Transition to Oral Feeding Is Not Always Easy
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WHAT TO DO WHEN EATING PROBLEMS OCCUR
When feeding problems are complex and multifactorial
in nature, a multidisciplinary approach to implementing a
feeding program is optimal. (1,5,9,10) Ideally, assessment of
feeding problems should include the following:
- medical assessment to look for any underlying condition
that might respond to therapeutic intervention (e.g.
neurologic compromise, medications which may have
adverse effects on hunger, vomiting, alertness, lab results
for underlying renal, hepatic, or metabolic abnormalities,
severe oral candidiasis, gastroesophageal reflux or reflux
esophagitis)
- assessment by a physio- or occupational therapist of
motor status, and oral-motor feeding skills and
recommendations regarding positioning and handling
- assessment by the dietitian for nutritional status and
advice regarding energy, nutrient, and fluid requirements
- a social worker's determination of the family's ability to
cope with the stresses associated with an aggressive oral
feeding program. If problems between the parent and
child are suspected, referral to a mental health
professional should be made for further assessment and
treatment.
- assessment by a speech pathologist of language skills and
advice regarding effective communication strategies.
Swallowing studies involving diagnostic imaging may be
helpful.
References
- Arts-Rodas D, Benoit D. Feeding problems in infancy and early childhood:
Identification and management. Paediatric Child Health 1998;3(1):21-7.
- Finney JW. Preventing common feeding problems in infants and young
children. Ped Clin NA 1986;33(4):775-88.
- Illingworth RS, Lister J. The critical or sensitive period, with special reference
to certain feeding problems in infants and children. J Pediatr 1964;65(6) part
1:839-48.
- Benoit D, Coolbear J. Post-traumatic feeding disorders in infancy: behaviors
predicting treatment outcome. Infant Mental Health Journal 1998;19(4):409-21.
- Babbitt RL, Hock TA. Behavioral assessment and treatment of pediatric feeding
disorders. Developmental and Behavioral Pediatrics 1994;15(4):278-91.
- Spalding K, McKeever P. Mothers' experiences caring for children with
disabilities who require a gastrostomy tube. J Pediatric Nursing
1998;13(4):234-43.
- Lemons PK, Lemons JA. Transition to breast/bottle feedings: the premature
infant. J Am Coll Nutr 1996;15(2):126-35.
- Handen BL, Mandell F, Russo DC. Feeding induction in children who refuse to
eat. Am J Dis Child 1986;140:52-4.
- Blackman JA, Nelson CLA. Reinstituting oral feedings in children fed by
gastrostomy tube. Clin Pediatr 1995;24(8):434-8.
- Schauster H, Dwyer J. Transition from tube feedings to feedings by mouth in
children: Preventing eating dysfunction. J Am Diet Assoc. 1996;96:277-81.
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