Assessing pediatric feeding disorders by domain in children with hypersensitive gagging 

Many of you know that I recently finished my PhD. Gagging in children with PFD has been an interest area of mine since I started in the field 30ish years ago. I attribute that to all the gagging we saw in children who had nissen fundoplications in the early 90’s. I know some of you seasoned therapists remember that time! Luckily, we do not see that as often anymore but as feeding therapists we do still see children with atypical gagging response across many contexts. Gagging that can disrupt feeding progression, contributes to oral aversion, and prevents progress with skill development! Gagging in this population is not well studied, thus not well understood. I was lucky during my doctoral studies to have mentors that supported my desire to further explore gagging in children with PFD (Drs. Lundgren, Thoyre, Kamhi) and to work with one of the only SLP researchers who has published in this area (Dr. Scarborough). I also want to say thank you to my colleagues at UNC that took data for me and the UNC Children’s Research Institute which enabled me to do this study.

I appreciate all of the support I have had on this journey. My dissertation just got published and I wanted to share the reference and abstract here. I hope to be able to publish the results in a journal and will keep you posted :). Thank you for all the support from my family, friends, colleagues, and blog readers over the last 4 years with my decreased posting on this blog. I hope to step it up a bit now that I’m finished. Thanks everyone!!!

Brackett, K. (2024). Assessing pediatric feeding disorders by domain in children with hypersensitive gagging (Order No. 31140049). Available from ProQuest Dissertations & Theses Global. (3061540032). Retrieved from http://libproxy.lib.unc.edu/login?url=https://www.proquest.com/dissertations-theses/assessing-pediatric-feeding-disorders-domain/docview/3061540032/se-2

Abstract

The purpose of this study was to improve our understanding of gagging in children with pediatric feeding disorder (PFD). This study explored prevalence and common triggers for gagging. Children with and without gagging were compared using the medical, nutrition, feeding skill, and psychosocial domains of PFD (Goday et al., 2019, Sharp et al., 2022).

One-hundred and sixteen participants met inclusion criteria through a retrospective chart review of three months of new patients seen in a hospital-based feeding clinic. The gagging group and non-gagging group were compared by demographics, frequency of domain identification, specific items within each domain, and the number of domains identified per participant between groups.

Results indicated that 60% of children in this sample had gagging as part of their PFD. Significant findings included that 70% of the gagging group was under the age of three years and was more likely to have issues in the medical domain, specifically gastrointestinal diagnoses (gastroesophageal reflux, emesis, and hypersensitivity). Additionally, the gagging group had more issues in the feeding skill domain, as well as signs of pharyngeal dysphagia, and oral motor delay as compared to the non-gagging group. The most common triggers were textured puree, mixed textures, dry solids, and non-preferred foods.

Given these findings, when working with young children who experience gagging as part of their PFD, clinicians are encouraged to carefully explore gastrointestinal issues, swallowing, and oral motor function. Additional research is needed to better understand how these factors influence gagging and to explore assessment and treatment strategies.