - Jose Cocjin
- Pediatric Gastroenterology, Children’s Mercy Kansas City
| | - Osama Almadhoun
- Department of Pediatrics, University of Kansas Medical Center
| | - Jianghua He
- Department of Biostatistics, University of Kansas Medical Center
| | - Amanda Bruce
- Department of Pediatrics, University of Kansas Medical Center,Center for Children’s Healthy Lifestyles & Nutrition
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