abstract: ABSTRACT Malawi, as a low and middle income country (LMIC), with one of the lowest per capita gross domestic products, faces challenges in the provision of healthcare to its citizens. According to the Centers for Disease Control (CDC), leading causes of death include but are not limited to, lower respiratory disease, stroke, cancer, neonatal disorders, and nutritional deficiencies. Feeding and swallowing disorders can present as a symptom to any of these medical diagnoses. Currently, there are no known studies focusing on the service provision for feeding and swallowing disorders in Malawi. This pilot study was designed to provide a baseline on how feeding and swallowing disorders are currently being provided for in an emerging country like Malawi. Malawian healthcare professionals who see patients with feeding and swallowing disorders completed a survey and interview pertaining to their personal demographics, caseload, opinions, experiences, and treatment recommendations regarding the management of swallowing disorders (dysphagia). Results indicate a wide range of occupations (Otolaryngoloists, Rehabilitation Technicians, Audiology Technicians, and Nurses) are involved in feeding and swallowing care. Participants expressed a high obligation to provide services for feeding and swallowing disorders, as well as a high concern for their patients. Generally, participants expressed high confidence in their treatment abilities, which did not correspond to knowledge of treatment recommendations that meet U.S. standards of care. Specifically, there was no variation in treatment recommendations across severities and a general lack of resources and tools for assessing and treating dysphagia. Treatment recommendations tended to align with resources currently available in Malawi. Implications for the utilization of NGOs (non-governmental organizations) and the education of healthcare providers on feeding and swallowing disorders in the social and cultural contexts of this country are discussed. / Dissertation/Thesis / Masters Thesis Communication Disorders 2018

<p dir="ltr">The development of feeding skills is essential for infant health, growth, and family well-being. Despite the importance of this skill, relatively little is known about the development of independent solid feeding skills relative to other body systems – like vocalizations – or external factors including caregivers or the feeding environment. The purpose of this preliminary study was to examine the relationship between feeding skills, vocalizations, and caregiver feeding responsiveness at the same point in 6-8-month-old infants. We conducted this study remotely in order to obtain the most accurate assessment of infant skills and include diverse infant feeding experiences within their own home environments. Twenty-five typically developing – low-risk – infants and a pilot group of ten infants at increased risk for feeding and communication disorders completed the study, along with their caregivers. Infants were categorized as “at-risk” if they spent time in the Neonatal Intensive Care Unit. We collected feeding data through caregiver-recorded videos of typical mealtimes, vocalization measures from daylong audio recordings, and responsiveness assessments from video-conferencing interviews with caregivers and the mealtime feeding videos. In our sample, it was feasible to use these remote data collection methods, and we obtained high inter- and intra-rater reliability for all measures (> 90%). In our preliminary study, we found that infants in the low- and at-risk groups demonstrated different oral motor feeding skills. In hierarchical regression models, the interaction between risk group and utterance duration was the most significant predictor of oral motor feeding skills, while neither vocalization measure was strongly related to eating efficiency. In the opposite direction, feeding skills were not predictive of either normalized child vocalization count or utterance duration. Relative to caregiver feeding responsiveness, we found that caregiver feeding responsivity alone did not predict feeding or vocalization measures. Responsivity in combination with weeks of feeding experience and medical risk group was related to oral motor feeding skill but not related to vocalization measures. Overall, this study provided initial evidence that feeding skills develop as a dynamic system, influenced by multiple within-child and external factors, and future research is warranted on the influence of these factors on feeding and communication skill development.</p>

In der vorliegenden Arbeit wurden drei Studien zur Diagnostik und Therapie frühkindlicher Fütterungsstörungen bei Frühgeborenen durchgeführt. Für der FAS-Studie wurde die Fütteraversionsskala (FAS) mit dem Ziel Fütterungsstörungen bei Frühgeborenen mit einem möglichst effizienten Fragebogen zu diagnostizieren. Das Verfahren wurde anhand einer Stichprobe von 46 Frühgeborener unterhalb 2000g Geburtsgewicht im korrigierten Alter von 9 -12 Monaten evaluiert. Die interne Konsistenz beträgt r=.83, die Reliabilität r=.82. Die Validität konnte mit r=.72 bestimmt werden. Bei einem kritischen Cut-Off Wert von >/=2 konnte die FAS alle Fälle von Nahrungsverweigerung erfassen. In der EFFS-Studie wurde das Essverhalten und Fütterungsprobleme von 21 Frühgeborenen im 1., 6. und 12. Lebensmonat mittels eines strukturierten Interviews erfasst. Die Annahme, dass reifungsbedingte und interaktionelle Fütterungsstörungen sich im Auftretensalter unterscheiden, konnte bestätigt werden. Nahrungsverweigerung ging in dieser Studie nicht in jedem Fall mit einer hohen FAS einher. Dieses ist unter Umständen auf die Durchführung als Interview zurückzuführen. Deshalb sollte die FAS nicht als Interview durchgeführt werden.In der TEFF-Studie wurde ein Therapieverfahren zur Behandlung von Fütterungsstörungen bei Frühgeborenen evaluiert. Dafür wurden 21 Frühgeborene mit Fütterungsstörungen vor und nach Therapiebeginn das Auftreten von Störungssymptomatik und der FAS erfasst. Verglichen wurden diese Fälle mit einer Kontrollgruppe. Mittelwertsunterschiede zwischen Interventions- und Kontrollgruppe vor der Intervention waren hinsichtlich FAS und Symptomatik hoch signifikant. Nach der Intervention traten signifikant weniger Symptome auf, der FAS war signifikant niedriger. Zwischen der Kontrollgruppe und der Interventionsgruppe erreichten Mittelwertsunterschiede nach Interventionsabschluss keine Signifikanz.

Description. Les troubles d’alimentation touchent de 33 à 80 % des enfants ayant un trouble du développement. L’évaluation clinique constitue une étape essentielle dans l’identification de la problématique. Alors qu’il existe des outils valides permettant d’évaluer la sphère oro-motrice, l’évaluation des problèmes d’origine sensorielle reste très limitée entraînant une négligence importante de cette dimension dans la prise en charge des problèmes d’alimentation. But. La présente étude avait pour but de développer une version préliminaire d’un instrument de mesure permettant l’identification précoce des problèmes d’alimentation d’ordre sensoriel chez la population pédiatrique. Méthodologie. Les premières étapes énoncées par Kielhofner et collègues permettant l’élaboration d’un nouvel outil d’évaluation ont été suivies. Résultats. Une version préliminaire de cet outil est proposée comprenant un questionnaire et un test. Le Questionnaire de la sphère sensorielle de l’alimentation (QSSA), constitué de 58 items, permet de documenter les capacités de l’enfant à traiter l’information sensorielle en lien avec l’alimentation et le Test de la sphère sensorielle de l’alimentation (TSSA) permet d’évaluer directement la tolérance de l’enfant à l’exploration buccale de matériel non comestible et comestible. Conséquences. La conception du questionnaire et du test de la sphère sensorielle de l’alimentation constituent les premières étapes du développement d’un outil d’évaluation visant spécifiquement la sphère sensorielle et les habitudes alimentaires chez le jeune enfant (6-36 mois). / Problem Statement. Thirty-three to 80% of children with developmental problems also have feeding problems. The clinical evaluation of these children constitutes an essential step in identifying feeding problems. Although valid tools for the assessment of oral-motor problems exist, evaluation of oral sensory problems remains very limited, resulting in a marked gap for addressing feeding problems of a sensory nature. Goal. The goal of this study was to put in place several critical steps necessary to develop a measurement instrument for the early identification of sensory feeding problems in the pediatric population. Methods. Several steps, described by Kielhofner and colleagues, for the development of a new evaluation tool were followed. Results. A preliminary version of a parent questionnaire (Questionnaire de la sphère sensorielle de l’alimentation), containing 58 items, has been developed. It allows the documentation of children’s ability to deal with oral sensory issues related to feeding. The test (Test de la sphere sensorielle de l’alimentation) permits evaluation of the tolerance to oral exploration of non-edible and edible items. Implications. This questionnaire and test constitute a first step in the development of a sound clinical oral sensory and feeding assessment tool for young children ages 6 to 36 months.

Description. Les troubles d’alimentation touchent de 33 à 80 % des enfants ayant un trouble du développement. L’évaluation clinique constitue une étape essentielle dans l’identification de la problématique. Alors qu’il existe des outils valides permettant d’évaluer la sphère oro-motrice, l’évaluation des problèmes d’origine sensorielle reste très limitée entraînant une négligence importante de cette dimension dans la prise en charge des problèmes d’alimentation. But. La présente étude avait pour but de développer une version préliminaire d’un instrument de mesure permettant l’identification précoce des problèmes d’alimentation d’ordre sensoriel chez la population pédiatrique. Méthodologie. Les premières étapes énoncées par Kielhofner et collègues permettant l’élaboration d’un nouvel outil d’évaluation ont été suivies. Résultats. Une version préliminaire de cet outil est proposée comprenant un questionnaire et un test. Le Questionnaire de la sphère sensorielle de l’alimentation (QSSA), constitué de 58 items, permet de documenter les capacités de l’enfant à traiter l’information sensorielle en lien avec l’alimentation et le Test de la sphère sensorielle de l’alimentation (TSSA) permet d’évaluer directement la tolérance de l’enfant à l’exploration buccale de matériel non comestible et comestible. Conséquences. La conception du questionnaire et du test de la sphère sensorielle de l’alimentation constituent les premières étapes du développement d’un outil d’évaluation visant spécifiquement la sphère sensorielle et les habitudes alimentaires chez le jeune enfant (6-36 mois). / Problem Statement. Thirty-three to 80% of children with developmental problems also have feeding problems. The clinical evaluation of these children constitutes an essential step in identifying feeding problems. Although valid tools for the assessment of oral-motor problems exist, evaluation of oral sensory problems remains very limited, resulting in a marked gap for addressing feeding problems of a sensory nature. Goal. The goal of this study was to put in place several critical steps necessary to develop a measurement instrument for the early identification of sensory feeding problems in the pediatric population. Methods. Several steps, described by Kielhofner and colleagues, for the development of a new evaluation tool were followed. Results. A preliminary version of a parent questionnaire (Questionnaire de la sphère sensorielle de l’alimentation), containing 58 items, has been developed. It allows the documentation of children’s ability to deal with oral sensory issues related to feeding. The test (Test de la sphere sensorielle de l’alimentation) permits evaluation of the tolerance to oral exploration of non-edible and edible items. Implications. This questionnaire and test constitute a first step in the development of a sound clinical oral sensory and feeding assessment tool for young children ages 6 to 36 months.

Objective: Little epidemiological evidence exists on rumination disorder behavior (RB) and pica behavior (PB). We examined prevalence of RB and PB and presence of comorbid feeding/eating disorder symptoms among school-aged children. Methods: In elementary schools in Switzerland, 1,430 children (54.0% female) ages seven to 13 completed Eating Disorder Examination-Questionnaire for children (ChEDE-Q) and Eating Disturbances in Youth Questionnaire (EDY-Q). Results: EDY-Q data behavior frequency showed 9.7% reported RB only, 10.0% reported PB only, and 3.1% reported RB+PB (≥1 on 0-6 Likert scale). At a clinical cut-off score of ≥4 (at least “often true”), 1.7% had RB only, 3.8% had PB only, and 1.1% had RB+PB. Avoidant/restrictive food intake disorder symptoms were most common in those with RB+PB, and more common in those with RB or PB than those without. Degree of eating disorder symptoms (by ChEDE-Q) over the past 28 days were similar among those with RB, PB, or RB+PB, but less common in those without RB or PB. Discussion: RB and PB were commonly reported in our sample of school-aged children, even at a potential clinically significant cut-off. Our findings also suggest that degree of eating disorder symptom comorbidity is similar between those with RB and PB.

Objective: Little epidemiological evidence exists on rumination disorder behavior (RB) and pica behavior (PB). We examined prevalence of RB and PB and presence of comorbid feeding/eating disorder symptoms among school-aged children. Methods: In elementary schools in Switzerland, 1,430 children (54.0% female) ages seven to 13 completed Eating Disorder Examination-Questionnaire for children (ChEDE-Q) and Eating Disturbances in Youth Questionnaire (EDY-Q). Results: EDY-Q data behavior frequency showed 9.7% reported RB only, 10.0% reported PB only, and 3.1% reported RB+PB (≥1 on 0-6 Likert scale). At a clinical cut-off score of ≥4 (at least “often true”), 1.7% had RB only, 3.8% had PB only, and 1.1% had RB+PB. Avoidant/restrictive food intake disorder symptoms were most common in those with RB+PB, and more common in those with RB or PB than those without. Degree of eating disorder symptoms (by ChEDE-Q) over the past 28 days were similar among those with RB, PB, or RB+PB, but less common in those without RB or PB. Discussion: RB and PB were commonly reported in our sample of school-aged children, even at a potential clinically significant cut-off. Our findings also suggest that degree of eating disorder symptom comorbidity is similar between those with RB and PB.

Eating and feeding disturbances are prevalent yet understudied health conditions in youth. They are characterized by aberrant eating behaviors, cognitive and emotional dysfunctions, and dysregulated body weight. The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition defines several feeding and eating disorders with a common onset in youth; however, data on their clinical validity at young ages are lacking. Further non-normative eating behaviors exist, but their clinical relevance needs elucidation. This Special Issue compiles state-of-the-art reviews and empirical research on the presentation, development, course, and maintenance of diverse eating and feeding disturbances as a prerequisite for delineating evidence-based interventions for treatment and prevention.