Examining Interventions and Effectiveness of Outpatient Pediatric Feeding Therapy

Almost half of all children/infants will experience some sort of feeding difficulty at some point in their lives (Howe & Wang, 2013). Although not all of these children will require skilled therapy intervention, many children with feeding difficulties benefit from feeding therapy services. Feeding becomes a problem when children have adequate nutrition available to them but are physically unable to eat or will not eat. Difficulties range from self-limiting food intake and variety to complete refusal of all foods (Estrem et al., 2017), due to a variety of reasons. Occupational therapists treat pediatric feeding and eating difficulties by utilizing a holistic approach, examining physiological, environmental, psychosocial, and cultural aspects of a child. Common evidence-based interventions include reinforcement-based behavioral interventions (Gosa et al., 2017), relationship-based interventions, parent education and training, oral-motor skill development, and sensory-based interventions. Despite the many evidence-based treatment interventions, there is little research to define what therapists are actually doing in treatment sessions to address feeding difficulties. Interventions that are poorly defined are not able to be studied for effectiveness. The purpose of this study was to examine the perceptions of outpatient pediatric feeding therapists to determine the most common interventions used in the treatment of feeding difficulties and to examine the perceived effectiveness of these interventions in attempt to define the interventions used treating feeding difficulties.

The study used qualitative methodology in a phenomenological tradition to examine the perceptions of therapists who perform feeding therapy in an outpatient setting. Sixteen occupational and speech therapists completed an online structured interview. Participants answered questions an open text box and could expand on answers in additional text boxes provided. Responses were input into a word processing document for analysis. Data were analyzed line by line using open coding to extract major themes from the data. The data were categorized and analyzed a second time to place themes into categories identified in the first coding. A constant comparison method was used to compare data and identify themes. Data were triangulated by three researchers, blinded to one another. A fourth researcher was used to ensure agreement of themes.

Results revealed four themes describing the perceived experience of therapists in the treatment of feeding difficulties in children. Those themes included interventions, relationship, progress, and the child’s emotional state. Interventions identified by therapists were sensory, oral motor, and behavioral interventions. Relationships encompassed the relationship between the therapist and child and family and child and were key to perceived success of interventions. Progress included how the therapists measured and assessed progress of therapy through intake of foods, tolerance, and perceived success. The child’s emotional state was an important component of the treatment process that therapists addressed throughout the intervention.

In summary, the study defines feeding therapy interventions used in addressing a variety of feeding difficulties and provides information as to the considerations of the therapists within feeding therapy that influence their intervention techniques and perceived progress of their clients. Overall, the study provides a foundation for further defining feeding therapy interventions, so they can be studied for effectiveness. It also provides evidence to support the importance of considering the holistic approach, frequently taken by occupational therapists, to address psychosocial components of feeding therapy.

References

Estrem, H. H., Pados, B. F., Park, J., Knafl, K. A., & Thoyre, S. M. (2017). Feeding problems in infancy and early childhood: evolutionary concept analysis. Journal of advanced nursing, 73(1), 56-70.

Gosa, M., & Dodrill, P. (2017). Pediatric Dysphagia Rehabilitation: Considering the Evidence to Support Common Strategies. Perspectives of the ASHA Special Interest Groups, 2(13).

Howe, T. H & Wang, T. N. (2013). Systematic review of interventions used in or relevant to occupational therapy for children with feeding difficulties ages birth-5 years. American Journal of Occupaitonal Therapy, 67(4), 405–412. doi. 10.5014/ajot.2013.004564