Nutritional care for children with feeding difficulties and disabilities: A scoping review

The Kumagai Method: Feeding Techniques Using the Pigeon Baby Cleft Palate Bottle

BACKGROUND/OBJECTIVES

This study aimed to identify the P-bottle feeding techniques systematically organized by Ms. Kumagai, an expert in nursing care for children with a cleft lip and/or palate (CLP), which were developed as she gained expertise in feeding affected children.

METHODS

We recruited three nurses who had mastered the Kumagai method for feeding with a P-bottle. Through analysis of participants' voices and videos during interviews, we focused on aspects such as dealing with a closed mouth, inserting the nipple in cases of unilateral and bilateral CLP, dealing with the child's movements after insertion, and key considerations when squeezing the bottle.

RESULTS

The interview analyses revealed numerous techniques used by nurses to manage the difficulties encountered while feeding children, ensuring successful provision of nourishment. Specifically, the nurses employed techniques such as placing the nipple along the midline of the child's tongue and varying the application of force on the nipple depending on the cleft type. The nurses reported that the objectives of these techniques were to prevent ulcer formation and encourage the use of the tongue, simulating original feeding movements.

CONCLUSIONS

We explored feeding techniques and the management of associated challenges. Our results suggest that the "Kumagai Method" could be valuable in improving feeding practices.

The nutritional and feeding status of children living in selected residential child care facilities in Zambia: implications for programs and policies

Introduction

This study aimed to estimate the prevalence of undernutrition and risk of feeding difficulties and describe common feeding practices for children from birth to 10 years of age living in residential care in Zambia.

Methods

This was a secondary analysis of de-identified cross-sectional data on 397 children living in 22 residential care facilities in four provinces. Child demographics, anthropometrics, hemoglobin levels, risk for feeding difficulties, and facility-level feeding practices were collected by a trained study team using Count Me In, a digital health app. Interviews with staff were conducted at 15 residential care facilities.

Results

Around half of the study sample were boys (53.4%) and <5 years old (55.4%). Special healthcare needs were reported in 10.3% of the children, with cerebral palsy being the most common (3.5%). Underweight, stunting, wasting (using weight-for-length/height), and anemia were found in 22.4, 28.0, 7.1 and 54.7% of children, respectively, with higher rates in children with special healthcare needs and children <24 months old. Duration of residential care was positively associated with length/height-for-age but not weight-for-age or weight-for-length/height z-scores. A risk for feeding difficulties was found in 41.4 and 26.0% of children with and without special healthcare needs, respectively. Suboptimal bottle-feeding practices, including the use of altered nipples and poor caregiver-infant interactions, were observed for infants <12 months old. Residential care staff reported suboptimal diets in their facilities and gaps in knowledge and resources to meet children's nutritional needs.

Conclusion

These results demonstrate that a large proportion of children living in residential care in Zambia are at high risk for undernutrition and feeding difficulties and contribute to the small body of literature on children living in residential care, both in Zambia and globally. In the context of Zambia's efforts to improve child nutrition and reform its alternative care, these findings can inform programming and policies for children living in residential care to fulfill their rights to health and family care.

Nutritional Status and Dietary Behaviors of Children with Intellectual or Developmental Disabilities in Saudi Arabia: A Systematic Review

Children with intellectual or developmental disabilities are susceptible to malnutrition. This systematic review was conducted to assess the nutritional status and dietary behaviors of children with intellectual or developmental disabilities in Saudi Arabia. The target population was children from Saudi Arabia aged 18 years or younger and diagnosed with intellectual or developmental disabilities. Appropriate research studies that were published from inception up to December 2023 were obtained and reviewed. The outcomes of interest, including anthropometric data, laboratory data, dietary intake data, and dietary behaviors data, were collected and organized in relevant tables. The methodological quality and bias risk for the involved studies were evaluated. Out of 286 screened articles, 31 research articles were selected. The review results show that the rates of overweight and obesity were significantly higher among children with intellectual or developmental disabilities compared to typically developing children. The laboratory data revealed that they were more likely to have nutritional deficiencies. Low intake of energy, protein, and several micronutrients is frequently reported among them. Moreover, they are anticipated to have unhealthy dietary behavior. In conclusion, the findings suggested that children with intellectual or developmental disabilities were at higher risk of malnutrition including deploying obesity and nutritional deficiencies. Healthy and balanced nutrition that considers dietary requirements and food preferences is critical to maintaining the optimal development of these children. This review could invite researchers and policy-makers in Saudi Arabia to put more effort into integrating individuals with disability into the healthcare system and community. Further research is required to determine the types of intervention measures that can be taken to reduce the risk of malnutrition. Additional action is needed to monitor the implementation of national policies and programs that target this part of society.

Acceptance of bite presentations and feeding behaviors of 8 to 12-month-old infants: A reflection of typical feeding development

PURPOSE

The lack of age-appropriate expectations for feeding acceptance patterns in early childhood is a barrier to early and accurate identification of pediatric feeding disorder (PFD). The objective of the study was to describe the process by which typically developing children 8-12 months of age accept or refuse bite presentations and their corresponding feeding behaviors, aiming to establish age-appropriate normative data for feeding acceptance.

METHOD

Using cross-sectional methodology, we studied the proportion of bite presentations accepted, the type of feeding behaviors-passive, disruptive, expulsion, feeding concerns- observed at presentation and acceptance or refusal, and the duration between presentation to acceptance or refusal in 63 healthy infants between 8 and 12 months of age. Descriptive statistics and a one-way ANOVA were conducted to compare the effect of age and texture.

RESULTS

Findings reveal high levels of bite acceptance of 80 % or > for children across ages, but with lower texture-specific differences. Both passive and disruptive behaviors were present even during acceptance of bites without any expulsion. Feeding concerns showed developmental trends with rapid reduction by 12 months suggesting improvement in oral feeding skills. The duration of acceptance and refusals revealed clear patterns by age and texture with an average of 3 s for acceptance but <1 s for refusal.

CONCLUSIONS

This study describes bite acceptance patterns in a cohort of typically developing infants between 8 and 12 months of age by examining the acceptance of bites, frequency and type of feeding behaviors, and duration differences when children accept versus refuse a bite. Findings may be applied in the future to provide more sensitive detection of problematic feeding patterns to aid in the detection of pediatric feeding disorder.