Food difficulties

In the pediatric population, feeding problems can present as symptoms of many conditions. It has been described as occurring in 20% of children with normative development, and up to 80% of children with developmental disorders. Despite their high incidence, feeding difficulties are often not well recognized or adequately treated.

WHAT ARE THE DIFFICULTIES IN FOOD?

Feeding difficulties are defined as poor oral intake that is not age-appropriate, and may be associated with one or more of the following dysfunctions:  medical, nutritional, psychosocial and/or food skills. It should be noted that not all children show dysfunction in all four domains, and it is recommended to assess each of them.

DETECTION OF FOOD DIFFICULTIES

Many times eating difficulties are multifactorial in nature requiring a comprehensive assessment that takes into account all four domains.

The optimal care of children with feeding difficulties requires a multidisciplinary assessment made up of: neuropaediatrics, nursing, rehabilitation doctors, speech therapy, occupational therapy, psychology and social work.

For the assessment of eating difficulties, an observation of intake is made in the most natural situation possible, and report questionnaires are administered both by parents and by PediEAT.

• Pediatric Eating Assessment Tool (PediEAT), is a parent-informed tool intended for children between 6 months and 7 years who eat some solid foods. Parents are asked to evaluate each item, and with a scale to calculate the frequency of certain behavior. Higher scores indicate more symptoms of problem eating. It is composed of four subscales where it is assessed:
  • Physiological symptoms: swallowing dysfunction (cough, voice quality, nausea), difficulty coordinating feeding and breathing or maintaining physiological stability (faster or more intense breathing, sweating and fatigue) and disorders or dysfunctions of the gastrointestinal tract such as vomiting or difficulty defecating.
  • Problematic behaviors when eating: acceptance or rejection of food. Stress behaviors during meals, and food preferences such as insisting that food be presented in a certain way.
  • Selective/restrictive feeding: preferences for certain textures, temperatures or food groups.
  • Oral processing: dysfunction in the oral phase of food bowl formation. It presents as retention of food in the oral cavity, using fingers to move the bowl inside the mouth, chewing food for a long time, or needing reminders to chew food.

THERAPEUTIC INTERVENTION

When feeding problems are complex or difficult to solve, referral to specialist care is essential. There are three essential criteria for integrated care in the most severe cases: involvement of specialists who address the four domains, behavioral intervention and active participation of carers.

To the Aspace Catalonia Foundation we have the Swallowing and feeding unit (UDN), in charge of making a diagnosis of food difficulties, and how they interfere in the day-to-day life of the people served in our service.

This unit is made up of an interdisciplinary team (rehabilitation doctor specializing in nutrition and dietetics, speech therapists specializing in swallowing, nurse specialist in nutrition and occupational therapist with training in sensory integration), which carry out a detailed diagnosis with an observational assessment and questionnaires to be filled in by the family, which allow the food difficulties of the people we serve to be located. Interconsultations are made with other professionals of the entity such as neuropediatrics and psychology when deemed necessary.

Subsequently, a treatment focused on these difficulties is carried out, giving tools and strategies to both the family and the person involved.

BIBLIOGRAPHIC REFERENCES

1. Goday, PS, Huh, SY, Silverman, A., Lukens, CT, Dodrill, P., Cohen, SS, Delaney, AL, Feuling, MB, Noel, RJ, Gisel, E., Kenzer, A., Kessler, DB, Kraus De Camargo, O., Browne, J., & Phalen, JA (2019). Pediatric Feeding Disorder: Consensus Definition and Conceptual Framework. Journal of Pediatric Gastroenterology and Nutrition, 68(1), 124–129. https://doi.org/10.1097/MPG.0000000000002188
2. Manikam, R., & Perman, JA (2000). Pediatric feeding disorders. Journal of Clinical Gastroenterology, 30(1), 34–46. https://doi.org/10.1097/00004836-200001000-00007
3. Sharp, WG, Volkert, VM, Scahill, L., McCracken, CE, & McElhanon, B. (2017). A Systematic Review and Meta-Analysis of Intensive Multidisciplinary Intervention for Pediatric Feeding Disorders: How Standard Is the Standard of Care? Journal of Pediatrics, 181, 116-124.e4. https://doi.org/10.1016/J.JPEDS.2016.10.002
4.  Thoyre, SM, Pados, BF, Park, J., Estrem, H., McComish, C., & Hodges, EA (2018). The Pediatric Eating Assessment Tool: Factor Structure and Psychometric Properties. Journal of Pediatric Gastroenterology and Nutrition, 66(2), 299–305. https://doi.org/10.1097/MPG.0000000000001765