Introduction: There has been a lack of longitudinal studies on maternal and infant factors associated with feeding difficulties. Feeding difficulties are common, cause much anxiety for parents, and are associated with a range of child health and behavioural outcomes. This study aims to gain an understanding of the prevalence and type of feeding difficulties found in a community sample, the prevalence of maternal mental ill-health and identify maternal and infant factors predictive of feeding difficulties. A final aim is to identify factors associated with successful and unsuccessful feeding experiences from a maternal perspective. Method: A short questionnaire with questions about support and help-seeking was compiled, and several standardised measures were included in the pack; a measure of maternal mood (DASS-21), social support (SOS-S), and eating disorder symptomatology (EAT-26). Questionnaires were given to mothers in pregnancy, and again when infants were around 3 and 7 months old. An adapted version of the Child Feeding Assessment Questionnaire, and the food fussiness subscale from the Children’s Eating Behaviour Questionnaire examined feeding behaviour and maternal response. The Infant Temperament Questionnaire examined maternal perception of infant temperament. Content analysis was used to identify themes in mother’s narrative about factors which help feeding and barriers to a successful feeding experience. A within subjects design was employed to examine predictors of infant feeding difficulties. Results: 23% of mothers of 3 to 5 month old infants, and 13% of mothers of 7 to 10 month olds reported their child as having one or more feeding difficulties. Levels of stress remained stable across the length of the study, but prevalence of maternal anxiety and depression reduced. 47% of those mothers who breast fed found breast feeding difficult or very difficult. Maternally identified barriers to successful feeding with feeding were child illness, and painful or difficult breastfeeding. Mothers wanted an improvement in support and knowledge of health professionals, and a reduction in pressure from health professionals in relation to feeding method. Maternal depression and stress were correlated with severity of food refusal in infants, as well as maternal anxiety and food fussiness, prior to post-hoc analyses. Following post-hoc analyses these relationships were no longer significant. Discussion: Relationships between infant behaviour, maternal health and feeding difficulties are explored. The low prevalence of feeding difficulties and reasons for negative findings in relation to predictors of feeding difficulties are discussed. Implications for health services are presented in the light of maternal views about support and barriers to successfully feeding their child.

The purpose of this study was to determine the efficacy of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) in identifying children at risk for feeding difficulties when given to parents by interview versus without assistance. Thirty subjects from Emory Developmental Progress Clinic (Emory DPC) participated in the study and were randomized to receive the BPFAS either by interview or without assistance. Mean BPFAS scores were compared by survey administration method and nutrition referral status for the total cohort as well as by age (1.5 year) and weight status (<25th percentile, 25-75th percentile, >75th percentile) using the t-test. The association between survey administration method as well as nutrition referral status and referral score category (84) was determined using the Chi-square test, as was the relationship between nutrition referral status and the response to each BPFAS question. No difference in mean BPFAS score or referral score category by survey administration method was found in the total cohort. However, a higher BPFAS score was observed for children >1.5 years of age who were referred for nutrition intervention vs. not referred (95.33 vs. 62.5, respectively; p=0.004). There was also a significant association between the number of patients referred for nutrition intervention vs. not referred and referral score (11 vs. 19, respectively; p=0.041). There was no association between responses to individual BPFAS questions and nutrition referral status. In conclusion, evaluation of other feeding assessment surveys or the in-house development of a screening tool may be better alternatives for the Emory DPC.

INTRODUCTION: Feeding difficulties are commonly multifactorial in nature, and no uniformly agreed-upon classification system for feeding difficulties currently exists. The Diagnostic and Statistical Manual of Mental Disorders (DSM)-V included a new diagnosis called Avoidant/Restrictive Food Intake Disorder (ARFID), created in order to address the weaknesses of the DSM-IV-text revision (TR) classification system by better capturing the range of feeding difficulties typically found in clinical practice. Little is known about the clinical characteristics associated with meeting the ARFID criteria, and no studies have investigated ARFID prevalence and associated clinical characteristics in patients below the age of 8 years. AIM: To describe the clinical characteristics of a sample of patients referred to Boston Children Hospital’s Growth and Nutrition Program, including the prevalence of ARFID, and identify clinical characteristics associated with meeting the criteria for ARFID. METHODS: We examined prospectively collected data from 69 subjects, age 9 months to 7 years, referred to the Growth and Nutrition Program for feeding difficulties and/or malnutrition between November 2013 and April 2016. Data was collected from caregiver-completed questionnaires, including the Behavioral Pediatrics Assessment Scale (BPFAS), and each patient’s electronic medical record. RESULTS: Premature birth (32.3%), digestive conditions (69.2%), developmental conditions (56.9%), food allergy (20.3%), and meal duration of over 30 minutes (36.2%) were common. Problematic feeding behaviors such as refusing to eat (62.1%) and gagging or vomiting when given new foods (29.2%) were also common. Strategies caregivers used to increase food and liquid consumption included offering only foods the child likes (60.9%) and feeding in front of the television or electronic devices (30.4%). 90.8% had a BPFAS score above threshold. 83.1% of the sample met criteria for ARFID. No statistically significant relationship was found between meeting ARFID criteria and having a BPFAS score above threshold, and there was no statistically significant relationship between meeting ARFID criteria and having a food allergy, having a first-degree relative with a food allergy, or with any of the feeding behaviors or strategies we investigated. CONCLUSION: This study suggests that the majority of patients between the ages of 9 months to 7 years with feeding difficulties referred to the Growth and Nutrition Program meet the criteria for ARFID. While no statistically significant relationship was found between ARFID and the investigated clinical characteristics, further analysis involving a larger sample of patients will be useful for better understanding the clinical characteristics associated with ARFID, and assessing ARFID’s clinical utility. / 2019-07-11T00:00:00Z

Background: The prevalence of neonatal dysphagia is increasing, as medical advances contribute to the survival of critically ill and preterm infants. Additional factors such as low birth weight (LBW), gastroesoephageal reflux disorder (GERD), failure to thrive (FTT) and exposure to HIV may increase the complexity of dysphagia symptoms. Knowledge of context-specific risk factors for dysphagia in the neonatal intensive care unit (NICU) may lead to an effective pathway of diagnosis and management in vulnerable neonates. Objective: The objective was to describe the feeding characteristics and categories of underlying medical conditions in 24 to 42 week gestational age infants while still in the NICU and who were referred for feeding and swallowing assessment. Method: The study was a retrospective investigation of 231 purposively selected medical and speech-language therapy records. Participants had a mean stay of 28.5 days in the NICU of a peri-urban public hospital and all had feeding concerns. An existing seven-category framework for the classification of suspected dysphagia was used. Results: Feeding characteristics of the participants demonstrated that 65.0% had previous enteral tube (NGT/OGT) feeding, and only 15.6% were referred for instrumental assessments such as a VFSS by doctors or speech-language therapists (SLTs). The majority of participants used a mixed manner of feeding such as cup and breastfeeding, or cup and syringe feeding. Only 29.7% of participants was able to breastfeed exclusively which was an indication of feeding difficulties as the hospital where the study was conducted promotes exclusive breastfeeding. Results indicated that the majority of participants (90.04%) presented with multiple medical conditions. Underlying neurological conditions (48.48%) and feeding difficulties secondary to systemic illness (65.80%) contributed mostly to suspected dysphagia in the sample. It was found that 70.99% of infants presented with feeding difficulties secondary to other conditions such as LBW and prematurity, highlighting the need for an expanded dysphagia classification framework. Conclusion: The results are in agreement with the outcomes of previous research and confirm the need for a unique classification framework for dysphagia in South Africa. Neonatal dysphagia is a complex condition and frequently associated with multiple risk factors. / Dissertation (M Communication Pathology)--University of Pretoria, 2016. / Speech-Language Pathology and Audiology / MCommunication Pathology / Unrestricted

Många kvinnor betraktar amning som det naturligaste sättet att ge sitt nyfödda barn föda. Mödrar får information av sjukvården att bröstmjölk innehåller all näring som det nyfödda barnet behöver samt antikroppar som skyddar barnet mot de vanligaste barnsjukdomarna. Det är inte alla kvinnor som kan amma i dagens samhälle och detta kan leda till att känslor väcks hos den nyblivna mamman som under graviditeten tänkt amma men som sedan inte kunnat göra det. Syftet med studien var att utifrån bloggtexter beskriva mödrars upplevelser av amningssvårigheter under de första sex månaderna efter barnets födelse. Studien har en kvalitativ metod med en induktiv ansats. Data samlades in genom blogginlägg samt kommentarer från femton olika bloggar och analyserades sedan med hjälp av en kvalitativ innehållsanalys. I resultatet framkom två kategorier: ”Leva upp till samhällets normer och attityder” samt ”Det professionella stödet i amningsrådgivning”. Kategorierna bildade sedan temat: ”Mödrars kamp att kunna balansera krav och förväntningar på amningen”. Utifrån denna studie kan personal som arbetar med mödrar och amningsrådgivning på olika vårdenheter, få ökad kunskap om hur mödrar upplever amningssvårigheter. Studien kan ligga till grund för ändrade vårdrutiner samt att patientsäkerheten ökas. Det i sin tur kan bidra till att mödrar upplever mindre lidande i möte med hälso- och sjukvården. / Many women consider breastfeeding as the most natural way to give their newborn child nutrition. Mothers receive information from medical staff that breast milk contains all the nutrients that the infant needs and antibodies that protect the baby against common childhood diseases. Not all women can breastfeed in today's society and that could wake feelings in mothers that during the pregnancy has been thinking to breastfeeding but who involuntarily have been unable to do so. The aim of the study was to with blog texts describe mother’s experiences of breastfeeding difficulties in the first six months following the birth. The study was based on a qualitative approach with an inductive approach. Data were collected through blog posts and comments from fifteen different blogs and then analysed using qualitative content analysis. The results are based on two categories: “Living up to the norms and attitudes” and “Professional support in breastfeeding consulting”. These categories formed a theme: “Mothers struggle to balance between the requirements and expectations of breastfeeding”. Based on this study, the staff who work with mothers and breastfeeding consulting on various health care units enhance the understanding of how mothers experiencing breastfeeding difficulties. This furthermore could contribute to mother´s experiencing less distress interaction with health and medical care.

INTRODUCTION: Gastrointestinal pathologies are a common etiology of organic failure to thrive and feeding difficulties; therefore failure to thrive can be a common indication for esophagogastroduodenoscopy (EGD), especially in infants and young children. However there has been no recent studies investigating diagnostic outcome of EGD in children specifically with failure to thrive or feeding difficulties. AIM: To investigate the outcome of EGD with biopsy in children presenting with failure to thrive or feeding difficulties and to determine the extent to which EGD with biopsy results led to a change in diagnosis or clinical management, including medication and nutritional supplements. METHODS: We performed a retrospective cohort study in children under the age of 3 (defined as from 0 up to and including 36 months) who had been seen at one of Boston Children’s Hospital’s outpatient gastroenterology clinics and undergone EGD for the investigation of failure to thrive or feeding difficulties from 1 January 2015 to 31 December 2015. RESULTS: Poor weight gain (55.6%), gastroesophageal reflux (44.4%) and food refusal (38.9%) were the most common presenting symptoms at the first GI clinic visit. The overall prevalence of any gross endoscopic abnormality was 24.8%. The overall prevalence of any histologic abnormality was 44.2%. Compared to subjects with normal esophageal histology, subjects with abnormal esophageal histology had a lower proportion of gastroesophageal reflux and vomiting as their main presenting symptom (63.4% vs. 44.4%, p-value = 0.04). Compared to subjects with normal esophageal histology, subjects with histologic abnormalities in the esophagus were more likely to have current allergy to milk (25% vs. 9.6%, p = 0.02), peanut (8.3% vs. 1.1%, p = 0.03) and tree nut (8.3% vs. 1.1%, p = 0.03). CONCLUSION: In this study gastroesophageal reflux was more prevalent in subjects with normal esophageal histologic findings than those with abnormal findings (63.4% vs. 44.4%, p-value = 0.04). Although the largest number of histologic abnormalities were found in infants, infants were still more likely to have normal than abnormal histology in the esophagus. This finding suggests a more a careful consideration of signs and symptoms prior to proceeding with EGD in infants. Subjects with current milk allergy were more likely to have esophageal histologic abnormalities (p-value = 0.02). Further analysis could indicate current milk allergies as a predictive variable in esophageal histologic abnormalities.

Background: The incidence of neonatal opioid withdrawal syndrome (NOWS), a drug withdrawal syndrome mainly associated with opioid exposure in-utero has significantly increased in the United States over the last decade with infants with NOWS staying longer in the hospital than those without NOWS. Objectives: To determine if feeding tube use while on admission is associated with length of hospital stay among infants diagnosed with NOWS. We also compared the differences between infants with NOWS who required the use of feeding tubes while on admission, and those that did not, based on infant and maternal characteristics. Methods: This was a retrospective cohort study of infants delivered between July 1, 2011 and June 30, 2016 at Ballad Health System. Our inclusion criteria were infants who were exposed to opioids in-utero and received a diagnosis of NOWS based on 2 consecutive Finnegan scores of 10, or 3 consecutive scores of 8, or treatment with morphine. Medical chart record of 294 infants who met these criteria were reviewed for infant and maternal characteristics. Our outcome variable was infant length of hospital stay and our predictor variable was feeding tube use an indicator for feeding difficulties. Chi-square test and t-test were used to compare infant and maternal characteristics by feeding tube use. Simple linear regression models were used to assess the effect of feeding tube use and infant and maternal characteristics on infant length of hospital stay. Multiple linear regression was used to model infant length of hospital stay predicted by feeding tube use, while adjusting for neonatal intensive care unit (NICU) admission, treatment with morphine, and maternal benzodiazepine use during pregnancy. All analyses were done using SAS 9.4. Results: Of the 294 infants diagnosed with NOWS, 22.11% had feeding difficulties that necessitated use of feeding tubes. Infants who used feeding tubes were significantly more likely to be born preterm (20.31% vs 8.73%, p=0.0096) to be admitted into the NICU (98.46% vs 51.09%, p=

INTRODUCTION: This Capstone project provided preliminary data on the OT Feeding Outcome Tool and general data on outcomes of feeding interventions at Children’s Specialized Hospital. The OT Feeding Outcome Tool is an internally developed and utilized tool to assess a wide range of pediatric feeding difficulties, regardless of diagnosis and intervention. THEORETICAL PERSPECTIVE: Sensory Integration and Behaviorism were the major theoretical frameworks. DESCRIPTION OF DOCTORAL CAPSTONE: A literature review, focus groups, interviews, chart audits, an online questionnaire and clinical participation and observation provided quantitative and qualitative data on the current state of the literature, barriers to implementation and outcomes of children who have received feeding therapy at Children’s Specialized Hospital. RESULTS: The majority of pediatric feeding assessments are based in behavioral theory and interventions and fail to capture the multi-faceted etiologies and intervention approaches that are seen in practice. Data analyses revealed children who receive feeding therapy at Children’s Specialized Hospital, regardless of diagnosis or intervention, have positive responses recorded by the OT Feeding Outcome Tool. Major barriers to tool implementation were logistical challenges, forgetting and lack of competency. Most effective education methods of the tool were discussion with colleagues, staff meeting and an education presentation. CONCLUSION: There is a significant lack of feeding assessment tools for pediatric populations in the literature, and specifically a lack of evaluations that incorporate an occupational therapy and sensory integration lens. The OT Feeding Outcome Tool is a promising assessment tool for the evaluation of feeding difficulties in pediatric populations.

Background: Autism Spectrum Disorder (ASD) is a developmental disorder characterized by difficulties with communication, problems with social interactions, and repetitive patterns. A greater proportion of children with ASD tend to experience nutritional difficulties and feeding issues compared to neurotypical (NT) children; however, limited research has been examined that compares nutritional behaviors between children with ASD and NT youth. Purpose: The purpose of this study was to examine the differences in gastrointestinal issues, weight concerns, and mealtime behaviors in youth with ASD and NT youth. Data was utilized from the 2019 National Survey of Children’s Health which consisted of items related to children’s health and well-being. Parent-reported variables on dietary behaviors, child weight concerns, mealtime behaviors, and food insecurity were compared between children with ASD and NT youth using chi-square analyses. Results: A total of 868 (weighted sample of 2,068,404) children with ASD and 28,441 (weighted sample of 72,451,623) NT children were included in the analysis. A greater percentage of parents of children with ASD reported weight-related concerns about their child (pp=0.57). Conclusion: Children with ASD experience more nutrition-related difficulties than NT youth although there were no differences in family mealtime patterns. Future research should examine food insecurity in families of children with ASD and its relationship with nutritional difficulties in this population.

Submitted by Maicon Juliano Schmidt (maicons) on 2015-03-16T18:35:32Z No. of bitstreams: 1 000010f6.pdf: 129075617 bytes, checksum: 991b553e42a0d8cd8252e569639c3a91 (MD5) / Made available in DSpace on 2015-03-16T18:35:32Z (GMT). No. of bitstreams: 1 000010f6.pdf: 129075617 bytes, checksum: 991b553e42a0d8cd8252e569639c3a91 (MD5) Previous issue date: 2014-07-01 / Nenhuma / Esta Dissertação de Mestrado aborda a maternidade e a relação mãe e bebê no contexto das dificuldades alimentares da criança. Compõe-se de dois artigos, um teórico e um empírico. O artigo teórico é uma revisão sistemática da literatura sobre as dificuldades alimentares na infância. Para isso, foi efetuada uma busca nas bases de dados internacionais BVS, Ebsco Host (Academic Search e Medline), Psychinfo, Pubmed, Scielo, Science Direct, e Scopus com as palavras-chave feeding difficulties, feeding disorder e feeding problems, juntamente com as palavras child e infancy e seus equivalentes em inglês nos últimos cinco anos. Do total de 3.077 itens encontrados, apenas 24 preencheram os critérios de inclusão. Os resultados indicam que o comportamento materno possui influência nas dificuldades alimentares da criança, assim como o alimento pode ser usado como uma forma de controle e também de conforto. O estudo empírico trata de um estudo qualitativo, com delineamento de estudo de casos múltiplos, cujo objetivo foi investigar de que forma se dá a relação entre mãe e bebê com dificuldades alimentares, e compreender como a interação entre a dupla interfere nesse âmbito. Os participantes foram três duplas mãe e bebê com idade entre sete e oito meses de idade com dificuldades na área da alimentação. Cada caso foi analisado a partir da experiência de ser mãe, primeiras experiências com a alimentação, transição dos alimentos e as dificuldades alimentares do bebê e a relação entre mãe e bebê. Os resultados apontam que a introdução da alimentação complementar pode ser vista como uma interferência na interação entre mãe e bebê, por ter que abrir mão do aleitamento materno exclusivo e dar lugar a um terceiro, representado pela colher e pelo alimento sólido. / Whereas relations between mother and son are indispensable to the healthy development of a child, it is necessary to reflect on them when they come into the scene baby feeding difficulties. Thus, the objective of this work is to understand how to configure the mother-son relationship with feeding difficulties. For that, we decided to conduct a qualitative research study design with multiple cases, and each case was examined individually, seeking their particularities, and then compared to the others, in order to investigate the convergences and divergences between them. Participated in three adult mothers and their babies between the ages of seven and eight months, with difficulties in the area of food. Were used as instruments: Clinical Data Sheet, Sociodemographic Data Sheet, Mental Mini Neuropsychiatric Interview (M.I.N.I.-Plus), Questionnaire Sympton Checklist - Evaluation of Psicofunctional Disorders of Early Childhood, Interview About the Experience of Motherhood and the Interaction Assessment Procedure (IAP). Each case was examined from the experience of being a mother, the first experiments with the food, the transition of food, baby food problems and the relationship between mother and baby. The results show that the introduction of complementary feeding can be seen as an interference in the interaction between mother and baby by having to give up exclusive breastfeeding and give rise to a third, represented by the spoon and food.