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Feeding disorders are psychological conditions that occur during infancy and early childhood, and result in insufficient intake of foods. Existing feeding disorder research identifies a raft of factors associated with predisposition, development and maintenance of feeding disorders, as well as a multitude of potential outcomes for the child and the system around them. However, neither feeding disorders nor their aetiological bases are well defined or uniformly applied in general, academic or clinical domains. Furthermore, the relationships and differences between observable characteristics, diagnostic criteria, and problem perceptions, and the bearing of these on disorder identification and treatment, are under-researched. The numerous definitions and profiles for feeding disorders make comprehension and knowledge gathering very difficult for caregivers and researchers, and thus hinder research and clinical progression in the field. The overarching aim of this thesis was to examine and characterise paediatric feeding disorders. The objective was to characterise and triangulate what feeding disorders are in terms of observable appearance, external perception, and psychometric properties, and better understand what constitutes a feeding disorder from multiple relevant perspectives. A mixed methods approach was taken to the collection and analysis of data, to obtain both depth and breadth of information. The results of the current thesis suggest that feeding disorders are characterised by a variety of behaviours and features within a biopsychosocial model. While physical models of feeding disorders are outdated, the potential for underlying physical contributing factors and resultant physical outcomes was highlighted throughout the current research and should not be ignored. However, overreliance on physicality, under-recognition of psychological processes, and consequent deficits to disorder identification within clinical settings, was also illustrated within the research. Furthermore, significant issues were raised regarding the lack of a consistent and inclusive model of feeding problems and disorders within healthcare systems. Though most clinicians saw feeding on a scale from normal to abnormal and frequently emphasised the value of early identification and treatment, the referral and treatment pathways that were discussed whereby only the most severe or physically affected children were treated, were not consistent with these models. Interviews with mothers highlighted the role of intrinsic child factors within the development of disordered feeding, including challenging behavioural characteristics, sensory sensitivities, difficult temperament, and lack of feeding motivation or avoidance of new foods. The importance of these child factors was supported by psychometric assessment, which identified distinct patterns of child characteristics associated with different types of problematic or disordered feeding, and a strong association between disordered feeding and the parent perception of having a difficult child. Furthermore, video observations of child mealtimes highlighted not only disparity in the amount of food eaten between disordered and non-disordered children, but a considerable deficit in the level of interest, motivation, and engagement with feeding shown by disordered children. Deficits to child feeding motivation pose a problem for parents that is less obvious than extreme emotional reactions, but which can be equally distressing for the parent who views nourishing their child as one of their major responsibilities. This point was reinforced across parent interviews and mealtime observations, and should be a key factor in the identification of families in need of support and intervention. Parent interviews, healthcare professional interviews, and psychometric assessment, all highlighted the considerable presence and role of parent anxiety within feeding disorder development. Parent anxiety was discussed as a potential cause and an outcome of challenging feeding behaviour, exacerbated by the perceived extent of the child s feeding condition and the dearth of support and information about dealing with significant feeding issues. Anxiety was seen by parents and healthcare professionals to influence the feeding strategies used by parents, and without intervention to contribute to a downward spiral of negative feeding interactions. Disordered feeding was also seen to interfere with social interactions, which would otherwise play an important role in the child s feeding and dietary development, and provide social support and guidance for parents. These patterns of problem and disorder perpetuation are liable to persist while general and clinical understanding of feeding disorders is minimal and inconsistent. The findings of the current thesis pose a great variety of potential influences and risk factors for feeding disorder development, supporting an individualistic approach to disorder identification and intervention, and the need for a significant change in the current systems for dealing with feeding disorders. It is essential to take each of the different components into consideration to understand the specific mechanisms underpinning the maintenance of the feeding disorder and aid selection of the most suitable and efficient approach to intervention. The pattern of factors implicated in each individual feeding disorder case will be differentiated according to the child, the parent and the child s general environment. Identification of the full range of children in need of support and intervention is reliant on recognition of the diversity in disorder type, severity and presentation.

Submitted in fulfilment of the Requirements for Degree of Master of Speech Pathology: The Discipline of Speech Pathology School of Human and Community Development Faculty of Humanities University of the Witwatersrand / Background: Fussy eating has become an increasing concern in paediatric care as a result of its far-reaching consequences for the developing child. However, there is currently a scarcity of published literature related to fussy eating internationally and even more so within the South African context, resulting in a lack of consensus regarding the definition of fussy eating. Aim: To explore the experiences and perceptions of SLTs with regards to fussy eating in children. Methods: The study was based on an exploratory, descriptive, qualitative research design. Data was gathered within semi-structured, in-depth interviews from 30 SLTs who consented to participate in the study. The data was analysed qualitatively, using thematic content analysis. Results: Fussy eating was described as a multi-factorial and heterogeneous condition arising from a number of inter-related aetiologies. The role of sensory integration was noteworthy in the understanding of fussy eating in children, and extended to almost every aspect of the study. The nature of fussy eating described within this study therefore appeared to lend to a multidisciplinary approach to adequately address the needs of this population. The findings of the study further indicated that socio-economic status contributed to the causes of fussy eating. Conclusion: Based on the findings of the study in conjunction with the literature pertaining to fussy eating, a working definition of fussy eating is proposed. The complexity of fussy eating calls for collaboration between healthcare professionals in dealing with this condition. All professionals dealing with fussy eating must therefore be adequately trained to deal with this condition adequately. Key Words: Fussy Eating, Feeding Disorders, Sensory Integration, South Africa

Efficacy of multidisciplinary inpatient treatment of feeding disordered children was sought through retrospective chart review of 40 G-tube dependent children ages 22 months to 7 years. Premature births were 55% of the sample ranging from 23 to 36 weeks gestation. The majority of co-occurring medical conditions included congenital anomalies (50%), gastroesophageal reflux disease (25%) and chronic lung disease (25%). Treatment effect analyzed from pre and post treatment measures of oral and G-tube caloric intakes resulted in a significant difference from admission to discharge for both oral intake, t (39) = 5.76, p < 0.001, d = 1.02, and G-tube dependency, t(39) = 10.94, p < 0.001, d = 2.03 with both showing strong treatment effects. Results indicated a highly reliable and valid method of treating severe pediatric feeding disorders.

Made available in DSpace on 2016-04-27T18:12:38Z (GMT). No. of bitstreams: 1 Patricia Trinta e Farias.pdf: 1110472 bytes, checksum: 1739798374fb2dd30939aeadadc88368 (MD5) Previous issue date: 2008-11-25 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The present paper had the objective of describing the transformation in the clinical-therapeutical perspective occurred during the ambulatory speechlanguage treatment of a young child with feeding problems that used an exclusive alternative feeding via gastrotomy. The difficulty concerning the feeding dynamic was understood beyond the organical and functional aspects, considering the patient s familial context. Being applied a clinical exploratory methodology, to collect the data there were used registrations (handbooks) of the attendances, including the parents interviews. In order to reflect about the transformation in the attendance process contemplating the child s life history, there were applied concepts of the Winnicottian theory, namely: holding, object management and presentation. Finally, it was possible to conclude that the speech-language therapist that deals with feeding problems, based on a favorable setting, may offer the patient conditions to a safe pleasant feeding / O presente estudo teve como objetivo descrever a transformação na perspectiva clínico-terapêutica ocorrida durante o tratamento fonoaudiológico ambulatorial de uma criança pequena com problema alimentar que utilizava uma via de alimentação alternativa exclusiva gastrostomia. A dificuldade em torno da dinâmica da alimentação foi compreendida para além dos aspectos orgânicos e funcionais, considerando-se o contexto familiar da paciente. Sendo a metodologia clínica exploratória, para a coleta dos dados foram utilizados registros (prontuário) dos atendimentos, incluindo as entrevistas com os pais. Para refletir sobre a transformação no processo de atendimento, contemplando a história de vida da criança, foram abordados conceitos da teoria winnicottiana, a saber: holding, manejo e apresentação de objeto. Por fim, foi possível concluir que o fonoaudiólogo que atua com problemas alimentares, a partir de um setting favorável, pode oferecer ao paciente condições para uma alimentação segura e prazerosa

Made available in DSpace on 2016-04-28T20:38:44Z (GMT). No. of bitstreams: 1 Eduardo Fraga de Almeida Prado.pdf: 424655 bytes, checksum: 0063d95661241621fd775e971f00bc99 (MD5) Previous issue date: 2013-09-20 / Feeding disorders is a term that comprehends a wide range of symptoms or complaints that include refusal and food selectivity. It has a multifactorial etiology and it involves biological, genetic, psychological, sociocultural and family-related factors. The consideration of the mother as being co-responsible for the child s eating habits is consensual, although it is impossible to identify where the difficulties arise in causal terms, whether from the mother s feelings or the child s behavior. The literature on the subject emphasizes childhood as the period par excellence for both the etiology and the extinction of the condition, often interpreting it as a "natural" stage in terms of development. The arising or persistency of food selectivity in adults is a less common phenomenon, normally classified as an unspecified eating disorder and, at first, it lacks further studies. With the assistance of Donald Woods Winnicott s Theory of Personal Development, this research aims at contributing to the understanding of the etiology and the possible therapeutic management of adult patients with food selectivity. In order to accomplish such task, we covered Winnicott's work with an exploratory approach, focusing on the items that could contribute to the subject of this study. Therefore, it was possible to approach the food selectivity phenomenon based on at least two assumptions: (1) as a defense mechanism of obsessive nature, (2) as a defense mechanism to try to deal with a persecutory anxiety. Lastly, in spite of the hypotheses explored in the survey, the conclusion points to the need for further studies in search of psychodynamic understanding of the food selectivity phenomenon / Distúrbios de apetite é um termo que abarca uma gama variada de sintomas ou queixas que incluem recusa e seletividade alimentar. Sua etiologia é multifatorial estando envolvidos fatores biológicos, genéticos, psicológicos, socioculturais e familiares. É consenso considerar a mãe co-responsável pelo padrão alimentar da criança, ainda que seja impossível apontar por onde começam as dificuldades em termos causais, se nos sentimentos da mãe ou no comportamento da criança. A literatura referente ao tema enfatiza a infância como o período privilegiado tanto da etiologia quanto da extinção do quadro, muitas vezes associando-o como uma etapa natural do desenvolvimento. A origem ou persistência de um quadro de seletividade alimentar em indivíduos adultos é um fenômeno menos comum que costuma ser classificado como um transtorno alimentar não especificado e, em princípio, carece de maiores estudos. Recorrendo à Teoria do Amadurecimento Pessoal de Donald Woods Winnicott, esta pesquisa teve por objetivo contribuir para a compreensão da etiologia e possível manejo terapêutico com pacientes adultos seletivos. Para tanto foi percorrido em caráter exploratório a obra de Winnicott enfocando os artigos que poderiam contribuir para o objeto deste estudo. Assim, foi possível aproximar-se do fenômeno da seletividade alimentar enquanto uma manifestação sintomática decorrente da não apropriação dos impulsos agressivos-destrutivos ao self. Em um segundo momento, apresentou-se um estudo de caso com vistas a relacionar a teoria com a prática clínica. Neste, a seletividade alimentar pôde ser compreendida ao menos a partir de duas modalidades defensivas: (1) enquanto um mecanismo de defesa de caráter obsessivo; (2) enquanto um mecanismo de defesa na tentativa de lidar com uma ansiedade persecutória. Por fim, em que pese a hipótese explorada na pesquisa, conclui-se pela necessidade de novos estudos em busca da compreensão psicodinâmica do fenômeno da seletividade alimentar

abstract: Latino parents of children with feeding disorders completed a survey about their experiences accessing support and the cultural competence of their providers. This work is a follow-up project to a presented American Speech and Hearing Association Conference poster (Stats-Caldwell, Lindsay, Van Vuren, 2017). That project revealed caregivers’ use of social media and indicated an overall perceived lack of support from providers. In the present survey, Latino caregivers identified the resources they consult and rated the level of helpfulness in addition to the types of supports they sought and received from these resources. Results indicate a considerable reliance on pediatricians in both frequency of consultation and helpfulness ratings. No significant difference was seen between the frequency of consultation between pediatricians, speech-language pathologists and other service providers. No significant difference was found in the helpfulness ratings between speech-language pathologists and topic-specific social media pages, nor speech-language pathologists and grandmothers. Participants indicated reliance on social media for informational resources. The influence of social media is discussed. The cultural implications of treating this population are also reviewed. / Dissertation/Thesis / Masters Thesis Communication Disorders 2018

The purpose of this study was to investigate parental influence on treatment progression in children with feeding disorders. Children diagnosed with a feeding disorder were recruited with their parents at the Children's House at Baylor (N=22; 11 boys, 11 girls). Caloric intake was recorded daily as outcome measures of treatment progression. It was hypothesized that the initial parental participation would delay the child's progress as measured by caloric intake. Patient's average caloric intake (measured in grams) for 3 days prior to parents entering the room was compared to the average caloric intake measured for 3 days after the parents entered the room. A paired t-test was performed on the averaged caloric intake three days pre and post-parental presence, yielding significant results: t(21) = 3.17, p = .005. Caloric intake was greater prior to parent involvement (M = 811.17) as compared to after the parent entered the room (M = 704.88).

The proposed study examined the relationship between parental anxiety, measured both subjectively (via self-report questionnaires) and objectively (via salivary cortisol) and the child's feeding progress. Children diagnosed with a feeding disorder were recruited with their parents at Our Children's House at Baylor (n=19; 11 females, 8 males). The patients and their parents were housed in the clinic for an eight-week intensive multidisciplinary pediatric feeding disorder treatment program. Calorie intake was recorded daily as outcome measures of treatment progression. Parental anxiety was measured by the Pediatric Inventory for Parents (PIP), state anxiety on the State Trait Anxiety Inventory (STAI), and by salivary cortisol at three different time points. The present study attempted to examine whether parental feeding (phase three of treatment program) would continue to cause a decrease in the child's caloric intake. In averaging ten meals prior to parental feeding in comparison to the average of ten meals following parental feeding, there was no significant difference as measured by a t-test. Paired t-tests examined parental anxiety from time one to time two and found that salivary cortisol increased significantly t(15) = -6.07, p = .000 from Time 1 (M = 2.30, SD = 1.64) to Time 2 (M = 5.24, SD = 2.58). This demonstrated that while parental anxiety increased as measured by salivary cortisol, the children continued to make improvements. This may be the result of the multidisciplinary feeding program which encompassed a strong behavioral component and parent training. Even though the current results did not demonstrate a direct relationship between parental stress and caloric intake, parental stress as measured by salivary cortisol did increase.

The efficacy of multidisciplinary inpatient and outpatient treatment for transitioning children with severe pediatric feeding disorders from gastrostomy tube dependency to oral nutrition was investigated utilizing caloric and fluid intakes as an outcome measure. The study involved 29 children ages 12 months to 5 years of age with gastrostomy tube dependency. Treatments were provided by speech therapists, occupational therapist, dietician and psychologist for a 30 day period. Four treatment groups were evaluated and average intakes compared at 4 observation periods including pretreatment, initiation of treatment, completion of treatment at 30 days and 4 month follow-up. Children receiving inpatient treatment for feeding disorders evidenced significant differences in oral caloric intake from pretreatment to discharge than outpatient treatment (p < .01) and wait list control group (p = .04). Oral caloric intake from discharge to 4 month follow up yielded no significant differences indicating treatment gains were maintained. Change in environment and caretaker showed a significant effect for the inpatient group (d = 1.89). Effects of treatment by age and weight at 4 month follow up were also analyzed.