On the Research Front: Literature Review 2015

On the Research Front: interesting research going on!

Odar Stough C^., Dreyer Gillette, M.L., Roberts, M.C, Jorgensen, T.D., Patton, S.R. (2015). Mealtime behaviors associated with consumption of unfamiliar foods by young children with autism spectrum disorder. Appetite, Dec 1;95:324-33.

doi: 10.1016/j.appet.2015.07.019. Epub 2015 Jul 21.

 

Researchers looked at parent and child mealtime behaviors associated with consumption of unfamiliar foods by children with ASD. Parents presented the child with an unfamiliar food and mealtime behaviors were subsequently coded. The child taking sips of their drink was the only behavior related to whether the child took a bite of the unfamiliar food throughout the course of the meal. Parent direct commands and parents feeding the child were related to greater frequency of subsequent bites in a close temporal window, while child play, the child being away from the table, and child talk about things other than food related to lower frequencies of subsequent bites. Clinical interventions for food selectivity in children with ASD might provide parents education on effective mealtime parenting strategies and decreasing inappropriate child mealtime behaviors.

 

Wyse, R., Wolfenden, L., Bisquera, A. (2015). Characteristics of the home food environment that mediate immediate and sustained increases in child fruit and vegetable consumption: mediation analysis from the Healthy Habits cluster randomized controlled trial. Int J Behav Nutr Phy Act, Sep 17;12:118.

doi: 10.1186/s12966-015-0281-6. (free article)

 

Results suggest that the effect of the intervention on the children’s fruit and vegetable consumption was mediated by parent fruit and vegetable intake and parent provision of these foods at both 2- and 12-month follow-up. It is recommended these variables be targeted in subsequent home food environment interventions to bring about immediate and sustained changes in child fruit and vegetable intake.

 

Zobel-Lachiusa, J., Andrianopoulos, M.V., Mailloux, Z., Cermak, S.A., (2015) . Sensory Differences and Mealtime Behavior in Children With Autism. Am J Occup Ther. Sep-Oct;69(5):6905185050p1-8. doi: 10.5014/ajot.2015.016790.

 

This study examined sensory differences and mealtime behaviors in children with autism spectrum disorder as compared typically developing aged matched peers. Results from parent-report and child-report questionnaires indicated that children with ASD scored significantly differently from TD peers on the measures of sensory differences and eating behaviors. Data also supported a correlation between sensory differences and eating difficulties in children with ASD. The findings also support a need to further explore the influence of sensory differences on mealtime behaviors.

 

Marshall, J., Hill, R.J., Ware, R.S., Ziviani, J., Dodrill, P. (2015).Clinical Characteristics of two Groups of Children with Feeding Difficulties.J Pediatr Gastroenterol Nutr. Jul 20. [Epub ahead of print]

 

The study compared the clinical characteristics of two groups of children presenting to a feeding clinic: children with Autism Spectrum Disorder (ASD) and children with a non-medically complex history (NMC)and compared participants according to degree of oral motor impairment, presence of oral hypersensitivity, and clinically significant parent stress. Both groups presented with a large number of difficult mealtime behaviors and caregiver stress was elevated in both groups. Parents of children in the ASD group reported significantly higher stress levels. Across both groups, the majority of children presented with mild to moderate oral motor impairments. Children with heightened oral sensory sensitivity consumed significantly fewer unprocessed fruits and vegetables, and their parents reported a significantly greater frequency of difficult mealtime behaviors.Features of feeding difficulty presented similarly across the ASD and NMC groups in this study. Oral motor impairment, oral sensory sensitivity, and parental stress should not be overlooked in management of children with feeding difficulties, regardless of etiology.

 

Curtin, C., Hubbard, K., Anderson, S.E., Mick, E., Must, A., Bandini, L.G., (2015).Food Selectivity, Mealtime Behavior Problems, Spousal Stress, and Family Food Choices in Children with and without Autism Spectrum Disorder. J Autism Dev Disord. Oct;45(10):3308-15. doi: 10.1007/s10803-015-2490-x.

 

Mealtime behavior problems and family stress occur frequently among families of children with autism spectrum disorder (ASD). The associations of high food selectivity with mealtime behavior problems, spousal stress, and influence on family members were assessed among children with ASD and typically developing (TD) children ages 3-11 years. Compared to TD children, children with ASD were more likely to have high food selectivity, and their parents reported more mealtime behavior problems, higher spousal stress, and influence on what other family members ate. High food selectivity was associated with mealtime behavior problems in both groups. Interventions to reduce food selectivity may lead to decreases in mealtime behavior problems.

 

Postorino, V., Sanges, V., Giovagnoli, G., Fatta, L.M., DePeppo, L., Armando, M., Vicari, S., Mazzone, L. (2015). Clinical differences in children with autism spectrum disorder with and without food selectivity. Appetite. Sep;92:126-32. doi: 10.1016/j.appet.2015.05.016. Epub 2015 May 18.

 

The everyday management of mealtime behaviors among children with ASD can have a negative impact on family routines and become a significant stressor for families. The objective of this study was to investigate clinical and behavioral features in individuals with ASD with the aim of identifying distinctive clinical profiles in children with and without food selectivity. Children with ASD were enrolled in this study with food selectivity (FS) were age and sex matched without food selectivity (No FS). No statistically significant difference on gastrointestinal symptoms and growth adequacy was found between the FS group and the No FS group. Overall, the FS group showed significantly higher rates of ASD symptoms as compared to the No FS group in the questionnaires completed by parents. Furthermore, parents of the FS group reported significantly higher levels of parental stress and a larger degree of their children’s behavioral problems as compared to the No FS group. Finally, there were no differences between the FS and the No FS group on any adaptive skill domain. Our findings suggest that the identification of distinctive clinical and behavioral patterns in children with ASD and food selectivity is a crucial issue for parents and therapists in the daily management.

 

Johnson, S.L., Davies, P.L., Boles, R.E., Gavin, W.J., Bellows, L.L. (2015). Young Children’s Food Neophobia Characteristics and Sensory Behaviors Are Related to Their Food Intake.J Nutr. Sep 30. pii: jn217299. [Epub ahead of print]

 

This study looked at the associations between children’s food neophobia, sensory sensitivity, and dietary intake in a diverse sample of typically developing preschoolers.Children’s neophobia and sensory sensitivity may be important in understanding underlying issues related to limited food acceptance in typically developing young children and for helping caregivers facilitate healthy dietary intake patterns for their children.

 

Kemps, G., Sewitch, M., Birnbaum, R., Daniel, S.J. (2015).Contrast pooling in videofluoroscopic swallowing study as a risk factor for pneumonia in children with dysphagia.Int J Pediatr Otorhinolaryngol. Aug;79(8):1306-9. doi: 10.1016/j.ijporl.2015.05.039. Epub 2015 Jun 8.

 

To determine if laryngeal contrast pooling on a videofluoroscopic swallowing study increases the risk for pneumonia and if laryngeal abnormalities or syndromic disorders increase the risk for pneumonia. Of the 239 patients: 40 (16.7%) exhibited pooling and 199 (83.3%) did not. Children with pooling on videofluoroscopic swallowing study did not have significantly more pneumonias than patients without pooling. Secondary analyses revealed that laryngeal abnormalities were a significant independent risk factor for pneumonia at 6 months, while being diagnosed with a syndrome was not.

 

Chinnadurai, S., Francis, D.O., Epstein, R.A., Morad, A., Kohanim, S. McPheeters, M. (2015). Treatment of ankyloglossia for reasons other than breastfeeding: a systematic review.Pediatrics. Jun;135(6):e1467-74. doi: 10.1542/peds.2015-0660. Epub 2015 May 4.

 

Children with ankyloglossia, an abnormally short, thickened, or tight lingual frenulum, may have restricted tongue mobility and sequelae, such as speech and feeding difficulties and social concerns. Results of literature search indicated 2 randomized controlled trials, 2 cohort studies, and 11 case series assessed the effects of frenotomy on feeding, speech, and social outcomes. Bottle feeding and social concerns improved more in treatment groups in comparative studies. Two cohort studies reported improvement in articulation and intelligibility with treatment. Other benefits were unclear. One randomized controlled trial reported improved articulation after Z-frenuloplasty compared with horizontal-to-vertical frenuloplasty. Numerous noncomparative studies reported speech benefits post treatment; however, studies primarily discussed modalities, with outcomes including safety or feasibility, rather than speech. We included English-language studies, and few studies addressed longer-term speech, social, or feeding outcomes; nonsurgical approaches, such as complementary and alternative medicine; and outcomes beyond infancy, when speech or social concerns may arise.Data are currently insufficient for assessing the effects of frenotomy on nonbreastfeeding outcomes that may be associated with ankyloglossia.

 

Francis, D.O., Krishnaswami, S., McPheeters, M.(2015).Treatment of ankyloglossia and breastfeeding outcomes: a systematic review. Pediatrics. Jun;135(6):e1458-66. doi: 10.1542/peds.2015-0658. Epub 2015 May 4.

 

Ankyloglossia is a congenital condition characterized by an abnormally short, thickened, or tight lingual frenulum that restricts tongue mobility. The objective of this study was to systematically review literature on surgical and nonsurgical treatments for infants with ankyloglossia. Results showed 29 studies reported breastfeeding effectiveness outcomes. Four RCTs reported improvements in breastfeeding efficacy by using either maternally reported or observer ratings, whereas 2 RCTs found no improvement with observer ratings. Although mothers consistently reported improved effectiveness after frenotomy, outcome measures were heterogeneous and short-term. Based on current literature, the strength of the evidence for this issue is low.The evidence base is limited, consisting of small studies, short-term outcomes, and little information to characterize participants adequately. No studies addressed nonsurgical interventions, longer-term breastfeeding or growth outcomes, or surgical intervention compared with other approaches to improve breastfeeding, such as lactation consultation.A small body of evidence suggests that frenotomy may be associated with mother-reported improvements in breastfeeding, and potentially in nipple pain, but with small, short-term studies with inconsistent methodology, strength of the evidence is low to insufficient.

 

Coulthard, H., Thakker, D.(2015). Enjoyment of tactile play is associated with lower food neophobia in preschool children. J Acad Nutr Diet. Jul;115(7):1134-40. doi: 10.1016/j.jand.2015.02.020. Epub 2015 Apr 29.

 

Previous research has shown that parental reports of food neophobia and tactile sensitivity are associated with lower fruit and vegetable (F/V) intake in children. This study aimed to pilot a behavioral observation measure of tactile play in young children. The primary aim of the study was to see whether children’s enjoyment of tactile play was associated with higher F/V consumption, as well as lower food neophobia. Children’s engagement in two tactile play tasks using sticky foods (mashed potatoes and vegetarian gelatin) was observed and rated by both the researcher and parent. Parents were asked to complete a series of questionnaires measuring F/V consumption, food neophobia, and sensory processing. It was found that lower child food neophobia was significantly related to enjoyment of tactile play, whereas child F/V consumption was associated with parental F/V consumption, but not enjoyment of tactile play. The findings strengthen the idea that tactile processing may be associated with the acceptance of food variety, but not the total amount of F/V consumed. Additional research is indicated to determine whether tactile play tasks can be used to lower child food neophobia.

 

Laureati, M., Bergamaschi, V., Pagliarini, E. (2014). School-based intervention with children. Peer-modeling, reward and repeated exposure reduce food neophobia and increase liking of fruits and vegetables. Appetite, Volume 83, 1 December, Pages 26–32.

 

This study investigated the effectiveness of the ‘Food Dudes’ school-based intervention consisting of rewards, peer-modeling and food exposure on food neophobia and the liking of fruits and vegetables (FV) in a large cohort of children. For 16 days, children in the experimental group watched motivational videos, were read letters to encourage them to eat FV and received a small reward for eating one portion of both a fruit and a vegetable. The control group was only provided with FV for the same time period. Food neophobia and liking were measured in both groups of children before and after the intervention, and a follow-up measurement was carried out 6 months later. The intervention was effective in reducing food neophobia and, most importantly, a persistent effect was observed 6 months after the intervention as children of the experimental group showed significantly lower neophobia scores than the control group. Additionally, the program was effective in increasing liking for both FV; however, this effect was maintained only for fruit after 6 months.

 

Kaviyani Baghbadorani, M., Soleymani, Z., Dadgar, H., Salehi, M. (2014).The effect of oral sensorimotor stimulations on feeding performance in children with spastic cerebral palsy. Acta Med Iran.52(12):899-904.

 

Oral feeding difficulties are common in children with cerebral palsy (CP). The purpose of the present study was to evaluate the effect of oral sensorimotor stimulations on feeding performance in children with spastic cerebral palsy. The results of the study revealed a significant improvement in feeding skills including mouth closure, lip closure on the utensil, lip closure during deglutition, control of the food during swallowing, mastication, straw suction and control of liquid during deglutition. There were more improvement in mouth closure and less in straw suction. This study showed sensorimotor stimulation is useful for the treatment of the feeding problems, but the progress was not perfect. This could be due to the role of the position and cognitive skills in feeding functions. Thus, other strategies should be considered to achieve more improvement in feeding performance.

 

Adamson, M., Morawska, A., Wigginton, B.(2015). Mealtime duration in problem and non-problem eaters.Appetite. Jan;84:228-34. doi: 10.1016/j.appet.2014.10.019. Epub 2014 Oct 22.

 

Research on meal duration, and therefore guidelines for appropriate meal length, is lacking. This research aimed to compare the meal duration of problem-eaters and controls, and to examine changes to meal length amongst problem-eaters following a parenting intervention. Meal duration was similar across groups, though problem-eaters engaged in more aversive behavior and less eating than controls. Observed eating and mealtime behavior altered following intervention but not duration. Parents who reported meal length as a specific concern had longer meals and reported less successful feeding than those who did not. These results suggest that what is happening during the meal may better distinguish problem-eaters than duration alone.

 

Gurberg J, Birnbaum R, Daniel SJ.( 2015). Laryngeal penetration on videfluoroscopic swallowing study is associated with increased pneumonia in children. Int J Pediatr Otorhinolaryngol. Nov;79(11):1827-30. doi: 10.1016/j.ijporl.2015.08.016. Epub 2015 Aug 28. PMID: 26381290

 

Children with laryngeal penetration on videofluoroscopic swallowing study had significantly more pneumonia than patients with neither penetration nor aspiration. Furthermore, analysis revealed that glottic abnormalities (e.g. laryngeal cleft) represented a significant independent risk factor for pneumonia and aspiration, while being diagnosed with a syndrome did not. This is the first study to demonstrate that laryngeal penetration on videofluoroscopic swallowing study is associated with significantly more cases of pneumonia in children. While this remains a retrospective study demonstrating a weak association, the results suggest a need for future prospective studies to evaluate this important clinical question in children.

 

Virbalas J, McMullen C, Cheng J.(2015 ). Injection laryngoplasty in children with cystic fibrosis and abnormal swallow. Int J Pediatr Otorhinolaryngol. Nov;79(11):1856-9. doi: 10.1016/j.ijporl.2015.08.024. Epub 2015 Aug 24. PMID: 26365895

 

Three patients with CF underwent injection laryngoplasty for evidence of aspiration or laryngeal penetration on MBS evaluation. Normal laryngeal anatomy was identified intraoperatively in each case. Presenting symptoms included chronic cough, cough with oral liquids, and recurrent pneumonia. Each patient underwent successful injection into the interarytenoid space. Post-operatively, modified barium swallow demonstrated resolution of aspiration or penetration in all patients. No procedure-related complications were encountered. Patients with CF are highly susceptible to pulmonary infections, and aggressive treatment of chronic aspiration is often necessary. Injection laryngoplasty may be effective in normalizing swallowing in these children. Future study will elucidate the duration of effect and if this technique improves long-term pulmonary outcomes in CF patients.

 

Simons, J.P., Greenberg, L.L., Mehta, D.K., Fabio, A., Maguire, R.C., Mandell, D.L. (2015). Laryngomalacia and swallowing function in children. Laryngoscope. Jul 7. doi: 10.1002/lary.25440. [Epub ahead of print]

 

There were 324 patients with laryngomalacia identified. Gastroesophageal reflux disease (GERD) was diagnosed in 69.8% of patients. Other medical comorbidities included Down syndrome, neurological impairment, and congenital heart disease. Symptoms of dysphagia or feeding difficulty were present in 50.3%, and failure to thrive was present in 9.6%. 75.7% of patients had at least one abnormal baseline swallowing assessment. There was no significant relationship between severity of laryngomalacia and presence of abnormal swallowing function based on symptoms, CSE, MBS, or FEES. However, patients with greater severity were more likely to have failure to thrive. There was not a significant association between the presence of swallowing dysfunction or disease severity and medical comorbidities such as Down syndrome, neurological impairment, or congenital heart disease. However, GERD was more likely to be present in patients with moderate and severe laryngomalacia than in patients with mild disease. Swallowing dysfunction is common in children with laryngomalacia regardless of disease severity or other medical comorbidities. Swallowing studies are frequently abnormal in laryngomalacia patients presenting both with and without subjective symptoms of dysphagia. Dysphagia assessment should be considered as part of the evaluation of infants with laryngomalacia.

 

Malas, K., Trudeau, N., Chagnon, M., McFarland, D.H.(2015). Feeding-swallowing difficulties in children later diagnosed with language impairment. Dev Med Child Neurol. Sep;57(9):872-9. doi: 10.1111/dmcn.12749. Epub 2015 Mar 25.

 

The aim of this retrospective study was to assess the relationship between feeding-swallowing difficulties (FSDs) and later language impairments in children. Findings suggest that early FSD’s may be used as a potential marker for language impairment. However, larger prospective studies are needed to confirm this.

 

Hauer, J.M., Solodiuk, J.C. (2015). Gabapentin for management of recurrent pain in 22 nonverbal children with severe neurological impairment: a retrospective analysis.J Palliat Med. May;18(5):453-6. doi: 10.1089/jpm.2014.0359. Epub 2015 Feb 6.

 

The study objective was to describe presenting pain behaviors, daily dose, and response to gabapentin for the management of frequent recurrent pain in children with severe impairment of the central nervous system (CNS). Pain behaviors commonly reported included facial grimacing, crying, or moaning. Intermittent increase in muscle tone was identified in 86%. Gastrointestinal (GI) symptoms occurred in 64%, including pain localized to the GI tract and vomiting. All were assessed for nociceptive pain sources, many with repeated testing. Most were on medications for spasticity and gastroesophageal reflux disease (GERD)(100%) prior to gabapentin use. Of the 22 treated with gabapentin, 91% had a significant decrease in symptoms. No serious adverse events occurred. The mean gabapentin dose for children five years of age or less was 50 mg/kg/day compared to children older than 11 years with a mean dose of 36 mg/kg/day. Gabapentin appears to be an effective treatment for children with severe impairment of the CNS and recurrent pain behaviors, including intermittent changes in muscle tone.

 

Souza, V.A., Abreu, M.H., Resense, V.L., Castilho, L.S. (2015). Factors associated with bruxism in children with developmental disabilities. Braz Oral Res.1-5. Epub 2014 Dec 2.

 

The aim of the present study was to investigate factors associated with bruxism in children aged from 1 to 13 years with developmental disabilities. A total of 389 dental records were examined. The bruxism analyzed was determined based on parental reports. The following variables were also analyzed: gender, age, International Code of Diseases (ICD), mouth breathing, history of gastroesophageal reflux, use of psychotropic drugs, gingival status, reports of xerostomia, hyperkinesis, pacifier use, thumb sucking and involuntary movements. For the purposes of analysis, the individuals were categorized as being with and without bruxism. Exhibiting involuntary movements, the female gender and gastroesophageal reflux are factors associated with bruxism in children with developmental disabilities.