Management of Paediatric Feeding Flashcards
What are the goals of feeding management and intervention?
- Safety (hydration, aspiration)
- Nutritional adequacy
- Efficiency
- Age-appropriate developmental skills
- Parent-child interaction/ positive mealtime experiences
List some principles your management decisions will depend on
- anatomy and physiology
- the child’s underlying skill and deficits identified in assessment
- multidisciplinary team goals
- child’s progress
- child’s developmental stage
- child’s pre-morbid feeding status
- child’s cognitive status and ability to learn new skills
- child’s level of independence/ physical status
- family resources (physical, financial, emotional)
Why is supporting families important in PFD?
- critically important to include families in goalsetting and as a part of the therapy time
- this is regardless of the child’s needs
- including the family increases the likelihood of successful therapy generalisation
What is some general advice for families of children with feeding difficulties?
- set up a predictable mealtime routine
- understand the division of responsibility
- provide good modelling of desirable behaviours
- set up a supportive mealtime environment
- set up clear and attainable goals, with clear expectations and outcomes for the child
What is parent training?
- critically important
- should include information about nutrition and behaviour
- will assist with carryover of work with the child to the home environment
- parents will be invested in the treatment and goals
- involvement of the parent and alleviates parent stress
What are the types of parent training
- theoretical
- guided commentary
- practical/immersion
Explain ‘theoretical’ parent training
- educational literature
- educational group programs
- hands-on educational program with several parents
- generally aimed at changing inconsistent parenting practices
- useful for fussy eaters
- commercial education programs
Explain ‘guided commentary’ parent training
- explanation of the session progress in terms of child and therapist actions to the parent
- parent may be observing from another room with a second therapist
Explain ‘practical/immersion’ parent training
- parent has the opportunity to practice applying the principles taught in a session with their child
- opportunity for feedback and troubleshooting is then applied, either after the session or via a ‘bug in the ear’ method
- associated with increased generalisation to the home environment in language therapy
What if I treat a child with an aspiration risk?
- parents need to understand the risks
- important to educate families with regard to anatomy and physiology
- parents should know the signs of aspiration
- review VFSS together/review report
- parents are not on the same page as you with regards to management may not follow
What are some practical tips for engaging parents?
- involve the parent in therapy goal-setting and planning from the beginning
- talk through any handouts to help them understand
- where possible, involve two therapists in session
- otherwise, video the session and provide parent with a copy
- handwrite a summary at the end of each session with 1-2 simple goals for the parent to try at home
Discuss ‘extra slow flow’ teats, including a description and the population they suit
- usually a standard drip teat
- fragile infants, premature infants
Discuss ‘slow flow’ teats, including a description and the population they suit
- standard drip teat with hole suggested for infants 0-3 months
- infants requiring slower flow, infants having difficulty with suck-swallow breath coordination
Discuss ‘medium flow’ teats, including a description and the population they suit
- standard drip teat with hole suggested for infants 3-6 months
- infants with a weak suck but good suck-swallow-breath coordination
Discuss ‘fast flow’ teats, including a description and the population they suit
- standard drip teat with hole suggested for infants 6 months
- infants with a weak suck but good suck-swallow-breath coordination
- infants on a medium flow teat requiring thickened fluids
Discuss ‘cross cut’ teats, including a description and the population they suit
- non-drip teat with Y or X cut that only opens when teat is compressed
- minimises chance of oral flooding
- infants who are on thickened fluids as has a larger opening
Discuss ‘variable flow’ teats, including a description and the population they suit
- the teat is twisted to alter the flow rate allowing the feeder to pace the feed
- infants who fatigue easily, infants who require pacing
What are the different types of pacing?
- strict/prescriptive
- responsive pacing
How can you promote successful cup drinking?
- sit upright
- wide-lipped clear cup
- familiar and preferred fluid
- thickener might help
- rest cup in lower lip corners
- support jaw if required
- single sips
- full is sometimes easier
How can you promote successful spoon feeding?
- sit at eye level
- flat spoon - small volume
- wait for mouth opening
- don’t scrape
- pause for lips
- guide lips if required and tolerated
- try sideways presentation
- go gradual - small texture changes
What does oral phase dysphagia treatment involve?
Generally:
- sensory skills
- motor skills
What does pharyngeal phase dysphagia treatment involve?
- teaching the child to modify feeding strategies
- teaching the child to modify the bolus
What are some things to consider when managing paediatric dysphagia?
- fatigue
- alertness
- positioning
- feeder
- time
- communication
What does good oral care aim to achieve?
- remove bacteria from mouth
- remove food debris without damaging gingiva
- keep oral mucosa clean, soft, moist and intact
- decrease risk of oral and systemic infection
- alleviate pain/discomfort
- prevent halitosis
- increase general wellbeing
What might a child with restricted-diet present with?
- disruptive behaviours that are affecting mealtimes
- poor weight gain/poor nutrition/ excessive weight gain
- parents that have a high degree of stress
- other developmental delays/disorders/medical conditions
- sensory processing disorder/oral motor skills delays
What are the goals of therapy for a child with a restricted diet?
- increase desirable behaviour
- decrease undesirable behaviour
What behaviour modification therapy types can be used in the management of a child with a restricted diet?
- systematic desensitisation
- operant conditioning
What is ‘responsive feeding’?
- new area
- child-led ‘facilitated mealtimes’
- based on building trust around food and following child’s lead
- no prompts or rewards
- aim is to create healthy mealtime interactions and dietary intake
What are some must haves of operant conditioning?
- shaping
- fading of prompts
- thinning reinforcement
- effective reinforcers
What are the must haves for systematic desensitisation?
- ideas for exposure and progression at each level of the hierarchy
- an understanding of the sensory properties of different foods
- a sense of play
- an understanding of when it is and isn’t an appropriate tool to use
What is the basic premise (in a play context) of systematic desensitisation?
Tolerates -> Interacts with -> Smells -> Touches -> Tastes -> Eats
When might systematic desensitisation not worl?
- parents who don’t cope with food play idea
- can take longer, so more likely to drop out
- if the child is not intrinsically motivated enough to actually eat the food
What are some at-risk populations in PFD?
- ex-premature
- CP
- DS
- cleft lip/palate
- tracheostomy
- ASD
