The Impact of Pediatric Feeding Disorders on the Family

  1. 1.  University of Virginia

Abstract

Abstract

Pediatric feeding disorders are common, especially among developmentally delayed children. The consequences of having these disorders can be severe: children could suffer from growth failure, chronic illness, and even death. In addition, these disorders have been reported to affect members of the entire family. While some interventions have been implemented to help families with children with these disorders, these studies are limited by small sample sizes and the lack of long-term follow-up visits. Moreover, there is a lack of a standardized system to classify children with these disorders, which directly impacts the diagnoses of children with these disorders. This paper reviews the relevant literature on the impact on the family of these feeding disorders and the current classification systems and interventions used to help children with these feeding disorders. It also recommends further research to create a more standardized classification system and to test the efficacy of current interventions, with the aim of improving accuracy of diagnoses and developing treatments tailored to children’s special needs.

Introduction

Feeding disorders are prevalent among children. Approximately 20-50% of normally developing children and 70-89% of children with developmental disabilities are reported to have some form of feeding disorder [1]. These disorders impose a large financial and social burden on the family, as previous studies have reported caregivers demonstrate higher levels of stress and anxiety while family routines and rituals are affected as well [2-3]. Multiple classification systems have been used to determine the prevalence of feeding disorders, including criteria from the DSM IV [4], the Stanford Feeding Questionnaire [5], and perceptions from caregivers [6]; however, the definition of a feeding disorder has not been standardized. Moreover, many interventions, such as non-nutritive sucking, oral motor interventions, feeding tubes, and behavioral and structural interventions, have been implemented to help children with these disorders [7-10]; however, many of these studies are limited by small sample sizes and long-term follow-up visits. Despite advances in knowledge of the impact and interventions that could be implemented to help children with these disorders, much remains unclear regarding the efficacy of these feeding disorder classification systems and interventions.

 

Identification of pediatric feeding disorders

A feeding disorder is often identified when, despite persistent attempts from parents or caregivers, a child fails to consume a sufficient amount or types of food in order to sustain weight and meet nutritional needs [11]. These disorders are often influenced by multiple organic factors, such as structural and gastrointestinal abnormalities, food allergies, and dysphagia [12], and environmental factors, such as insufficient exposure to textured or different types of food and behavioral mismanagement [13]. In addition, they often arise from combined behavioral and medical etiologies [14], which complicate the diagnosis and treatment of these disorders.

 

Classification of feeding disorders

Multiple classification systems have been used to categorize feeding disorders. Jacobi et al. discovered 21% of children were classified as picky eaters using the Stanford Feeding Questionnaire [5], and similar results were replicated by Mascola et al. [15]. Esparo et al. found 4.8% of children were categorized as picky eaters based on DSM IV criteria [4]. In addition, some research groups established the prevalence of feeding disorders based on the perceptions of caregivers. Carruth et al. discovered 19% to 50% of children from 4-24 months were classified as picky eaters based on the perceptions of caregivers [16].

 

Children with feeding disorders can also be categorized based on the etiology of these disorders. Budd et al. classified 26% of children with feeding disorders as organic nature, 40% primarily organic, 24% primarily nonorganic, and 10% nonorganic [17]. In addition, Palmer, Thompson, and Linscheid classified 79% of pediatric feeding disorders to neuromotor dysfunction and 21% to behavioral mismanagement [18]. Thus, many pediatric feeding disorders can be attributed to organic factors, such as structural abnormalities, metabolic syndromes, genetic abnormalities, and neurological deficits. On the other hand, there are also nonorganic factors that should be considered in the etiology of these feeding disorders. For instance, Tarbell and Allaire suggested that physical/emotional, educational, social, environmental, and behavioral issues should be considered in the classification of pediatric feeding disorders [19]. While these classification systems do exist, none of them are universally accepted, which calls for the need to evaluate these methods to determine a standardized classification system for these feeding disorders.

 

Impact of pediatric feeding disorders on the family

Pediatric feeding disorders have a huge impact on the family. Coulthard et al. and Singer et al. demonstrated mothers whose children have feeding disorders have significantly higher anxiety and depression compared to others [20-21]. In addition, Benton et al. demonstrated children with feeding disorders are associated with mealtime frustration and a lack of understanding by other family members [22]. Moreover, Darke et al. suggested that while mothers of medically compromised children reported higher levels of stress, fathers of children with cystic fibrosis or congenital heart disease did not differ in stress compared to those of healthy children [23]. Although many studies have suggested that children with feeding disorders have a large impact on their mothers, which are consistent with clinical impressions that mothers share a larger psychological burden of their children’s illnesses than fathers, further research is needed to determine whether this trend stays consistent with children of other feeding disorders and whether these children have an impact on other members of the family.

 

Interventions used to treat children with feeding disorders

Multiple interventions have been used to treat children with feeding disorders. Pinelli et al. concluded that non-nutritive sucking may be associated with a decrease in length of stay, a faster transition from tube to bottle feeds, and better bottle feeding performance and behavior [24]. In addition, Wilcox et al. and Morgan et al. have suggested oral-motor therapy may improve sensorimotor skills; however, further research is needed to evaluate this type of intervention [25-26]. Moreover, Peterson et al. and Sleigh et al. suggested that feeding tubes may relieve some stress in the caregiver and may aid the child in gaining weight, however, larger studies are needed to evaluate the benefits of this intervention [27-28]. Furthermore, Cornwell et al., Clawson et al., and Greer et al. suggested that intensive, interdisciplinary and multidisciplinary feeding programs may decrease stress on the caregiver and improve mealtime behaviors, weight, and caloric intake for the children [29-31]. However, given that many of these studies have small sample sizes and lack follow-up visits, larger studies are needed to evaluate the efficacy of these interventions.

 

Conclusion

A growing body of evidence suggests that pediatric feeding disorders have severe consequences on the children and may have a huge impact on the family. While some interventions have been implemented to help families with children with these disorders, such as non-nutritive sucking, oral-motor therapy, feeding tubes, and intensive interdisciplinary programs these studies are limited by small sample sizes and the lack of long-term follow-up visits. Moreover, there is a lack of a standardized system to classify children with these disorders, which directly impacts the diagnoses of children with these disorders. Further research is needed to create a more standardized classification system and to test the efficacy of current interventions in order to develop treatments that could aid children with feeding disorders.

 

References:

1. Benjasuwantep, B., Chaithirayanon, S., & Eiamudomkan, M. “Feeding problems in healthy young children: Prevalence, related factors and feeding practices.” Pediatric Reports, 2013: 38-42. doi: 10.4081/pr.2013.e10.

2. Seymour, M., Wood, C., Giallo, R., & Jellett, R. “Fatigue, stress and coping in mothers of children with an autism spectrum disorder.” Journal of Autism and Developmental Disorders, 2013: 1547-1554. doi: 10.1007/s10803-012-1701-y.

3. Estes, A., Munson, J., Dawson, G., Koehler, E., Zhou, X., & Abbott, R. “Parenting stress and psychological functioning among mothers of preschool children with autism and developmental delay.” Autism, 2009: 375–387. doi: 10.1177/1362361309105658.Parenting.

4. Esparó, G., Canals, J., Jané, C., Ballespí, S., Viñas, F., & Domènech, E. “Feeding problems in nursery children: prevalence and psychosocial factors.” Acta paediatrica, 2004: 663-668. doi: 10.1080/08035250410029308.

5. Jacobi, C., Agras, W. S., Bryson, S., & Hammer, L. D. “Behavioral validation, precursors, and concomitants of picky eating in childhood.” Journal of the American Academy of Child and Adolescent Psychiatry, 2003: 76-84. doi: 10.1097/00004583-200301000-00013.

6. Reau, N. R., Senturia, Y. D., Lebailly, S. A., & Christoffel, K. K. (1996). “Infant and toddler feeding patterns and problems: Normative data and a new direction. J Dev Behav Pediatr, 1996: 149-153. doi: 10.1097/00004703-199606000-00002.

7. Barlow, S. M. “Oral and respiratory control for preterm feeding.” Current opinion in otolaryngology & head and neck surgery, 2009: 179-86. doi: 10.1097/MOO.0b013e32832b36fe.

8. Arvedson, J., Clark, H., Lazarus, C., Schooling, T., & Frymark, T. “Evidence-based systematic review: Effects of oral motor interventions on feeding and swallowing in preterm infants.” American Journal of Speech-Language Pathology, 2010: 321-340. doi: 10.1044/1058-0360(2010/09-0067).

9. Milnes, S. M., Piazza, C. C., & Carroll, T. “Assessment and treatment of pediatric feeding disorders. Encyclopedia on Early Childhood Development, 2013: 1-5.

10. Luiselli, J. K. “Teaching and behavior support for children and adults with autism spectrum disorder: A practitioner’s guide.” New York, 2011. New York: Oxford University Press.

11. Shore, B., & Piazza, C. C. (1997). “Pediatric feeding disorders.” In E. A. Konarski, J. E. Favell, & J. E. Favell (Eds.), Manual for the assessment and treatment of the behavior disorders of people with mental retardation (Tab BD22, pp. 1-10). Morgantown, NC: Western Carolina Center Foundation.

12. Riordan, M. M., Iwata, B. A., Wohl, M. K., & Finney, J. W. “Behavioral treatment of food refusal and selectivity in developmentally disabled children.” Applied Research In Mental Retardation, 1980: 95-112. doi: 10.1016/0270-3092(80)90019-3.

13. Feltmeier, Morgan L. (2014). Behavioral feeding interventions for pediatrics. Research Papers. Paper 506. http://opensiuc.lib.siu.edu/gs_rp/506.

14. Homer, C., & Ludwig, S. “Categorization of etiology of failure to thrive.” Am J Dis Child1981: 848-851. doi: 10.1001/archpedi.1981.02130330058019.

15. Mascola, A. J., Bryson, S. W., & Agras, W. S. “Picky eating during childhood: A longitudinal study to age 11years.” Eating Behaviors, 2010: 253-257. doi: 10.1016/j.eatbeh.2010.05.006.

16. Carruth B. R., Ziegler P. J., Gordon A., Barr S. I. “Prevalence of picky eaters among infants and toddlers and their caregivers’ decisions about offering a new food.” J Am Diet Assoc, 2004: s57-64. doi: 10.1016/j.jada.2003.10.024.

17. Budd, K. S., McGraw, T. E., Farbisz, R., Murphy, T. B., Hawkins, D., Heilman, N., & Werle, M. “Psychosocial Concomitants of Childrenʼs Feeding Disorders.” Journal of Pediatric Psychology, 1992: 81-94. doi: 10.1093/jpepsy/17.1.81.

18. Palmer, S., Thompson, R. J. J., & Linscheid, T. R. “Applied behavior analysis in the treatment of childhood feeding problems.” Dev Med Child Neurol, 1975: 333-339. doi: 10.1111/j.1469-8749.1975.tb04671.x.

19. Tarbell M. C, Allaire J. H. “Children with feeding tube dependency: Treating the whole child.” Infants and Young Children, 2002: 29–41.

20. Coulthard, H., & Harris, G. “Early food refusal: The role of maternal mood.” Journal of Reproductive and Infant Psychology, 2003. doi: 10.1080/02646830310001622097.

21. Singer, L. T., Song, L. Y., Hill, B. P., & Jaffe, A. C. “Stress and depression in mothers of failure-to-thrive children.” Journal of Pediatric Psychology1990: 711-720. doi: 10.1093/jpepsy/15.6.711.

22. Benton, K., Swenny, C., Cox, S., Fraker, C., & Fishbein, M. “Pediatric outpatient feeding clinic: If you build it, who will come?” Journal of Parenteral and Enteral Nutrition2014: 855-859. doi: 10.1177/0148607114537072.

23. Darke P., Goldberg S. “Father-infant interaction and parent stress with healthy and medically compromised infants.” Infant Behavior and Development, 1994: 3-14. doi: 10.1016/0163-6383(94)90017-5.

24. Pinelli, J., & Symington, A. J. “Non-nutritive sucking for promoting physiologic stability and nutrition in preterm infants (Review). Cochrane Database of Systematic Reviews 2005, 2010: CD001071. doi: 10.1002/14651858.CD001071.pub2.

25. Wilcox DDPotvin MCPrelock PA. “Oral motor interventions and cerebral palsy: using evidence to inform practice.” Early Interv School Special Interest Sect Q 2009: 14.

26. Morgan, A. T., Dodrill, P., & Ward, E. C. “Interventions for oropharyngeal dysphagia in children with neurological impairment.” Cochrane Database Syst Rev, 2012: CD009456. doi: 10.1002/14651858.CD009456.pub2.

27. Peterson, M. C., Kadia, S., Davis, P., Newman, L., & Temple, C. “Eating and feeding are not the same: Caregivers’ perceptions of gastrostomy feeding for children with cerebral palsy.” Developmental Medicine and Child Neurology, 2006: 713-717. doi: 10.1017/S0012162206001538.

28. Sleigh, G., Sullivan, P. B., & Thomas, A. G. “Gastrostomy feeding versus oral feeding alone for children with cerebral palsy.” Cochrane Database of Systematic Reviews, 2004: CD003943. doi: 10.1002/14651858.CD003943.pub2.

29. Cornwell, S. L., Kelly, K. & Austin, L. “Pediatric Feeding disorders: Effectiveness of multidisciplinary inpatient treatment of gastrostomy-tube dependent children.” Children’s Health Care, 2010: 214-231. doi: 10.1080/02739615.2010.493770.

30. Clawson, E. P., Kuchinski, K. S., & Bach, R. “Use of behavioral interventions and parent education to address feeding difficulties in young children with spastic diplegic cerebral palsy.” NeuroRehabilitation, 2007: 397-406.

31. Greer, A. J., Gulotta, C. S., Masler, E. A., & Laud, R. B. “Caregiver stress and outcomes of children with pediatric feeding disorders treated in an intensive interdisciplinary program.” Journal of Pediatric Psychology, 2008: 612-620. doi: 10.1093/jpepsy/jsm116.

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