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| Considerations for Safety and Readiness in the Treatment of Pediatric Feeding Disorders |
| Sunday, May 28, 2023 |
| 3:00 PM–4:50 PM |
| Hyatt Regency, Capitol Ballroom 5-7 |
| Area: CBM; Domain: Applied Research |
| Chair: Connor Sheehan (Center for Pediatric Behavioral Health) |
| Discussant: Caitlin A. Kirkwood (Center for Pediatric Behavioral Health) |
| CE Instructor: Caitlin A. Kirkwood, Ph.D. |
| Abstract: Children diagnosed with a feeding disorder represent a unique population due to the wide range of presenting problems (e.g., from refusal to self-feed to food selectivity to total food refusal ). The etiology of feeding disorders is complex due to underlying medical and biological conditions likely contributing to the feeding difficulties; therefore, a comprehensive and interdisciplinary evaluation is necessary to evaluate if a child is medically safe and ready to begin feeding therapy (Rommel et al., 2003). Additionally, children with feeding disorders often engage in inappropriate mealtime behavior, self-injurious behavior, and/or have skill deficits (e.g., oral-motor delays) that can interfere with food or liquid consumption leading to reliance on tube feedings, pureed foods, and/or liquids. The current symposium includes two studies that evaluated the importance of collaboration amongst interdisciplinary team members before and throughout treatment. Additional studies addressed the readiness and safety for beginning feeding therapy when children engage in self-injurious behavior or have oral-motor skill delays. The presenters will discuss best practice in the treatment of feeding disorders in regard to safety and readiness for feeding therapy. |
| Instruction Level: Intermediate |
| Keyword(s): Chewing, Feeding Disorders, Interdisplinary, Self-injurious behavior |
| Target Audience: Board Certified Behavior Analysts |
| Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) describe the importance of ongoing and comprehensive interdisplinary evaluation within a feeding context; (2) identify assessments used to determine as starting point for skills training within a feeding context; and (3) describe considerations for treatment for children with feeding disorders who engage in self-injurious behaviors. |
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| Coordination of Care During Day-Treatment Feeding Therapy |
| RONALD J. CLARK (University of Florida), Vivian F Ibanez (University of Florida), Faith Kirkland (Florida Autism Center, a division of BlueSprig Pediatrics, University of South Florida), Nicole Perrino (Florida Autism Center, University of Florida), Daniella Nicole Fronte (Florida Autism Center - a division of BlueSprig Pediatrics), Timothy R. Vollmer (University of Florida) |
| Abstract: The etiology of feeding disorders is multiple and complex (Rommel et al., 2003). Therefore, a comprehensive, interdisciplinary evaluation is necessary to indicate a child with a feeding disorder is medically ready for feeding therapy. However, ongoing support might be required for health complications (e.g., aspiration, allergies, constipation) that emerge during treatment, particularly as intake increases. Unfortunately, less is known about these events and the contributions of different disciplines (e.g., nutrition, occupational therapy; Sharp et al., 2016). For some emergent problems, collecting data on clinical markers like stool patterns, vocal quality, or temperature after oral intake could support the coordination of care between a behavior analyst and other disciplines. In the current investigation, we reviewed the medical records of children admitted to a day-treatment feeding program to understand how often health complications occurred after initial medical clearance and how data on temperature and stool score influenced the recommendations of other providers (e.g., speech, gastroenterology, cardiology). We discuss considerations for monitoring other symptoms like changes in vocal quality or disrupted sleep patterns and how these may be critical for important oversight and safeguards in day-treatment feeding programs which aim to promote substantial and rapid changes in oral intake (Sharp et al., 2020). |
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Assessing Safety and Readiness Among Children With Feeding Disorders |
| BRITTANY JEAN MARTINO (Childrens Specialized Hospital), Jaime Crowley-Zalaket (Children's Specialized Hospital), Kathryn Peterson (Rutgers University and Children's Specialized Hospital), Christopher W Engler (Children's Specialized Hosptial) |
| Abstract: Given the complex etiology of pediatric feeding disorders, it is best practice for behavior analysts who assess and treat these disorders to work collaboratively with interdisciplinary teams. Experts in in pediatric swallow safety can evaluate a child to confirm whether they are safe oral feeders and provide recommendations for appropriate textures and bolus. However, children who engage in persistent food refusal often fail to participate in swallow evaluations, making it difficult for swallow-safety experts to provide confident safety recommendations. We addressed the food refusal of a seven-year-old male with autism who was bottle dependent. During his day-treatment admission, we decreased behavior that interfered with consumption and increased acceptance of both pureed solids and liquids, with the initial goal of preparing him for a modified barium swallow study. Results of a modified barium swallow study at this stage yielded inconclusive results due to the child’s unique packing behavior. Following additional assessment and in conjunction with input from the swallow-safety expert, we initiated a treatment comprised of antecedent and reinforcement-based strategies that successfully increased his swallowing of pureed solids and later, of thin liquids. Once we observed improvements in swallowing, the child underwent a second modified barium swallow study that confirmed he was swallowing safely. |
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| Using a Sequential Skills Training Model to Increase Oral Motor Skills for Consuming Table Textured Foods |
| HOLLY M NEY (Clinic 4 Kidz), Meeta R. Patel (Clinic 4 Kidz & Stanford University School of Medicine ) |
| Abstract: Children with pediatric feeding disorders often display deficits in oral motor skill development related to chewing and consuming table textured foods. Chewing is a complex skill that is not explicitly taught but emerges with experience with different types and textures of foods. However, with children with pediatric feeding disorders, the necessary experience may be interrupted due to underlying medical issues, which may result in reliance on tube feedings, pureed foods, and/or liquids. Therefore, these children may not go through the same developmental stages of eating, hence leading to oral motor deficits with regards to consuming table textured foods. Increasing oral motor skills to be able to successfully eat table textured foods goes beyond just teaching chewing. The purpose of this study was to evaluate a skills training model that focused on individual skills, such as mashing and tongue lateralization, in addition to chewing to increase consumption of table textured foods. At the conclusion of skills training, a child with pediatric feeding disorders was successfully consuming table textured foods. These data are discussed in relation to the developmental model of chewing and assessments necessary to determine the starting point for skills training. |
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Self-injurious Behavior During Treatment of Pediatric Feeding Disorders: An Evaluation of Treatment Outcomes |
| SARAH D HANEY (Kennedy Krieger Institute), Hailey Ripple (Mississippi State University), Racheal Clark (Brighter Hope Wellness Center), Alison Kozlowski (Kennedy Krieger Institute and Johns Hopkins University School of Medicine) |
| Abstract: Children with feeding disorders often engage in inappropriate mealtime behavior (e.g., pushing the utensil away, covering their mouth) that can interfere with food or liquid consumption. Although self-injurious behavior (SIB; self-biting, self-hitting) is less frequently discussed in relation to feeding disorders, researchers have found that some children with feeding disorders may also engage in SIB during meals (e.g., González & Stern, 2016; Wilder et al., 2005). Research has shown that behavior analytic interventions are the most empirically supported interventions for pediatric feeding disorders, but less is known about treatment outcomes for children who engage in SIB during meals. In the current study, experimenters compared treatment outcomes for children with feeding disorders who engaged in SIB during meals with those of children who did not engage in SIB during meals (i.e., SIB Group and Control Group). Interestingly, there were no statistically significant differences in problem behavior (e.g., inappropriate mealtime behavior, negative vocalizations) between groups throughout their admissions. However, there were statistically significant differences in the types of treatments used between groups. The experimenters discuss these results in terms of considerations for treatment for children with feeding disorders who may engage in SIB during meals. |
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