Nursing Perspective on

Feeding Evaluation and

Treatment

Cyndi Chapman, APRN,MSN,MHCL

August 2017

Nursing Perspective on Feeding Evaluation and

Treatment

• OBJECTIVES:

• Participant will understand the nursing assessment regarding feeding issues

• Participant will be able to verbalize the nurse’s role in the interdisciplinary

team for feeding plans

• Participant will learn different tools from a nursing perspective for feeding

evaluation.

Nursing Perspective on Feeding Evaluation and

Treatment

• Different stages of newborn/pediatrics

• Prematurity

• Newborn

• Specific diagnosis

• Developmental disabilities

• Infant

• Toddlers

• Adolescents

• Pre teen

• Teenager

Nursing Perspective on Feeding Evaluation and

Treatment

• Prematurity

• Assessment

• Gestational age

• Specific diagnosis

• Breast feeding strengthening

• Feeding readiness

• Feeding cues

Nursing Perspective on Feeding Evaluation and

Treatment

• Feeding Cues

Nursing Perspective on Feeding Evaluation and

Treatment

Nursing Perspective on Feeding Evaluation and

Treatment

• Categories

• Structural Abnormalities-anatomic abnormalities of the structures associated with eating and feeding. Examples: defects associate with Pierre-Robin syndrome, retrognathic jaw, cleft palate, posterior tongue placement, macroglossia, tracheotomy, esophageal strictures or stenosis.

• Neurological conditions- feeding problems associated with central nervous systems insult or musculoskeletal disorders. Example, CP, muscular dystrophies, cranial nerve dysfunctions, mental retardation/develo0pmental disabilities, brain stem injury, pervasive developmental disorders

• Behavioral Issues-feeding difficulties resulting from psychosocial difficulties (poor environmental stimulation, dysfunctional feeder-child interaction), negative feeding behaviors shaped and maintained by internal and/or external reinforcement (selective food refusal, rumination) and/or emotionally based difficulties (phobias, conditioned emotional reactions, depression).

Nursing Perspective on Feeding Evaluation and

Treatment

• Categories, cont.

• Cardiorespiratory Problems-feeding difficulties associated with diseases and

symptoms which compromise the cardiovascular and respiratory systems,

complicating the coordination of sucking, swallowing and breathing during feeding.

Ex tachypnea associated with bronchopulmonary dysplasia

• Metabolic dysfunctions-feeding difficulties associate with metabolic diseases and

syndromes which interfere with the development and/or maintenance of normal

feeding patterns. Ex hereditary fructose intolerance, dumping syndrome.

Nursing Perspective on Feeding Evaluation and

Treatment

• Complex pediatric feeding problems

• Normal development

• Pediatric difficulties either medical or developmental

• 25-35%of normal developing have issues

• 33-80% of development delay

• 50-70% of premature infants born before 36 weeks require significan feeding support

• Biobehavioral conditions

• Need to assess biological aspects

• Need to assess behavioral aspects

• Nonorganic vs organic origins

• Non-disruptive social and environmental emotional antecedents and consequences for feeding

• Organic-structural, neuromuscular,or other physiologic reasons

Nursing Perspective on Feeding Evaluation and

Treatment

• Feeding observations are best done in natural environments*

• Assessments should include:

• Manifestation of problem Thorough medical/developmental history

• Data on growth and weight Emotional climate during meals

• Family Stressors Motor skills, posture and tone

• Antenatal and perinatal history Feeding routines and environments

• Oral motor skills and swallowing Sensory processing

• Feeding routines/environments Child behavior prior to and during meals

• Self-regulation/level of alertness Strategies previously used

Nursing Perspective on Feeding Evaluation and

Treatment

• Quality and timing of oral motor skills

• •Strength

• •Coordination

• •Sensory function

• •Tone

• •Asymmetry

• •Cranial nerve function

• •Motor planning

• •Gag, cough, quality of voice, watery eyes/nose –may be indicators of aspiration

• 6/

Nursing Perspective on Feeding Evaluation and

Treatment

• After Assessment

• Oral Motor Stimulation and Exercise

• Positioning

• Behavioral Strategies

• Medications

• Altered Diets

• Sensory Strategies

• Feeding Tubes

• Vital Stim

Nursing Perspective on Feeding Evaluation and

Treatment

• Team discipline

• Pediatric Gastroenterology

• Nursing

• Nutrition

• Occupational Therapy

• Psychology

• Speech pathology

• Pediatricians

• Case Management

Nursing Perspective on Feeding Evaluation and

Treatment

Nursing Perspective on Feeding Evaluation and

Treatment

• Nursing as a part of the interdisciplinary team

• Assessing family situation

• Assessing current situation

• Assessing patient- age dependent

• Social situation

• Eating is learned, not instinctual

• •History of negative experiences

• •Gastrointestinal issues

• •Neurological problems

Nursing Perspective on Feeding Evaluation and

Treatment

• •Congenital malformation

• •Allergies

• •Cardiac and/or respiratory problems

• •Abnormal muscle tone

• •Disordered child-caregiver relationships

• •KIDS DON’T EAT IF THEY DON’T FEEL WELL

Nursing Perspective on Feeding Evaluation and

Treatment

• Feeding is a science

• Feeding is evidence based

• Studies are done based on everything we talk about

• Physiology plays a part

• Breast feeding

• Textures or something else

• It’s all about the baby/child

Nursing Perspective on Feeding Evaluation and

Treatment

• Persistent problem with eating, feeding, and/or swallowing*

• •Chronic food refusal

• •Feeding tube dependence

• •Food selectivity

• •Poor oral intake

• •Swallowing disorder

• TPN

• Oral Aversion

• Hirschsprungs etc

Nursing Perspective on Feeding Evaluation and

Treatment

• Positioning Infants

Key factors for positioning infants*(fair evidence)

•Positioning should be first intervention

•Overall ‘feeling of flexion”

•Head aligned with trunk, elevated

•Most feed optimally semi-upright, with side-tilt positioning

•May also position in front of you with head/neck supported to

facilitate eye contact

•Swaddling provides additional support

Nursing Perspective on Feeding Evaluation and

Treatment

• Position older children

Key factors for positioning older children***(good evidence)

•Goal –Most function with the least support/restriction

•Stable pelvis in neutral position

•Supported feet!

•Neutral or slightly flexed head

•Arms forward and free to move

Nursing Perspective on Feeding Evaluation and

Treatment

• Babbitt RL, Hoch TA, Coe DA, Cataldo MF, Kelly KJ, Stackhouse C, Perman JA. Behavioral assessment and treatment of pediatric feeding disorders. Developmental and Behavioral Pediatrics 1994;15(4):278-291.

• Troughton KE, Hill AE. Relation between objectively measured feeding competence and nutrition in children with cerebral palsy. Developmental Medicine and Child Neurology 2001;43(3):187-190.

• Sharp W G, Jaquess D L, Morton J F, Herzinger C V. Pediatric feeding disorders: A quantitative synthesis of treatment outcomes. Clinical Child and Family Psychology Review 2010.

• Burklow,KathleenA, Phelps, Anne N, Schultz, Janet R, McConnell, Keith, Rudolph, Colin. Classifying Complex Pediatric Feeding Disorders. Journal of Pediatric Gastroenterology& Nutrition 1998. Volume 27. Issue 2 pp143-147.

• Schwarz,Steven M, Corredor, Julissa, Fisher-Medina,Julie, Cohen, Jennifer and Rabinowitz, Simon. Diagnosis and Treatment of Feeding Disorders in Children with Developmental Disabilities. Pediatrics 2001: 108:671.

• Babbitt, Roberta L, Hoch, Theodore A., Coe, David A., Cataldo, Michael F., Kelly, Kevin J., Stackhouse, Claire, Perman, Jay A. Journal of Developmental and Behavioral Pediatrics. August 1994.

Nursing Perspective on Feeding Evaluation and

Treatment

THANK YOU

Questions??