Britt Frisk Pados

Assessment Tools for Evaluation of Oral Feeding in Infants Younger Than 6 Months.

Background:Feeding difficulty is common in infants younger than 6 months. Identification of infants in need of specialized treatment is critical to ensure appropriate nutrition and feeding skill development. Valid and reliable assessment tools help clinicians objectively evaluate feeding. Purpose:To identify and evaluate assessment tools available for clinical assessment of bottle- and breastfeeding in infants younger than 6 months. Methods/Search Strategy:CINAHL, HaPI, PubMed, and Web of Science were searched for “infant feeding” and “assessment tool.” The literature (n = 237) was reviewed for relevant assessment tools. A secondary search was conducted in CINAHL and PubMed for additional literature on identified tools. Findings/Results:Eighteen assessment tools met inclusion criteria. Of these, 7 were excluded because of limited available literature or because they were intended for use with a specific diagnosis or in research only. There are 11 assessment tools available for clinical practice. Only 2 of these were intended for bottle-feeding. All 11 indicated that they were appropriate for use with breastfeeding. None of the available tools have adequate psychometric development and testing. Implications for Practice:All of the tools should be used with caution. The Early Feeding Skills Assessment and Bristol Breastfeeding Assessment Tool had the most supportive psychometric development and testing. Implications for Research:Feeding assessment tools need to be developed and tested to guide optimal clinical care of infants from birth through 6 months. A tool that assesses both bottle- and breastfeeding would allow for consistent assessment across feeding methods.

The Pediatric Eating Assessment Tool: Factor Structure and Psychometric Properties

Objectives: The Pediatric Eating Assessment Tool (PediEAT) is a parent-report instrument developed to assess symptoms of feeding problems in children aged 6 months to 7 years. The purpose of this study was to identify the factor structure of the PediEAT and test its psychometric properties, including internal consistency reliability, temporal stability, and construct validity. Methods: Participants included 567 parents of children aged 6 months to 7 years. Fifty-four percent of the sample had parent report of a diagnosed feeding problem or feeding concerns. Exploratory factor-analysis techniques were used to remove redundant or non-endorsed items and identify the factor structure of the instrument. Construct validity was examined with 466 parents completing the Mealtime Behavior Questionnaire as a criterion standard. Known-groups validation was used to compare PediEAT scores between children with and without diagnosed feeding problems. Temporal stability of the PediEAT was examined with 97 parents repeating the PediEAT after 2 weeks. Results: Principal components factor analysis with varimax rotation supported a 4-factor model accounting for 39.4% of the total variance. The 4 subscales (Physiologic Symptoms, Problematic Mealtime Behaviors, Selective/Restrictive Eating, Oral Processing) demonstrated acceptable internal consistencies (coefficient alphas: 0.92, 0.91, 0.83, 0.83; respectively). Construct validity was supported in 2 ways. The PediEAT correlated with the Mealtime Behavior Questionnaire (r = 0.77, P < 0.001) and total score and subscale scores were significantly different between children with and without diagnosed feeding problem (P < 0.001). Temporal stability was demonstrated through test-retest reliability (r = 0.95, P < 0.001). Conclusions: Strong psychometric properties support the use of the PediEAT in research and clinical practice.

Milk Flow Rates From Bottle Nipples Used for Feeding Infants Who Are Hospitalized

PURPOSE This study tested the milk flow rates and variability in flow of currently available nipples used for bottle-feeding infants who are hospitalized. METHOD Clinicians in 3 countries were surveyed regarding nipples available to them for feeding infants who are hospitalized. Twenty-nine nipple types were identified, and 10 nipples of each type were tested by measuring the amount of infant formula expressed in 1 min using a breast pump. Mean milk flow rate (mL/min) and coefficient of variation were used to compare nipples within brand and within category (i.e., Slow, Standard, Premature). RESULTS Flow rates varied widely between nipples, ranging from 2.10 mL/min for the Enfamil Cross-Cut to 85.34 mL/min for the Dr. Browns Y-Cut Standard Neck. Variability of flow rates among nipples of the same type ranged from a coefficient of variation of 0.05 for Dr. Browns Level 1 Standard- and Wide-Neck to 0.42 for the Enfamil Cross-Cut. Mean coefficient of variation by brand ranged from 0.08 for Dr. Browns to 0.36 for Bionix. CONCLUSIONS Milk flow is an easily manipulated variable that may contribute to the degree of physiologic instability experienced by infants who are medically fragile during oral feeding. This study provides clinicians with information to guide appropriate selection of bottle nipples for feeding infants who are hospitalized.

FIRST, DO NO HARM: A Response to "Oral Alimentation in Neonatal and Adult Populations Requiring High-Flow Oxygen via Nasal Cannula".

A recent paper [1] has proposed that the use of respiratory support delivered via high-flow nasal cannula (HFNC) does not have a direct impact on the safety of oral (PO, per os) feeding. As a group of NICU clinicians and researchers, we are writing to express our concern about the design and conclusions presented in this study. Specifically, the article does not present sufficient data for the NICU sample studied to support their conclusions in relation to this population (as detailed below). We believe that this could potentially place vulnerable infants at risk of unsafe feeding practices. Within the NICU environment, HFNC is used as an intervention for many infants with pulmonary disease. Common clinical benefits of HFNC support in infants identified in the literature include a ‘CPAP’ effect (i.e., delivering positive pressure that stents open the airway), providing anatomic O2 reservoirs in the pharynx and allowing rinsing of pharyngeal dead space [2, 3]. To swallow safely, the bolus needs to be contained in the oral cavity prior to the swallow, and the laryngeal vestibule needs to close (deglutition apnea) as the bolus moves through the pharynx, to ensure transport to the esophagus and not into the larynx or lower airway. To swallow safely during breastfeeding and bottle feeding, the precise timing of the suck-swallow-breath sequence needs to be maintained over every one of the swallows that occur in quick succession for minutes at a time while the infant is latched and suckling at the breast or bottle. We are not aware of any objective data using instrumental assessment that show that the presence of HFNC does not (a) impair swallow function during infant suckle feeding or (b) increase aspiration risk in NICU infants (many of whom are at heightened risk for aspiration from their underlying lung disease in itself). The Leder et al. paper [1] does not provide any such data but appears to encourage the practice of allowing (at least some) infants who are dependent on HFNC to feed PO. Of note, the authors report that 34 % (17/50) of infants on HFNC were deemed ‘safe’ to PO feed by MD/RN staff (although it appears that all continued to require tube feeds, indicating that they were not fully functional PO feeders, and is not clear how ‘safety’ was monitored). On examination of the information presented, it is apparent that none of the infants included in this study had a direct feeding evaluation (either formal clinical assessment or instrumental assessment) to confirm the safety of PO feeding. The authors report on their initial criteria for determining readiness to consider trying PO feeds, but make no mention of direct feeding evaluation and no & Pamela Dodrill PDodrill@partners.org

Age-based norm-reference values for the Child Oral and Motor Proficiency Scale

To determine reference values for the Child Oral and Motor Proficiency Scale (ChOMPS) based on healthy, typically developing and typically eating children between six months and seven years old.

Effects of milk flow on the physiological and behavioural responses to feeding in an infant with hypoplastic left heart syndrome.

Infants with hypoplastic left heart syndrome often experience difficulty with oral feeding, which contributes to growth failure, morbidity, and mortality. In response to feeding difficulty, clinicians often change the bottle nipple, and thus milk flow rate. Slow-flow nipples have been found to reduce the stress of feeding in other fragile infants, but no research has evaluated the responses of infants with hypoplastic left heart syndrome to alterations in milk flow. The purpose of this study was to evaluate the physiological and behavioural responses of an infant with hypoplastic left heart syndrome to bottle feeding with either a slow-flow (Dr. Browns Preemie) or a standard-flow (Dr. Browns Level 2) nipple. A single infant was studied for three feedings: two slow-flow and one standard-flow. Oral feeding, whether with a slow-flow or a standard-flow nipple, was distressing for this infant. During slow-flow feeding, she experienced more coughing events, whereas during standard-flow she experienced more gagging. Disengagement and compelling disorganisation were most common during feeding 3, that is slow-flow, which occurred 2 days after surgical placement of a gastrostomy tube. Clinically significant changes in heart rate, oxygen saturation, and respiratory rate were seen during all feedings. Heart rate was higher during standard-flow and respiratory rate was higher during slow-flow. Further research is needed to examine the responses of infants with hypoplastic left heart syndrome to oral feeding and to identify strategies that will support these fragile infants as they learn to feed. Future research should evaluate an even slower-flow nipple along with additional supportive feeding strategies.

The Neonatal Eating Assessment Tool: Development and Content Validation

Abstract Purpose: To develop and content validate the Neonatal Eating Assessment Tool (NeoEAT), a parent-report measure of infant feeding. Design: The NeoEAT was developed in three phases. Phase 1: Items were generated from a literature review, available assessment tools, and parents’ descriptions of problematic feeding in infants. Phase 2: Professionals rated items for relevance and clarity. Content validity indices were calculated. Phase 3: Parent understanding was explored through cognitive interviews. Sample: Phase 1: Descriptions of infant feeding were obtained from 12 parents of children with diagnosed feeding problems and 29 parents of infants younger than seven months. Phase 2: Nine professionals rated items. Phase 3: Sixteen parents of infants younger than seven months completed the cognitive interview. Main Outcome Variable: Content validity of the NeoEAT. Results: Three versions were developed: NeoEAT Breastfeeding (72 items), NeoEAT Bottle Feeding (74 items), and NeoEAT Breastfeeding and Bottle Feeding (89 items).

Age-based norm-reference values for the Pediatric Eating Assessment Tool

Background and objectivesDifferentiating problematic feeding from variations of typical behavior is a challenge for pediatric providers. The Pediatric Eating Assessment Tool (PediEAT) is a parent-report measure of symptoms of problematic feeding in children 6 months to 7 years old with evidence of reliability and validity. This study aimed to determine age-based, norm-referenced values for the PediEAT.MethodsParents of children between 6 months and 7 years old (n = 1110) completed the PediEAT. Descriptive statistics were calculated for subscale and total scores of the PediEAT within 11 age groups.ResultsThe PediEAT total scores followed a general downward trajectory with increasing age. Physiologic Symptoms were relatively steady from 6 to 15 months, and then rapidly declined in 15–18 month olds and continued to decline thereafter. Problematic Mealtime Behaviors increased from 6 to 9 months to a peak in 24–30 month olds and then declined with increasing age. Selective/Restrictive Eating increased from 6 to 9 months to a peak at 12–15 months and then decreased over time thereafter. Symptoms of difficulty with Oral Processing were highest in 6–9 month olds and decreased with age.ConclusionsThe PediEAT now has age-based norm-reference values to guide score interpretation and clinical decision-making.

“It's a Long-Term Process”: Description of Daily Family Life When a Child Has a Feeding Disorder

Pediatric feeding problems occur in 25% of the general pediatric population and up to 80% of those who have developmental delays. When feeding problems place the child at nutritional risk, families are typically encouraged to increase their childs intake. Family mealtime can become a battle, which further reinforces problematic feeding behaviors from the child and intensifies well-intentioned but unguided parental mealtime efforts. Family has an essential influence on feeding; however, studies to date neglect to address the family context of feeding difficulty. In this study we describe, in the context of everyday life, family management of feeding when a child had a significant feeding problem. Parents of children with feeding problems were interviewed with the Family Management Style Framework components as a guide. Twelve parents participated, representing nine families of children with feeding disorder. Description of family management of feeding provides a foundation for development of family feeding interventions.

Factor Structure and Psychometric Properties of the Neonatal Eating Assessment Tool–Breastfeeding

&NA; The purpose of this study was to identify the factor structure of the Neonatal Eating Assessment Tool–Breastfeeding (NeoEAT–Breastfeeding) and to assess its psychometric properties, including internal consistency reliability, test–retest reliability, and construct validity as measured by concurrent and known‐groups validity. Exploratory factor analysis conducted on responses from 402 parents of breastfeeding infants younger than 7 months old showed a 62‐item measure with seven subscales and acceptable internal consistency reliability (Cronbachs &agr; = .92). Test–retest reliability was also acceptable (r = .91). The NeoEAT–Breastfeeding has evidence of concurrent validity with the Infant Gastroesophageal Reflux Questionnaire (r = .69) and Infant Gastrointestinal Symptoms Questionnaire (r = .62). The NeoEAT–Breastfeeding total score and all subscale scores were higher in infants with feeding problems than in typically feeding infants (p < .001, known‐groups validity). The NeoEAT–Breastfeeding is a parent‐report assessment of breastfeeding in infants from birth to 7 months old with good initial evidence of reliability and validity.