How to monitor children with feeding diffi culties in a multidisciplinary scope? Multidisciplinary care protocol for children and adolescents – pilot study
Objectives: To present the results of the implementation of a multidisciplinary approach to feeding difficulties in childhood and adolescence in a reference service. Method: The protocol was designed for outpatient patients aged from zero to 19 years old, with complaints of feeding difficulties and without psychiatric diagnoses, with signed parental consent. The protocol consists of paediatrician, speech therapist and nutritionist assessment in the same appointment, with common observation of evaluations and following multidisciplinary discussion. Diagnoses were categorized according Kerzner et al (2015), and parenting styles according to Hughes (2005). Statistical analysis was conducted via SPSS v21 through frequency distribution (%), mean ± standard deviation, Chi-square test and ANOVA. Significance level was considered at 5%. Results: Sample consisted of 56 children, 67.9% of males, most (75%) younger than 5 years old. The most frequent diagnosis was selectivity (30%). There was association between diagnoses and organic diseases in 30%. Start of complaints occurred at 18 months old. Speech-therapy alterations were detected mostly in speech (29%) and oral-motor skills (32%). Anthropometric assessment showed average normal growth patterns and average dietary assessment of protein intake derived from dairy products was above recommendations (18g/day). Conclusions: Results herein justify the presence of the multidisciplinary team in monitoring feeding difficulties in childhood and adolescence, and highlight the importance of longitudinal research nationwide.
Tharner A, Jansen PW, Kiefte-de Jong JC, Moll HA, van der Ende J, Jaddoe VW, et al. Toward an operative diagnosis of fussy/picky eating: a latent profi le approach in a population-based cohort. Int J Behav Nutr Phys Act. 2014;11:14. DOI: http://dx.doi.org/10.1186/1479-5868-11-14
Dubois L, Farmer A, Girard M, Peterson K, Tatone-Tokuda F. Problem eating behaviors related to social factors and body weight in preschool children: A longitudinal study. Int J Behav Nutr Phys Act. 2007;4:9. DOI: http://dx.doi.org/110.1186/1479-5868-4-9
Mascola AJ, Bryson SW, Agras SW. Picky eating during childhood: A longitudinal study to age 11years. Eat Behav. 2010;11(4):253-7. DOI: http://dx.doi.org/10.1016/j.eatbeh.2010.05.006
Kerzner B, Milano K, MacLean Jr WC, Berall G, Stuart S, Chatoor I. A practical approach to classifying and managing feeding diffi culties. Pediatrics. 2015;135(2): 344-53. DOI: http://dx.doi.org/10.1542/peds.2014-1630
Sampaio AB, Nogueira TL, Grigolon RB, Roma AM, Pereira LE, Dunker KL. Seletividade Alimentar: uma abordagem nutricional. J Bras Psiquiatr. 2013;62(2):164-70. DOI: http://dx.doi.org/10.1590/S0047-20852013000200011
Ostberg M, Hagelin E. Feeding and sleeping problems in infancy - a follow up at early school age. Child Care Health Dev. 2011;37(1):11-25. DOI: http://dx.doi.org/10.1111/j.1365-2214.2010.01141.x
Jansen PW, Roza SJ, Jaddoe VW, Mackenbach JD, Raat H, Hofman A, et al. Children’s eating behavior, feeding practices of parents and weight problems in early childhood: results from the population-based Generation R Study. Int J Behav Nutr Phys Act. 2012; 9:130. DOI: http://dx.doi.org/10.1186/1479-5868-9-130
Xue Y, Lee E, Ning K, Zheng Y, Ma D, Gao H, et al. Prevalence of picky eating behaviour in Chinese school-age children and associations with anthropometric parameters and intelligence quotient. A crosssectional study. Appetite. 2015;91:248-55. DOI: http://dx.doi.org/10.1016/j.appet.2015.04.065
Dovey TM, Farrow CV, Martin CI, Isherwood E, Halford JC. When does food refusal require professional intervention? Current Nutr Food Sci. 2009;5(3):160-71. DOI: http://dx.doi.org/10.2174/157340109789007162
Story M, Neumark-Sztainer D, French S. Individual and environmental infl uences on adolescent eating behaviors. J Am Diet Assoc. 2002;102(3):S40-51.
Schwartz C, Scholtens PA, Lalanne A, Weenen H, Nicklaus S. Development of healthy eating habits early in life. Review of recent evidence and selected guidelines. Appetite. 2011;57(3):796-807. DOI: http://dx.doi.org/10.1016/j.appet.2011.05.316
Dovey TM, Aldridge VK, Dignan W, Staples PA, Gibson EL, Halford JC. Developmental differences in sensory decision making involved in deciding to try a novel fruit. Br J Health Psychol. 2012;17(2):258-72. DOI: http://dx.doi.org/10.1111/j.2044-8287.2011.02036.x
Rommel N, De Meyer AM, Feenstra L, Veereman-Wauters G. The complexity of feeding problems in 700 infants and young children presenting to a tertiary care institution. J Pediatr Gastroenterol Nutr. 2003;37(1):75-84.
Marshall J, Hill RJ, Ware RS, Ziviani J, Dodrill P. Multidisciplinary intervention for childhood feeding difficulties. J Pediatr Gastroenterol Nutr. 2015;60(5):680-7. DOI: http://dx.doi.org/10.1097/MPG.0000000000000669
Owen C, Ziebell L, Lessard C, Chuercher E, Bourget V, Villenueve H. Interprofessional group intervention for parents of children age 3 and younger with feeding difficulties: pilot program evaluation. Nutr Clin Pract. 2012;27(1):129-35. DOI: http://dx.doi.org/10.1177/0884533611430231
Edwards S, Davis AM, Ernst L, Sitzmann B, Bruce A, Keeler D, et al. Interdisciplinary Strategies for Treating Oral Aversions in Children. JPEN J Parenter Enteral Nutr. 2015;39(8):899-909. DOI: http://dx.doi.org/10.1177/0148607115609311
Arvedson JC. Assessment of pediatric dysphagia and feeding disorders: clinical and instrumental approaches. Dev Disabil Res Rev. 2008;14(2):118-27. DOI: http://dx.doi.org/10.1002/ddrr.17
Conroy C, Logan DDE. Pediatric multidisciplinary and interdisciplinary teams and interventions. Clinical Practice of Pediatric Psychology. 2014; p.93.
American Psychiatric Association. Manual diagnóstico e estatístico de transtornos mentais. 4th ed. Artmed; 2002.
Hughes SO, Power TG, Orlet Fisher J, Mueller S, Nicklas TA. Revisiting a neglected construct: parenting styles in a child-feeding context. Appetite. 200544(1):83-92. DOI: http://dx.doi.org/10.1016/j.appet.2004.08.007
Krom H, Otten MAGM, Veer L van der S, Zundert SMC van, Khawaja FK, Benninga MA, et al. Multidisciplinary approach in young children with severe feeding disorders. 2013;81:72. DOI: http://dx.doi.org/10.1007/s12456-013-0070-6
Poeta LS, Duarte MFS, Giuliano ICB, Mota J. Interdisciplinary intervention in obese children and impact on health and quality of life. J Pediatr (Rio J). 2013;89(5):499-504. DOI: http://dx.doi.org/10.1016/j.jped.2013.01.007
Dubois L, Farmer AP, Girard M, Peterson K. Preschool children’s eating behaviours are related to dietary adequacy and body weight. Eur J Clin Nutr. 2007;61(7):846-55. DOI: : http://dx.doi.org/10.1038/sj.ejcn.1602586
Bento IC, Esteves JMM, França TE. Alimentação saudável e dificuldades para torná-la uma realidade: percepções de pais/responsáveis por pré-escolares de uma creche em Belo Horizonte/MG, Brasil. Ciênc Saúde Coletiva. 2015;20(8):2389-2400. DOI: http://dx.doi.org/10.1590/1413-81232015208.16052014
Hughes SO, Shewchuk RM. Child temperament, parent emotions, and perceptions of the child’s feeding experience. Int J Behav Nutr Phys Act. 2012;29:9:64. DOI: http://dx.doi.org/10.1186/1479-5868-9-64
Curtin C, Hubbard K, Anderson SE, Mick E, Must A, Bandini LG. Food Selectivity, Mealtime Behavior Problems, Spousal Stress, and Family Food Choices in Children with and without Autism Spectrum Disorder. J Autism Dev Disord. 2015;45(10):3308-15. DOI: http://dx.doi.org/10.1007/s10803-015-2490-x
Almeida CAN, Mello ED, Maranhão HS, Vieira MC, Barros R, Fisberg M, et al. Difi culdades alimentares na infância: revisão da literatura com foco nas repercussões à saúde. Pediatr Mod. 2012;48(9):24-26.
Sociedade Brasileira de Pediatria (SBP). Manual de orientação para a alimentação do lactente, do préescolar, do escolar, do adolescente e na escola. 3rd ed. Rio de Janeiro: SBP; 2012.
Drent LV, Pinto EALC. Problemas de alimentação em crianças com doença do refl uxo gastroesofágico. Pró-Fono R Atual Cient. 2007;19(1):59-66. DOI: http://dx.doi.org/10.1590/S0104-56872007000100007
Taylor CM, Wernimont SM, Northstone K, Emmett PM. Picky/fussy eating in children: Review of defi nitions, assessment, prevalence and dietary intakes. Appetite. 2015; 1(95):349-59. DOI: http://dx.doi.org/10.1016/j.appet.2015.07.026
Bigornia SJ, LaValley MP, Moore LL, Northstone K, Emmett P, Ness AR, et al. Dairy intakes at age 10 years do not adversely affect risk of excess adiposity at 13 years. J Nutr. 2014;144(7):1081-90. DOI: http://dx.doi.org/10.3945/jn.113.183640
Günther AL, Remer T, Kroke A, Buyken AE. Early protein intake and later obesity risk: which protein sources at which time points throughout infancy and childhood are important for body mass index and body fat percentage at 7 y of age? Am J Clin Nutr. 2007;86(6):1765-72.
Morris SE, Klein MD. Pre-feeding skills: a comprehensive resource for feeding development. Tucson: Therapy Skill Builders; 1987.
Ruscello DN. Nonspeech Oral Motor Treatment Issues Related to ChildrenWith Developmental Speech Sound Disorders. Language, Speech and Hearing Services in Schools. Am Speech Language Hearing Association. 2008;39: 380-91.
Neistadt ME, Crepeau EB. Willard and Spackman’s occupational therapy. 9th ed. New York: Lippincott; 1998.
Ferriolli BHVM. Associação entre as alterações de alimentação infantil e distúrbios de fala e linguagem. CEFACS. 2010;12(6):990-7. DOI: http://dx.doi.org/10.1590/S1516-18462010005000037
Felício CM, Ferreira-Jeronymo RR, Ferriolli BHVM, Freitas RLRG. Análise da associaçäo entre sucçäo, condiçöes miofuncionais orais e fala. Pró-Fono. 2003;15(1):31-40.
Connaghan KP, Moore CA, Higashakawa M. Respiratory kinematics during vocalization and nonspeech respiration in children from 9 to 48 months. J Speech Lang Hear Res. 2004;47(1):70-84. DOI: http://dx.doi.org/10.1044/1092-4388(2004/007
Moore CA, Caulfi eld TJ, Green JR. Relative kinematics of the rib cage and abdomen during speech and nonspeech behaviors of 15-month-old children. J Speech Lang Hear Res. 2001;44(1):80-94.
Moore CA, Ruark JL. Does speech emerge from earlier appearing oral motor behaviors? J Speech Hear Res. 1996;39(5):1034-47.
Martinelli RLC, Marchesan IQ, Berretin-Felix G. Lingual frenulum evaluation protocol for infants: relationship between anatomic and functional aspects. Rev CEFAC. 2013;15(3):599-610.
Marchesan IQ, Oliveira LR, Costa ML, Araujo RL. Análise comparativa da mastigação em pacientes com e sem alteração do frênulo lingual. In XV Congresso Brasileiro de Fonoaudiologia e VII Congresso Internacional de Fonoaudiologia. Gramado: 2007.
Lalakea ML, Messner AH. Ankyloglossia: the adolescent and adult perspective. Otolaryngol Head Neck Surg. 2003;128(5):746-52.
Messner AH, Lalakea ML, Aby J, Macmahon J, Bair E. Ankyloglossia: incidence and associated feeding difficulties. Arch Otolaryngol Head Neck Surg. 2000;126(1):36-9.
Ballard L, Auer E, Khoury C. Ankyloglossia: Assessment, Incidence, and Effect of Frenuloplasty on the Breastfeeding Dyad. Pediatrics. 2002 nov; 110(5):e63.
Marchesan IQ. Protocolo de avaliação do frênulo da língua. Rev CEFAC. 2010; 12(6):977-89.
World Health Organization (WHO). Child growth standards and the identifi cation of severe acute malnutrition in infants and children. Switzerland: WHO; 2009.
Sociedade Brasileira de Pediatria (SBP). Obesidade na infância e adolescência: manual de orientação. Rio de Janeiro: Departamento de nutrologia; 2008.
Junqueira P, Maximino P, Ramos CC, Machado RHV, Assumpção I, Fisberg M. O papel do fonoaudiólogo no diagnóstico e tratamento multiprofi ssional da criança com difi culdade alimentar: uma nova visão. CEFACS. 2015;17(3):1004-11. DOI: http://dx.doi.org/10.1590/1982-021620151614
Institute of Medicine (IM). Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and amino acids. Washington: The National Academies Press. 2002/2005.
CODE OF CONDUCT FOR JOURNAL PUBLISHERS
Publishers who are Committee on Publication Ethics members and who support COPE membership for journal editors should:
- Follow this code, and encourage the editors they work with to follow the COPE Code of Conduct for Journal Edi- tors (http://publicationethics.org/files/u2/New_Code.pdf)
- Ensure the editors and journals they work with are aware of what their membership of COPE provides and en- tails
- Provide reasonable practical support to editors so that they can follow the COPE Code of Conduct for Journal Editors (http://publicationethics.org/files/u2/New_Code.pdf_)
- Define the relationship between publisher, editor and other parties in a contract
- Respect privacy (for example, for research participants, for authors, for peer reviewers)
- Protect intellectual property and copyright
- Foster editorial independence
Publishers should work with journal editors to:
- Set journal policies appropriately and aim to meet those policies, particularly with respect to:
– Editorial independence
– Research ethics, including confidentiality, consent, and the special requirements for human and animal research
– Transparency and integrity (for example, conflicts of interest, research funding, reporting standards
– Peer review and the role of the editorial team beyond that of the journal editor
– Appeals and complaints
- Communicate journal policies (for example, to authors, readers, peer reviewers)
- Review journal policies periodically, particularly with respect to new recommendations from the COPE
- Code of Conduct for Editors and the COPE Best Practice Guidelines
- Maintain the integrity of the academic record
- Assist the parties (for example, institutions, grant funders, governing bodies) responsible for the investigation of suspected research and publication misconduct and, where possible, facilitate in the resolution of these cases
- Publish corrections, clarifications, and retractions
- Publish content on a timely basis