When Feeding Becomes Disordered: Strategies to Improve Pediatric Health Outcomes, with my feeding team from UNC, we had a good time!
It was a great weekend despite the April snow in Philly. Thank you CHOP for hosting such an informative meeting!
On Friday, there was a business meeting for feeding programs to discuss the establishment of an association for pediatric feeding and swallowing disorders. 67 specialists attended (as well as some who called in) including physicians, psychologists, SLP, OT, RD, NP, and researchers. We met to discuss needs of the field and future directions. Many ideas were discussed about the role of the organization including:
- Strong consensus on need for evidence based practice and more research.
- Need for advocacy and better funding for treatment.
- Need for education of professionals and caregivers.
- Desire for annual meeting.
If you want to be part of this ongoing topic, join the discussion group: https://groups.google.com/d/forum/feeding-programs
Feeding matters presented on their support and advocacy for pediatric feeding disorders. Please visit their website to learn more about what they are doing! https://www.feedingmatters.org
On Saturday, there was a day long conference with breakout sessions.
Here are some of the things I found interesting-
Avoidant/Restrictive Food Intake Disorder: A Clinical and Research Update
Rachel Bryant-Waugh, Ph.D.
This interesting presentation focused on ARFID as a new diagnosis for feeding disorders. Criteria for diagnosing this and it’s impact was presented.
Diet Quality, Nutrition Status and Health Outcomes of Disordered Eating
Virginia A. Stallings, M.D.
I loved this talk probably because I am really interested in nutrition and feel this is the most important part of feeding program. Dr. Stallings discussed the importance of growth and nutrition for our pediatric patients.
- Importance of looking at the child, not just growth charts
- do nutritional rehab before puberty (girls do not grow much after puberty)
- for our underweight kids or failure to thrive, the problem most often is calorie deficiency
- children can have nutrient deficiency’s as well and the most common is iron deficiency
- appetite abnormalities are rare
With poor growth (growth faltering pattern)
- with malnutrition, children will first have poor weight gain, then poor linear growth, then lastly poor head growth.
- The body has preservation of head circumference and brain growth (skull grows if brain grows)
Important to have good growth management. Tools to manage growth:
- growth charts: weight/age (weight is environmental), length/age (height genetic), and weight for length or BMI. She stressed to not just look at BMI but consider all parameters. Always consider the parents’s stature.
- She also recommended using measurements of fat stores (tricep fold, sub-scapular fold) because this is the best indicator of calories from last month.
- Kids that are malnourished are grumpy and have a hard time learning, studies have linked lower BMI to higher mortality.
Break and Exhibits The Role of the Gut Microbiota in Pediatric Nutrition and Health
Lindsey G. Albenberg, D.O.
Dr. Albenberg presented current research on gut microbiota (most of which is too complicated for me to explain). This is an area that is growing fast and exploding with new info. She discussed studies looking at babies born vaginally, babies born via c-section, breast fed infants and formula fed infants. Research is showing these factors influence an infants microbiotia which may play a role in overall health.
Behavioral Interventions for Pediatric Feeding Problems in Children with Developmental Disabilities Karen Wohlheiter, Ph.D.; Colleen T. Lukens, Ph.D.
This presentation discussed using behavioral intervention with children with obesity and also with feeding problems. Case examples of using desensitization and reinforcement strategies were presented. When to initiate this type of intervention and the importance of nutrition and stable weight being addressed first was discussed.
A. Appetite Manipulation in the Management of Pediatric Feeding Problems Goldie Markowitz, M.S.N., C.R.N.P.; Colleen T. Lukens, Ph.D.
This seemed to be a very popular session which means many of us are dealing with appetite issues with our clients. Poor appetite can be related to dysphagia, GERD, motility, allergies, pain, and in rare cases even choking. Intervention can include use of prokinetic medicines, appetite stimulants, and altering tube feeding and oral feeding schedules in conjunction with behavioral feeding therapy. Appetite regulating hormones was described.
Cyproheptidine (or periactin) is the most common medicine currently used for appetite stimulation. There was good discussion on it’s use. For example some physicians won’t use it under the age of 2, some 1, where I work we will use it in infants. A prescription might be written for 1-3x/day. Consensus was that there is a lot we do not know and research is needed. The presenters cited some interesting research, one study supported the use of periactin in conjunction with meds for GERD and motility as having the best effect. I will dig that reference up and post the info.
B. Assessment of and Intervention for Food Insecurity as it Relates to Pediatric Feeding and Eating Problems Amy Dean, M.P.H., R.D., C.S.P., L.D.N.; Saba Khan, M.D.
I attended this interesting session that discussed food insecurity (not having enough food) as a reason for picky and poor eating. The presenters provided back ground information on prevalence of food insecurity and suggested that all clinicians screen for this. It is a delicate topic but we will not know the prevalence of this if we do not ask. They made suggestions for interventions that include putting together a handout of local resources to assist families, starting a food pharmacy, looking at ways to stretch formula and resources as well as organizations and foundations that may help.
I personally have had the experience where a client was FTT partly because the family did not have resources to feed the child. I have also had experiences where caregivers were reluctant to purchase food to work on expanding a child’s diet or even puree food when there was a high likelihood of the child not eating the food. This is a tough situation and one that warrants creativity, discussion, and assistance from us.
I did not get to attend these sessions, you could only pick 2 sessions.
C. Utilizing Functional Activities of Daily Living to Promote Healthy Eating Across the Developmental Spectrum Michelle Hagenbaugh, O.T.R./L.; Amy Levin, M.S., O.T.R./L.
D. Treating the Patient with Pediatric Obesity: Therapeutic Interventions Incorporating Nutritional and Physical Activity Guides Colleen O’Connor, M.S., O.T.R./L.; Erin B. Rasnake, P.T., M.S., P.C.S.; Elizabeth Coover, R.D., C.S.P., L.D.N.