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Enteral Nutrition
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Stephanie G. Harshman, Lauren G. Fiechtner
Children requiring EN often meet criteria for pediatric feeding disorder (Chapter 6). Infants, children, and adolescents with pediatric feeding disorder present as a complex clinical challenge because of the heterogeneous underlying etiologies. Thus, a multidisciplinary team approach is essential for prompt interventions, management, and monitoring. When physically and physiologically appropriate and safe, children requiring EN should work toward increasing oral intake. As part of the multidisciplinary team, the speech-language pathologist (SLP) or occupational therapist (OT) has an integral role in determining a child’s skills and working with the team to develop and coordinate an appropriate intervention. SLP/OT collaboration and education with team members and caregivers is essential for intervention success. Additional support may be provided by a behavioral psychologist dependent on the patient’s needs.
Management of feeding problems in children with a chronic illness
Published in Southall Angela, Feeding Problems in Children, 2017
Anthony. Schwartz, Zuzana. Rothlingova
This formulation leans more towards problem description than medical diagnosis. Medical criteria for a feeding disorder in infancy or childhood require that it 'generally involves refusal of food or extreme faddiness' (ICD-10, 1992). Archer et al. (1991) accept that the assessment and treatment of these problems has been highly variable. They recommend that eating and mealtime disorders be regarded as a separate clinical entity regardless of medical diagnosis. Researchers have begun to treat feeding problems as distinct from the syndrome 'failure to thrive' or malnutrition and based solely on the feeding process (Lindberg et al, 1991), as many children with feeding problems do not reach this cut-off point. Linscheid (1992) supports this view and cites estimates suggesting that between 25% and 35% of children have recognised or reportable eating problems, whereas only 1%-2% have feeding problems that result in impaired growth.
Feeding problems in children with autism spectrum disorders: a systematic review
Published in Speech, Language and Hearing, 2023
Rita Pinto-Silva, Ana Margarida Nunes Costa, Inês Tello-Rodrigues
A group of authors with great experience in the study of feeding problems recently proposed a new diagnostic term to unify the different perspectives (Goday et al., 2019). These authors proposed the term ‘Paediatric Feeding Disorders’ that was defined as ‘impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction’. The characterization of feeding difficulties found in this review has some aspects in common with the criteria presented by the authors of Paediatric Feeding Disorder Diagnosis (Goday et al., 2019). Some diagnostic criteria as follows are particularly linked with our findings: (1) ‘Nutritional dysfunction, as evidenced by (…) specific nutrient deficiency or significantly restricted intake of one or more nutrients resulting from decreased dietary diversity’; (2) ‘Feeding skill dysfunction, as evidenced by any of the following: (a) Need for texture modification of liquid or food, (b) Use of modified feeding position or equipment; (c) Use of modified feeding strategies’; and (3) ‘Psychosocial dysfunction, as evidenced by any of the following: (a) Active or passive avoidance behaviour by child when feeding or being fed, (b) Inappropriate caregiver management of child’s feeding and/or nutritional needs, (c) Disruption of social functioning within a feeding context, (d) Disruption of caregiver-child relationship associated with feeding’. The diagnosis of paediatric feeding disorder is not so intrinsically related to the intensity of symptoms in comparison with classical diagnoses in the DSM-5.
Five years of Avoidant/Restrictive Food Intake Disorder: no consensus of understanding among health professionals in New Zealand
Published in Speech, Language and Hearing, 2022
Bianca N. Jackson, Léa A. T. Turner, Georgina L. Kevany, Suzanne C. Purdy
The new diagnosis of ARFID, aimed to ‘identify patients with clinically significant restrictive eating, the magnitude of which results in severe nutritional deficiencies and/or persistent inability to meet energy needs’ (Zimmerman & Fisher, 2017, p. 97). Consequently, this should enable children and their families to receive the appropriate care (Ornstein et al., 2013). Diagnostic consensus influences access to resources for clinicians and families of children with the disorder, in terms of funding and interdisciplinary support, as well as enabling access to educational and social supports. Ongoing challenges with diagnosis include its overlap across the boundaries of feeding disorder and eating disorder. Approaching ARFID from only one of these two perspectives can result in other suitable approaches being invisible as they are not within the scope or knowledge of the clinician (Sharp & Stubbs, 2019). The eating disorders approach to ARFID is dominant in the research literature, with a majority of relevant articles being published in eating disorders journals, including a special issue dedicated to ARFID (Eddy & Thomas, 2019). A subtype taxonomy has been proposed to help clinicians and researchers differentiate between clinical features and provide suitable approaches to intervention specific to the presenting concerns. Three subtypes have been proposed for the paediatric ARFID population including the fear presentation, the appetite/interest presentation and the selective/neophobic eating (Zickgraf, Murray, Kratz, & Franklin, 2019).
Avoidant/restrictive food intake disorder symptoms in children: Associations with child and family variables
Published in Children's Health Care, 2019
Sónia Gonçalves, Ana Isabel Vieira, Bárbara César Machado, Renata Costa, Joana Pinheiro, Eva Conceiçao
Our findings should be interpreted within the context of the study’s limitations. First, the retrospective nature of this study cannot address the causal relationships between ARFID and child and family variables. Second, to our knowledge, there are no validated measures for ARFID in Portugal. Third, parents reported their children’s weight and height, and these values were not measured by researchers, which limits the accuracy of the BMI z-scores. Is it possible that parents underestimate or overestimate their child’s weight according to their concerns, and therefore the results regarding BMI z-score must be interpreted with caution. Finally, ARFID data were collected using a parent-report questionnaire developed by the authors and not an interview with the parents, and some of the parents might misunderstood the questions regarding ARFID symptoms. Despite these limitations, we evaluated symptoms of a feeding disorder, in which research is still scarce, considering a large sample of school-aged children. Moreover, we used data from two types of informants, parents and children.