PFD Treatment Considerations and Transitional Feeders Flashcards
ICFQ 6 Question Screener
early identification/early intervention integrate into all case history for preschool and younger (6-question subset):
1. does your baby/child let you know when he is hungry? yes/no
2. do you think your baby/child eats enough? yes/no
3. how many minutes does it usually take to feed your baby/child? yes/no
4. do you have to do anything special to help your baby/child? yes/no
5. does your baby/child let you know when he is full?
6. based on the questions above, do you have concerns about your baby/child’s feeding?
assessments: general overview
- your assessment is a window into the child and family’s story
- this can be a stressful time for many families; give them grace and be respectful of cultural norms, the medical journey, etc.
- family’s understanding about your skill set and how you will be able to help the family, or where you can refer them for appropriate services
- you may not gather everything you need in the first session
- what you see is most likely the tip of the iceberg
- chart review, preparing for the assessment, evaluation of skill, parental goals, and synthesizing information
- stressing the importance of humility in one’s knowledge and skill
assessment: you may not gather everything you need in the first session
every session following this will be treatment and ongoing assessment
assessment: what you see is most likely the tip of the iceberg
go deeper and understand what underpinnings exist
assessment: stressing the importance of humility in one’s knowledge and skill
- you may not be ready for this particular child
- be honest and let the parents know that you are learning or will need mentorship but are willing to work together
evaluations: using the PFD domains
- address each area of the PFD framework
- we “live in” the oral skill/sensory domain but still need to see the “big picture”
- list the referrals already undergone and results and also make appropriate referrals
- have the most naturalistic observations
- caregiver input is paramount
- if the child is coming from a community providers, you may be the first stop!
- advocate advocate advocate
clinical assessment session structure
- chart review
- case history and interview
- oral mech
- observation of typical feeding/what is successful
- challenge foods/what the concerns are
- sensory and skill assessment with foods
clinical assessment session structure: sensory and skill assessment with foods
- want to see a variety, levels of interaction, etc.
- use norms to guide what you present and look for
parent interview across the age spectrum: key questions to ask all parents (regardless of the age)
- feeding time: how long does it take to feed your child?
- mealtime stress: are mealtimes stressful to child and/or parent?
- growth: is your child gaining weight ok?
- respiratory system: are there signs of respiratory problems?
- GI system: are there things like reflux, GI retching, irritability with feeds?
- consider a food dairy
parent interview across the age spectrum: you obviously need to gather information about skill, utensils, etc., however, these are some key areas that you should target first
- you can always gather skill data and utensils etc. in subsequent appts as well
- take mental notes of the care
- family and child interaction
parent interview across the age spectrum: take mental notes of care
- family and child interactions
- immature vs. disordered/abnormal patterns
- food refusal may occur for many reasons (in-depth treatment of the topic would be an entirely separate session)
parent interview across the age spectrum: family and child interaction
gather the following information (by direct observation and caregiver reports):
- what is the child’s appetite, hunger, interest in eating?
- does the child have regular mealtimes or snacks/grazing?
- what is the duration of mealtimes?
- are distractions present?
- are rewards give for eating?
developmental feeding continuum: approximate developmental age and type of food
- 0-13 months: breast milk/bottle (formula)
- 5-6 months: thin baby food cereals
- 6-7 months: thin baby food purees (Gerber Stage 1)
- 7-8 months: thicker baby food cereals
- 8-9 months: soft mashed table foods and table food smooth purees
- 9 months: meltable solids (Towne House crackers, Gerber biter biscuits, graham crackers)
- 10 months: soft solids (bananas, Gerber Graduate fruits, avocado)
- 11 months: soft single texture solids (Gerber Stage 3, macaroni and cheese, french fries, lasgna)
- 12-14 months: soft table foods
assessment considerations for children over 6 months: sensory regulation
food and non-food related experiences and input
assessment considerations for children over 6 months: oral mechanism exam
adapting it with considerations for behavior, dentition, previous oral experiences
nutritive feeding assessment
- observation across textures (accepted and challenging/new foods)
- is the utensil choice contributing to the deficits
- be prepared to step back and build rapport during this session or not even get into the mouth
thoughts on formal assessments
- multiple from feeding flock group (now infant feedingcare.com)
- PediEat is a good resource for a wide range 6 months +
- no one standardized assessment: still researching broad range of “typical”
- one you’ve identified that “feeding skills” is the top domain for intervention (oral sensory, oral motor, or pharyngeal function), you must determine what therapeutic activities to utilize…treatment next
intervention considerations: oral sensory function
using intake log and assessment of various texture to determine
intervention considerations: oral motor function
- postural stability correlated to oral motor skills
- use identified areas of growth from oral motor assessment to identify areas of needed intervention
intervention considerations: pharyngeal function
- silent aspiration not uncommon in infants
- can target exercises from physiological deficits identified in MBS in preschoolers + (same activities as adults but with a peds twist!)
feeding skill domain: intervention considerations
note that sensory function and motor skill can be closely tied/not easy to tease out
establishing treatment priorities and goal writing
- finding balance between caregiver goals child’s ability/stage
- are there treatment targets we can address, while waiting for information regarding other areas?
- communication on what we plan to target and how to measure progress
- clinician expertise and comfort level
establishing treatment priorities and goal writing: are there treatment targets we can address, while waiting for information regarding other areas?
while we wait for results from a swallow study (medical/skill domain), can we work on educating the parents on stop cues, not forcing a child (psychosocial)
establishing treatment priorities and goal writing: clinician expertise and comfort level
- know your scope and expertise
- “do no harm”, “just wing it”, “trial and error”, is it appropriate?
- establish common ground and jargon so clinicians and caregivers are on the same page
- carryover goals into the home in a realistic manner