Paediatric Feeding Difficulties Andrea Fourie Jennifer Kirk Speech Occupational Therapist 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 Andrea Fourie & Jennifer Kirk 2019 (ASHA, n.d.)
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 RELATIONSHIP SENSORY MOTOR Andrea Fourie & Jennifer Kirk 2019
Sensory Components Related to Eating Andrea Fourie & Jennifer Kirk 2019
(Miller at al, 2007.) Andrea Fourie & Jennifer Kirk 2019
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 Reflexive sucking becomes active of toys Sitting for 3-5 mins Emergence of skills required for Stable head control puree Rolling Emerging tongue lateralisation Sits and reaches for toys/food Vertical munching Lip closure for food propulsion Cruising and walking Active tongue lateralisation Rotary chewing Andrea Fourie & Jennifer Kirk 2019 (Törölä et al., 2012)
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 only 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
How does this influence the parent-child interaction? • Parental stress and anxiety over eating unresponsive feeding styles – Controlling Feeding Style – Indulgent Feeding Style – Uninvolved feeding style (Hurley, et al. 2008) slate.com Andrea Fourie & Jennifer Kirk 2019 25
Questions??? Andrea Fourie & Jennifer Kirk 2019
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