Search

Purpose: The aim of this study was to evaluate the bottle nipple flow rate of liquid barium sulfate of three different International Dysphagia Diet Standardisation Initiative (IDDSI) thicknesses (i.e., thin, slightly thick, and mildly thick) and compare flow rates of infant formula thickened with Gelmix or oatmeal cereal to comparable thicknesses. Method: Liquid preparations were IDDSI flow tested to determine thickness. Nipple flow rate testing was conducted using 50 ml of liquid in a 4-oz Dr. Brown's bottle with the venting system in place. Liquid was extracted using a breast pump. The weight of liquid extracted was converted to flow in milliliters per minute using the density of the liquid in grams per milliliter. Results: Across nipple types and liquid thicknesses, the flow rate through the bottle nipple with formula was faster than with barium of the same thickness. Thickening with oatmeal cereal resulted in clogging of the nipple. Pulverizing the oatmeal did not improve clogging but did impact caloric density of the formula. Conclusions: Bottle nipple flow rates of liquid barium sulfate are not consistent with flow rates of thin infant formula or formula thickened with Gelmix to the same IDDSI thickness. These findings may impact the safety of oral feeding for some infants. Parents and clinicians need to be aware of clogging with oatmeal cereal as a factor that could contribute to variability in flow as well as difficulty extracting fluid for nutrition. [ABSTRACT FROM AUTHOR]

Treatment of tongue-tie in infants suggests improvements for breastfeeding mothers, including reduced nipple pain and improved latching onto the breast. The effects of frenotomy on infant feeding and gastrointestinal dysfunction remain controversial, with insufficient evidence on the relationship between tongue-tie and disorders of the gastrointestinal tract. The purpose of this study was to compare symptoms of gastrointestinal (GI) distress and gastroesophageal reflux (GER) prior to and 2 weeks following frenotomy in infants with tongue-tie. Parents were surveyed prior to frenotomy and 2 weeks post procedure, using the Gastrointestinal and Gastroesophageal Reflux (GIGER) Scale for Infants and Toddlers. Eighty-four participants completed surveys at both time points, with significant improvements in GI and GER symptoms 2 weeks after frenotomy. Younger infants and those with more severe tongue-tie had the greatest improvements in GI and GER symptoms. Infants with tongue-tie and symptoms of GI tract distress may experience improvement in symptoms after frenotomy. [ABSTRACT FROM AUTHOR]

Objectives: Reflux is common in infancy; however, persistent signs and symptoms of gastrointestinal distress are often attributed to gastroesophageal reflux disease (GERD). In this pilot study, we aimed to characterize associations between signs and symptoms of suspected GERD and noninvasive markers of intestinal inflammation in preterm infants. Methods: We reviewed Electronic Medical Record (EMR) data to identify clinical signs and symptoms among case patients (n = 16). Controls (n = 16) were matched on gestational age. Univariate and multivariate regression analyses were used to compare fecal calprotectin and urinary intestinal fatty acid binding protein (I-FABP) levels between cases and controls. Results: We found no differences in baseline characteristics between cases and controls. In the multivariate regression analysis controlling for the proportion of mother's milk, cases had higher fecal calprotectin levels than controls, with no differences in I-FABP levels between cases and controls. Conclusion: Our findings suggest that preterm infants with signs and symptoms of GERD have higher levels of intestinal inflammation as indicated by fecal calprotectin compared to their controls. Further studies are needed to evaluate the role of intestinal inflammation in signs and symptoms of gastrointestinal distress and whether fecal calprotectin might have predictive value in diagnosing GERD. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the effect of infant formula type and preparation (i.e., ready-to-feed vs. powder) on International Dysphagia Diet Standardisation Initiative (IDDSI) thickness level and milk flow rates from bottle teats/nipples. Method: The ready-to-feed and powder formulations of the following products were tested for IDDSI thickness level, using IDDSI guidelines, and for milk flow rate, using established flow testing methods: Similac Advance, Similac For Spit-Up, Enfamil Infant, and Enfamil A.R. Analysis of variance was used to compare flow rates among formula types/preparations. Results: Enfamil A.R. ready-to-feed was classified as IDDSI “slightly thick.” All other formula types/preparations were found to be IDDSI “thin” liquids. The standard infant formulas (Similac Advance and Enfamil Infant) had comparable flow rates to each other, regardless of preparation (ready-to-feed and powder). The gastroesophageal reflux–specific formulas (Similac For Spit-Up and Enfamil A.R.) had slower flow rates than the standard formulas; within this category, there were significant differences in flow rates between ready-to-feed and powder. Enfamil A.R. powder had the slowest flow rate, but was the most variable. Conclusion: For infants with difficulty coordinating sucking, swallowing, and breathing, clinicians and parents should consider the impact that changes to infant formula type and preparation may have on the infant’s ability to safely feed. [ABSTRACT FROM AUTHOR]

Aim: The aims of this systematic review were to first identify and summarise original research that compared symptoms of problematic feeding in infants with tongue tie before and after frenotomy and then evaluate the quality of measures used to assess problematic feeding. Methods: CINAHL and PubMed were searched for ((tongue‐tie) or (ankyloglossia)) and ((feeding) or (breastfeeding) or (bottle‐feeding)) and ((frenotomy) or (frenectomy) or (frenulectomy) or (frenulotomy)). Original research reporting on feeding before and after frenotomy in infants under 1 year old was included. Results: Maternal nipple pain, breastfeeding self‐efficacy and LATCH scores improved after frenotomy. Few data are available on the effect of frenotomy on infant feeding. The measures used to assess infant feeding were not comprehensive and did not possess strong psychometric properties. Conclusion: Literature suggests that maternal nipple pain, self‐efficacy and LATCH scores improve in breastfeeding mother‐infant dyads after frenotomy. However, current literature does not provide adequate data regarding the effect of frenotomy on the infant's ability to feed or which infants benefit from the procedure. Future research should utilise comprehensive, psychometrically sound measures to assess infants for tongue tie and to evaluate infant feeding to provide stronger evidence for the effect of frenotomy on feeding in infants with tongue tie. [ABSTRACT FROM AUTHOR]

This article describes the development and content validation of the Child Oral and Motor Proficiency Scale (ChOMPS), a parent-report assessment of eating, drinking, and related skills in children 6 months to 7 years of age. Initially, 69 items for the ChOMPS were generated from literature review. Nineteen professionals evaluated the ChOMPS using content validity indices (CVI). Significant revisions were made to items and directions based on professional feedback. CVI were acceptable for both the relevance and clarity of items. Cognitive interviews were then conducted with 19 parents to explore parent understanding of items. Additional revisions were made based on parent feedback. The reading grade level of the resulting ChOMPS was less than sixth grade. The 70-item ChOMPS has evidence of content validity, indicating the items are relevant and clear to professionals, and parents understand the directions and items as intended. [ABSTRACT FROM AUTHOR]

Purpose: to develop and content validate the neonatal eating Assessment tool (neoEAT), a parent-report measure of infant feeding. Design: the neoeAt was developed in three phases. phase 1: items were generated from a literature review, available assessment tools, and parents' descriptions of problematic feeding in infants. phase 2: professionals rated items for relevance and clarity. content validity indices were calculated. phase 3: parent understanding was explored through cognitive interviews. Sample: phase 1: descriptions of infant feeding were obtained from 12 parents of children with diagnosed feeding problems and 29 parents of infants younger than seven months. phase 2: nine professionals rated items. phase 3: sixteen parents of infants younger than seven months completed the cognitive interview. Main Outcome Variable: content validity of the neoEAT. Results: three versions were developed: neoEAT Breastfeeding (72 items), neoEAT Bottle Feeding (74 items), and neoEAT Breastfeeding and Bottle Feeding (89 items). [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to report an analysis of the concept of pediatric feeding problems. Background Reviews of the literature on pediatric feeding problems and disorders repeatedly reference the lack of a shared conceptualization of feeding problems. It is difficult to track aetiology, prevalence and incidence of a phenomenon when available definitions and diagnoses lack practical utility. Design An evolutionary concept analysis. Data sources A search was conducted in October 2014 of Google Scholar, CINAHL, PubMed and Web of Science databases, with Me SH terms and key words including: failure to thrive, feeding disorder/difficulty/problems, infantile anorexia, oral aversion, mealtime behaviour and dysphagia. Inclusion criteria were: subject of feeding problems, index children 0-10 years of age, English language and full text. Methods The articles ( n = 266) were sorted into disciplines of authorship, including Psychology, Medicine, Nursing, Nutrition, Occupational Therapy, Speech Language Pathology or Other. The sample was divided into a historical sample ( n = 42) for pre-2000 articles and current for those published post-2000. The current sample was later reduced to 100 and coded for surrogate terms, related concepts, attributes, antecedents and consequences. Results The historical view of pediatric feeding problems shows a tradition of mother blame or parental culpability, both direct and indirect. Currently, there exist many different definitions and typologies, but none have sound validity or generalizability. Areas of attribute consensus across disciplines are problematic feeding behaviours and selective or restrictive intake. Conclusion A spectrum conceptualization of feeding problems is suggested for further development, with attributes that would be critical to have a feeding problem. [ABSTRACT FROM AUTHOR]

Purpose: This study tested the milk flow rates and variability in flow of currently available nipples used for bottle-feeding infants who are hospitalized. Method: Clinicians in 3 countries were surveyed regarding nipples available to them for feeding infants who are hospitalized. Twenty-nine nipple types were identified, and 10 nipples of each type were tested by measuring the amount of infant formula expressed in 1 min using a breast pump. Mean milk flow rate (mL/min) and coefficient of variation were used to compare nipples within brand and within category (i.e., Slow, Standard, Premature). Results: Flow rates varied widely between nipples, ranging from 2.10 mL/min for the Enfamil Cross-Cut to 85.34 mL/min for the Dr. Brown’s Y-Cut Standard Neck. Variability of flow rates among nipples of the same type ranged from a coefficient of variation of 0.05 for Dr. Brown’s Level 1 Standard- and Wide-Neck to 0.42 for the Enfamil CrossCut. Mean coefficient of variation by brand ranged from 0.08 for Dr. Brown’s to 0.36 for Bionix. Conclusions: Milk flow is an easily manipulated variable that may contribute to the degree of physiologic instability experienced by infants who are medically fragile during oral feeding. This study provides clinicians with information to guide appropriate selection of bottle nipples for feeding infants who are hospitalized [ABSTRACT FROM AUTHOR]

Purpose: In this article, the authors describe the development and content validation of a parent-report measure of problematic eating behaviors: the Pediatric Eating Assessment Tool (Pedi-EAT). Method: In Phase I, items were generated from parents' descriptions of problematic feeding behaviors of children, review of literature, and review of existing eating-related instruments. In Phase II, interdisciplinary experts on pediatric eating behaviors rated the items for clarity and relevance using content validity indices (CVI) and provided feedback on the comprehensiveness of the instrument. In Phases III and IV, 2 groups of parents of children with and without feeding difficulties participated in cognitive interviews to gain respondent feedback on content, format, and item interpretation. The authors analyzed interviews using matrix display strategies. Results: Experts rated the total scale CVI > .90 for both relevance and clarity; item CVI ranged from .67 to 1.0 for relevance and .5 to 1.0 for clarity. Analysis of each item with low scores, along with experts' and parents' feedback, resulted in refinement of the items, scoring options, and directions. Experts and parents added additional items. Readability after refinements was acceptable at less than a 5th-grade level. Conclusion: The Pedi-EAT was systematically developed and content validated with input from researchers, clinicians, and parents. [ABSTRACT FROM AUTHOR]

Purpose: In this article, the authors describe the development and content validation of a parent-report measure of problematic eating behaviors: the Pediatric Eating Assessment Tool (Pedi-EAT). Method: In Phase I, items were generated from parents' descriptions of problematic feeding behaviors of children, review of literature, and review of existing eating-related instruments. In Phase II, interdisciplinary experts on pediatric eating behaviors rated the items for clarity and relevance using content validity indices (CVI) and provided feedback on the comprehensiveness of the instrument. In Phases III and IV, 2 groups of parents of children with and without feeding difficulties participated in cognitive interviews to gain respondent feedback on content, format, and item interpretation. The authors analyzed interviews using matrix display strategies. Results: Experts rated the total scale CVI > .90 for both relevance and clarity; item CVI ranged from .67 to 1.0 for relevance and .5 to 1.0 for clarity. Analysis of each item with low scores, along with experts' and parents' feedback, resulted in refinement of the items, scoring options, and directions. Experts and parents added additional items. Readability after refinements was acceptable at less than a 5th-grade level. Conclusion: The Pedi-EAT was systematically developed and content validated with input from researchers, clinicians, and parents. [ABSTRACT FROM AUTHOR]