Date Presented 4/1/2017
A systematic review was conducted to evaluate the efficacy of feeding interventions for children with developmental disabilities. Findings suggest that quality evidence to support feeding interventions in this population is extremely limited, identifying an urgent need for further research.
Primary Author and Speaker: Molly Hamre
Additional Authors and Speakers: Kate Dorrance, Karla Ausderau
PURPOSE: Feeding problems are identified in 80% of children with developmental disabilities. Such problems can occur from biological, psychological, and social components of a developmental disability and interfere with daily life and affect a child’s overall health and well-being. The purpose of this systematic review was to evaluate the efficacy of feeding interventions for children with developmental disabilities and feeding problems.
DESIGN: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) were used to conduct the systematic review and guide the reporting. PRISMA is an evidence-based minimum set of items for reporting systematic reviews according to the PRISMA statement (Moher, Liberati, Tetzlaff, & Altman, 2009). A systematic search of relevant academic databases, including PubMed, CINAHL plus, Web of Science, and OTseeker, was conducted using key words related to child, developmental disabilities, feeding, eating, and intervention. The criteria for study inclusion were children ages 1–12 yr with a developmental disability, a specific feeding intervention evaluated in the study, and at least one study outcome related to food volume or variety. After the initial search, 1,232 articles were identified. The articles were screened by title and then abstract. Forty-nine articles were selected for a full-text review, with 27 articles being included in the final synthesis for the study. The American Occupational Therapy Association’s (AOTA’s) level of evidence criteria were used to assess the methodological quality of the included articles, with all five levels eligible for inclusion.
RESULTS: Using AOTA’s levels of evidence, one article was identified as Level I, one article as Level II, three articles as Level III, and the remaining 22 articles as either Level IV or V. Results were categorized into three types of feeding interventions: parent education, behavioral, and positioning. In addition, results were analyzed by their outcome variables, number of bites and variety of foods accepted. The strong majority of interventions were categorized as behavioral, with escape extinction being the most common with the goal of increasing bite acceptance. Limited evidence was found to support any of the types of feeding intervention for increasing number of bites or food variety in children with developmental disabilities.
CONCLUSION AND IMPACT STATEMENT: Overall, limited evidence was found to support current feeding interventions for children with developmental disabilities when targeting specific outcomes. Although parent education programs and positioning were represented, the current research heavily focuses on behavioral interventions. None of the included studies focused on sensory or motor interventions, even though these are primary barriers to eating for many children with developmental disabilities, or on meaningful eating or mealtime outcomes. In addition, 19 of the studies focused on children with autism spectrum disorder, demonstrating limited research regarding other disabilities such as cerebral palsy or Down syndrome.
There is an urgent need for the development and testing of contextually relevant feeding interventions for children with developmental disabilities due to their high prevalence of feeding problems and significant impact on daily life. Occupational therapists commonly treat children with feeding challenges and are key members of interdisciplinary feeding teams. Occupational therapists need to be aware of the limited strength of the evidence when implementing feeding interventions and consider how to incorporate it into their clinical decision making. We can be advocates for the development of family-centered feeding interventions targeting the needs of a child’s underlying feeding problem as well as addressing more holistic eating and mealtime outcomes.
References
Laud, R. B., Girolami, P. A., Boscoe, J. H., & Gulotta, C. S. (2009). Treatment outcomes for severe feeding problems in children with autism spectrum disorder. Behavior Modification, 33, 520–536. https://doi.org/10.1177/0145445509346729
Manikam, R., & Perman, J. (2000). Pediatric feeding disorders. Journal of Clinical Gastroenterology, 30, 34–46.
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA statement. Annals of Internal Medicine, 151, 264–269. https://doi.org/10.7326/0003-4819-151-4-200908180-00135
Sharp, W. G., Jaquess, D. L., Morton, J. F., & Herzinger, C. V. (2010). Pediatric feeding disorders: A quantitative synthesis of treatment outcomes. Clinical Child and Family Psychology Review, 13, 348–365. https://doi.org/10.1007/s10567-010-0079-7
