Paediatric Feeding Difficulties Andrea Fourie Jennifer Kirk Speech - - PowerPoint PPT Presentation

Andrea Fourie Speech Therapist

Paediatric Feeding Difficulties

Jennifer Kirk Occupational Therapist

Objectives

Talk Two:

• Allergies and introduction of solids
• Causes of paediatric feeding disorders
• General treatment strategies
• Ethical considerations

Andrea Fourie & Jennifer Kirk 2019

Objectives

Talk Two:

• Allergies and introduction of solids
• Causes of paediatric feeding disorders
• General treatment strategies
• Ethical considerations

Andrea Fourie & Jennifer Kirk 2019

Allergies and Introducing Solids

• What are common allergens?

Andrea Fourie & Jennifer Kirk 2019

Allergies and Introducing Solids

• All children should be exposed to allergens

before 12 months at age

• Documented family history/early allergen

reactions (i.e. CMPA)

– Referral to a paediatric dietician/allergologist – Between 4-6 months exposure (tastes/play) – Volume (spoon feeding) only once

developmentally ready

– Ongoing exposure regularly (Chan, et al. 2018)

Andrea Fourie & Jennifer Kirk 2019

Causes of Feeding Disorders

Medical Conditions Nutritional Factors Feeding Skill Factors Psychosocial Factors

Disorders that affect oral, nasal or pharyngeal function Undernutrition/ Overweight Oral sensory functioning Developmental delay/disorder Aerodigestive disease Airway Pulmonology Gastrointestinal Micronutrient deficiency Macronutrient deficiency Need for tube feeding Oral motor functioning Mental/Behavioural Health Heart Disease Dehydration/ Constipation Pharyngeal sensory processing and/or motor functioning Social Neurological, developmental and psychiatric disorders Environmental

(Goday, et al. 2019)

Andrea Fourie & Jennifer Kirk 2019

Sensory Strategies

• Ensure the child is calm and regulated before

starting any feeding

– Read child’s level of arousal before meal time (over or under aroused = dysregulated)

• Reduce the sensory demands of the

environment

– Light, noise, TV/distractions, smells

• Build in sensory prep activities before feeding

Andrea Fourie & Jennifer Kirk 2019

Sensory Strategies

Calming Activities Exciting Activities

Quiet and predictable sounds

• Quiet and slow voice
• Calming music

loud and unpredictable sound

• loud and fast voice
• loud music

Slow linear vestibular movement Fast, blast movement Deep pressure

• Deep pressure hugs
• squashing
• massage

light touch Heavy muscle work

• climbing
• pushing and pulling
• carrying

Andrea Fourie & Jennifer Kirk 2019

Stages of Sensory Development

Acceptance Touch Smell Taste Eating

(Ernsperger & Stegen-Hanson, 2004)

Andrea Fourie & Jennifer Kirk 2019

Food Chaining

• List of foods that have the same features

– Texture, flavour or aftertaste

• “A child will eat what he likes”
• Change one small thing at a time

Breaded chicken Breaded fish Breaded pork Breaded vegetable Nugget with tomato sauce Nugget with BBQ sauce Nugget with tartar sauce Nugget with chili sauce

(Fraker et al, 2007)

Andrea Fourie & Jennifer Kirk 2019

Motor Strategies

• Postural support and stability

– Alignment, pelvis, foot and shoulder stability – Consideration of feeding chairs

• Select foods based on the child’s

developmental level and oral-motor skill

• Demonstrate how to chew, manipulate and

move the food around your mouth

Andrea Fourie Eating Workshop 2017

(Ernsperger & Stegen-Hanson, 2004)

Environmental Strategies

• Boundaries

– Respect the child’s autonomy and don’t force anything into his mouth – Role-models are important – Everyone eats the same meal – Child size portions – The child chooses if and how much they eat, the adult choses where and what.

Andrea Fourie Eating Workshop 2017

(Ernsperger & Stegen-Hanson, 2004)

Environmental Strategies

• Mealtime behaviours

– Don’t force the child to eat – Be supportive and provide appropriate models for eating regardless of behaviour – Routine prior to eating

• Wash hands and wipe face with warm washcloth
• Wipe table and have a damp face cloth during the meal
• Set table

– No distractions/tv/screen time

Andrea Fourie Eating Workshop 2017

(Ernsperger & Stegen-Hanson, 2004)

Ethical Considerations

• Scope of practice

– Professional practice – Skill set, training and experience

• Referral Pathways

– Multidisciplinary Assessments/Treatment

• Cultural consideration
• Family stress during mealtimes/social events
• Parental beliefs
• Food availability

Andrea Fourie & Jennifer Kirk 2019

Case Study

• Grade R Child
• Dx: SPD and motor planning
• Diet: white foods, nandos, McDonalds chips (perfect),

white bread, pink lady apples, barbie banana yoghurt, vanilla ice-cream, iced tea, formula in a bottle

• Oral motor - low oral tone, no lateralisation, anterior,

messy eater, no utensil use.

• Neophobia - visual and smell. Visual gagging
• Caregiver use of inappropriate strategies - bombarding

with everything (food), bargaining and manipulation

Andrea Fourie & Jennifer Kirk 2019

Questions……?

Andrea Fourie & Jennifer Kirk 2019

References

• American Speech-language and Hearing Association. (n.d.).

https://www.asha.org/public/speech/swallowing/Feeding-and-Swallowing-Disorders- in-Children/ Accessed on 01 October 2019.

• Centers for Disease Control and Prevention. (n.d.).

https://www.cdc.gov/nutrition/infantandtoddlernutrition/foods-and-drinks/when-to- introduce-solid-foods.html Accessed on 01 October 2019.

• Chan, et al. (2018). Early introduction of foods to prevent food allergy. Allergy, Asthma and

Clinical Immunology, 14, 93-101.

• Ernsperger & Stegen-Hanson. (2004). Just Take a Bite. Future Horizons.
• Fraker et al. (2007). Food Chaining: The proven 6-step plan to stop picky eating, solve feeding

problems, and expand your child’s diet. Da Capo Press.

• Goday, et al. (2019). Pediatric Feeding Disorder—Consensus Definition and Conceptual
• Framework. Journal of Pediatric Gastroenterology and Nutrition, 68, 124-129.
• Hurley, et al. (2008). Maternal symptoms of stress, depression, and anxiety are related to

non-responsive feeding styles in a statewide sample of WIC participants. Journal of nutrition, 138, 799-805.

• Miller et al. (2007). Concept evolution in sensory integration: a proposed nosology for
• diagnosis. The American Journal of Occupational Therapy, 61, 135-140.
• Törölä, et al. (2012). Feeding skill milestones of preterm infants born with extremely low

birth weight (ELBW). Infant behavior & development, 35, 187-194.

Andrea Fourie & Jennifer Kirk 2019