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

Andrea Fourie Speech Therapist

Paediatric Feeding Difficulties

Jennifer Kirk Occupational Therapist

Objectives

Talk One:

• New Paediatric Feeding Disorder Definition
• Signs and symptoms
• Highlighting sensory components
• Motor aspects influencing feeding
• Relationship with food and eating

Andrea Fourie & Jennifer Kirk 2019

Paediatric Feeding Disorder - New Definition?

• Discrepancies in classification

– Organic vs non-organic – Phases of swallowing – DSM V

• International Classification of Functioning, Disability

and Health (ICF)

– Impairment – Activity Limitation – Participation Restrictions

(Goday, et al. 2019)

Andrea Fourie & Jennifer Kirk 2019

“PFD is defined as impaired oral intake that is not age appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction.”

(Goday, et al. 2019)

Andrea Fourie & Jennifer Kirk 2019

(Goday, et al. 2019)

Andrea Fourie & Jennifer Kirk 2019

Signs and Symptoms

Andrea Fourie & Jennifer Kirk 2019

Signs and Symptoms

• Parental reports

– Delayed weaning and transition to developmentally appropriate foods – Drops previously liked foods – Prolonged mealtimes – Tantrums and crying at mealtimes – Increased family stress at mealtimes/social events

(ASHA, n.d.)

Andrea Fourie & Jennifer Kirk 2019

Signs and Symptoms

• Food restrictions

– Favourite food textures

– Avoidance based on sensory properties – Selectivity based on branding – Resistance to try new foods – Restricted variety of foods or food groups

(ASHA, n.d.)

Andrea Fourie & Jennifer Kirk 2019

Signs and Symptoms

• Physical presentations

– Coughing, choking or gagging with food – Back arching with feeds – Vomiting during or after feeds – Crying or fussing with feeding – Gurgling, hoarseness or wet voice with feeds – Spitting food out – Refusing to eat – Tantrums at mealtimes

(ASHA, n.d.)

Andrea Fourie & Jennifer Kirk 2019

Factors Influencing Eating

SENSORY MOTOR RELATIONSHIP

Andrea Fourie & Jennifer Kirk 2019

Sensory Components Related to Eating

Andrea Fourie & Jennifer Kirk 2019

Andrea Fourie & Jennifer Kirk 2019

(Miller at al, 2007.)

Sensory Modulation Disorder

• Tactile

–Sensitivity (over-responsive) –Under-responsive

• Taste

–Sensitivity (over-response) –Under-responsive

• Smell

–Over-responsive

Andrea Fourie & Jennifer Kirk 2019

Sensory Based Motor Disorder

• Dyspraxia

–Knowing how to eat a variety of food –being confident in eating new/unfamiliar food

• Postural disorder

–unable to maintain posture for eating –tires easily whilst eating

Andrea Fourie & Jennifer Kirk 2019

Sensory Discrimination Disorder

• Tactile Discrimination

– awareness of the tactile dimensions of food – identifying different tactile elements

• Proprioceptive awareness

– knowing where food is within mouth – Knowing how much food is in the mouth – Knowing when full/ hungry

Andrea Fourie & Jennifer Kirk 2019

Case Study

• 4 year old female child
• Diet: fish fingers, plain crisps, plain yoghurt,

dry wors, plain white bread

• Avoids: fruit, vegetable, chicken

Andrea Fourie & Jennifer Kirk 2019

Motor Factors and Eating

Andrea Fourie & Jennifer Kirk 2019

Readiness for Solids

• Skills:

– Good head and neck control in sitting (with

minimal support)

– Demonstrates an interest in food – Reaches out for food – Integration of tongue thrust reflex (CDC, n.d.)

Andrea Fourie & Jennifer Kirk 2019

Motor and Oral Milestones

Physical Motor Milestones Oral Motor Milestones

Steady Head Control Anterior-posterior sucking Hand to mouth play and exploration

• f toys

Reflexive sucking becomes active Sitting for 3-5 mins Stable head control Emergence of skills required for puree Rolling Sits and reaches for toys/food Emerging tongue lateralisation Vertical munching Lip closure for food propulsion Cruising and walking Active tongue lateralisation Rotary chewing

(Törölä et al., 2012)

Andrea Fourie & Jennifer Kirk 2019

Oral Motor Skills And Food Selection

• Spoon feeding: smooth puree until 9 months
• Lateral tongue movements: finger foods (not for

swallowing or those that dissolve)

• Rotational chewing: (open mouth) - 1 texture easy

to chew

• Cup drinking (open cup - no sippi cups)
• Straw drinking
• Active tongue lateralisation PLUS rotational chewing

= mixed textures (only after 12 months and often

• nly with walking)

Andrea Fourie & Jennifer Kirk 2019

Case Study

• 14 month old male child
• Cruising, not yet walking, functionally low

postural tone

• Interested in all foods - willing to taste and

try

• Pocketing of food, chewing and spitting out
• Eating with mouth and lips closed
• Gagging on mixed textures

Andrea Fourie & Jennifer Kirk 2019

Relationship With Food

Andrea Fourie & Jennifer Kirk 2019

Relational Factors

• Developmental factors - delay vs disorder
• Mental + behavioural health problems

– Child – Caregiver

• Social influences
• Environmental factors

– distraction! – Schedules – Responses (Goday, et al. 2019)

Andrea Fourie & Jennifer Kirk 2019

How a relationship with food difficulty manifests...

• Learned feeding aversions
• Stress and distress
• Disruptive behaviour
• Food overselectivity
• Caregiver use of inappropriate strategies
• Controlling food brands and packaging
• Using food to manipulate (parents and child)
• Food not touching on a plate
• Eating certain foods in different environments
• Control around food preparation

(Goday, et al. 2019)

Andrea Fourie & Jennifer Kirk 2019

• Parental stress and anxiety over eating

unresponsive feeding styles

– Controlling Feeding Style – Indulgent Feeding Style – Uninvolved feeding style

Andrea Fourie & Jennifer Kirk 2019

slate.com

How does this influence the parent-child interaction?

25

(Hurley, et al. 2008)

Questions???

Andrea Fourie & Jennifer Kirk 2019