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Objectives Previous studies have described the negative impact that tube feeding of children with complex chronic diseases has on the caregivers’ emotions, relationships and daily life. It is unclear whether these negative experiences persist or change during and after the weaning process. We sought to explore mothers’ experiences and perceptions of their child being weaned off tube feeding within a Paediatric Feeding Program (PFP). Methods We conducted a qualitative study using semi-structured interviews with mothers whose children Results We conducted 9 interviews with mothers of children (n = 10) in the PFP at which point data saturation was achieved. Three main themes emerged: a) the initial emotional toll on mothers stemming from fear of perceived adverse consequences of decreasing tube feeds and uncertainty surrounding efficacy of weaning; b) achievement of weaning via a family-centered approach through gaining trust, close contact, and collaboration with the team; and c) attainment of mothers’ expectations of family life through transformed relationships and social activities. A positive evolution of emotions was observed, attributable to the support of the PFP. Conclusions These experiences suggest that our outpatient weaning program had a positive impact on the stress, fear, and relational challenges that mothers reported before and during initial tube weaning. These findings highlight potential areas of discussion with families at multiple stages of the child’s tube feeding experience, to help normalize emotions for families and support coping strategies.

Feeding problems are common, with implications for nutrition, growth and family stress, placing burden on primary care services. The Montreal Children's Hospital Feeding Scale (MCHFS) is a quick and reliable measure of feeding problems for clinical settings, but there is little examination of its relationship to commonly used research measures of parental feeding practice, child eating behaviour and observations of parent-infant interaction at mealtimes. We examined the relationships between the MCHFS, demographics and early feeding history, weight across the first year, parental report of feeding practices and child eating behaviours, and observations of maternal-infant feeding interaction at 1 year. The MCHFS, Comprehensive Feeding Practices Questionnaire (CFPQ) and Child Eating Behaviour Questionnaire (CEBQ) were completed by 69 mothers when their infants were 1-year-old (37 male, 32 female). Infant weight was measured at 1 week, 1 month, 6 months and 1 year. Mothers were observed feeding their infants at 1 year. The MCHFS was reliable (Cronbach's alpha = .90) and showed significant overlap with other measures of feeding and eating. Potential feeding problems were identified in 10 of the children (14%) reflecting similar rates in other community samples. Higher MCHFS scores were associated with lower birthweight and weight across the first year, greater satiety responsiveness, fussiness and slowness in eating, lower enjoyment of food and food responsiveness, and less observed infant food acceptance. Parents of infants with more feeding problems reported less encouragement of balance and variety in their children's diets. Conclusion: MCHFS showed good criterion validity with other parental report measures of eating and observations of mealtime interactions. MCHFS may be a useful tool for researching feeding problems in community samples.

Los problemas de alimentación son muy comunes entre los niños pequeños. El objetivo de esta investigación fue adaptar y validar en Argentina un cuestionario para padres que detecta dificultades en la alimentación. Se analizaron las propiedades psicométricas de la Escala Argentina de Dificultades Alimentarias en Niños (EADAN) en una muestra argentina de 263 niños, entre los 6 meses y los 6 años 11 meses de edad. Existen diferencias significativas entre la media por ítem y del puntaje total en los grupos con dificultades y sin dificultades en la alimentación. La fiabilidad de la escala es buena con un valor α= .79. Se realizó un Análisis Factorial Exploratorio que arrojó dos factores que representan el 49.4% de la varianza. Se compararon los puntajes obtenidos por niños prematuros y nacidos a término. Se concluye acerca de la validez del instrumento para la detección de dificultades en la alimentación en niños argentinos. The objective of this study was to adapt and validate in Argentina a questionnaire for parents that detects feeding difficulties, which are very common among young children. Psychometric properties of the Argentine Scale of Feeding Difficulties in Children (EADAN) were analyzed in an Argentinian sample of 263 children, aged 6 months to 6 years 11 months. There are significant differences between the item mean and the total score mean between the groups with feeding difficulties and without feeding difficulties. The reliability of the scale is good, with an α = .79. An exploratory factor analysis showed two factors that represent 49.4% of the variance. Scores obtained by premature and full-term infants were compared. It is concluded that this instrument is valid for the detection of feeding difficulties in Argentine children. Fil: Hauser, Maria Paulina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Saavedra 15. Centro Interdisciplinario de Investigaciones en Psicología Matemática y Experimental Dr. Horacio J. A. Rimoldi; Argentina Fil: Taborda, Ruth Alejandra. Universidad Nacional de San Luis. Facultad de Psicología; Argentina Fil: Oiberman, Alicia Juana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Saavedra 15. Centro Interdisciplinario de Investigaciones en Psicología Matemática y Experimental Dr. Horacio J. A. Rimoldi; Argentina Fil: Ramsay, María. Hospital de Niños de Montreal; Canadá

The aim of this study was to assess the efficacy and safety of cyproheptadine (CY) use in infants and young children with poor growth treated at our multidisciplinary pediatric feeding program, and to describe changes in their weight and feeding behaviors.A retrospective chart review of children treated with CY from January 2007 to July 2011 was performed. Demographic data, medical diagnosis, adverse effects of the drug, and changes in mealtime behaviors were extracted from the patients' medical records. For each patient who received the CY, weight-for-age z scores (WtZ) were calculated before and during treatment. Repeated-measures mixed model was used to analyze the pattern of change in WtZ over time and between groups. Differences in mean WtZ were tested between patients regularly receiving CY and a naturally conceived comparison group.Of the 127 patients in treatment owing to poor weight gain who received the CY, 82 took the medication regularly as prescribed in combination with our interventional program. For these patients, the majority of the parents (96%) reported a positive change in mealtime and feeding behaviors. A significant improvement in mean WtZ was observed after starting CY when compared with the WtZ before treatment for those patients regularly receiving the medication. This effect was independent of patients' age and/or presence of an underline medical problem. No significant differences in mean WtZ were observed over time within the comparison group.In our experience, the use of CY in combination with a specialized multidisciplinary interventional program is a safe and effective therapy in infants and young children with low appetite and poor growth.

SUMMARY A group of 32 children (20 boys, 12 girls) who weighed less than 1251g at birth and whose gestation was 31 weeks or less was followed-up for a minimum of five years. In all cases the birth weight was appropriate for gestational age. At the age of five years 10 of the children were completely normal, and growth for the whole group was adequate in all dimensions, the mean height, weight and head circumference being at the 40th to 50th percentiles. Recurrent respiratory tract infections occurred in 16 children and accounted for one death. Vision was normal in 24 children, but in two others there was significant retrolental fibroplasia. One child had mild conductive hearing loss associated with chronic otitis media. Speech defects occurred in 13 boys and four girls and were predominantly due to delayed maturation of both receptive and expressive ability. One child had spastic diplegia and another had epileptic attacks, an incidence of 6 per cent of major neurological abnormalities. Minimal brain dysfunction was diagnosed in nine other children, and 16 children had abnormal EEG tracings, mainly diffuse and non-specific. The mean IQ was 88 for the boys and 92 for the girls. Perceptuo-motor difficulties were diagnosed in 10 children, seven of whom were doing poorly in school. RESUME L'amelioration du devenir des petits nouveaux-nes prematures Une etude prospective de 32 nourrissons de poids normal pour le terme, nes prematurement depuis 1959 et avec des poids de naissance inferieurs a 1251g a ete conduite durant un minimum de 5 ans et les resultats ont ete compares a des etudes similaires sur des enfants prematures nes avant 1960. L'etude comprend 20 garcons et 12 filles. Les moyennes de taille, poids et tour de tete se situaient entre le 40eme et le 50eme percentile. Les infections des voies respiratoires inferieures etaient habituelles et ont ete cause d'un deces. Les defauts de langage on ete notes chez 14 garcons et 4 filles. Deux enfants presentaient des troubles neurologiques graves et 9 avaient un Q1 de 80 ou moins; 10 enfants (6 garcons et 4 filles) etaient tout a fait normaux. ZUSAMMENFASSUNG Die verbesserte Prognose fur das kleine Fruhgeborene Die Ergebnisse einer prospektiven Studie uber mindestens funf Jahre an 32 altersentsprechend entwickelten Fruhgeborenen, die nach 1959 mit einem Geburtsgewicht unter 1215g geboren wurden, wurden mit ahnlichen Untersuchungen an Fruhgeborenen, die vor 1960 geboren wurden, verglichen. Die Studie umfasste 20 Jungen und 12 Madchen. Die Mittelwerte fur Gewicht, Grose und Kopfumfang lagen zwischen der 40iger und 50iger Percentile. Infektionen des Respirationstraktes waren haufig und in einem Fall die Todesursache. Bei 14 Jungen und 4 Madchen fand man Sprachstorungen. 2 Madchen hatten schwerwiegende neurologische Symptome und 9 hatten einen IQ von 80 oder darunter. 10 Kinder (6 Jungen und 4 Madchen) waren ganz gesund. RESUMEN Las perspectivas de mejoria en ninos nacidos prematuramente pequenos Se realizo durante un minimo de 5 anos un estudio prospectivo de 32 ninos nacidos antes de termino de acuerdo con la cronologia, desde 1959 y con peso de nacimiento de menos de 1251grs. Los resultados se compararon con estudios similares realizados en ninos nacidos antes de termino con anterioridad a 1960. El estudio comprendio 20 varones y 12 hembras. Los promedios de peso, estatura y perimetro craneano estaban entre los percentiles 40 y 50. Infecciones del tracto respiratorio bajo eran corrientes y ocasionaron una defuncion. Se hallaron defectos de lenguaje en 14 chicos y 4 ninas. Dos ninos tenian anormalidades neurologicas mayores, nueve menores y nueve tenian un CI de 80 o menos. Diez ninos (6 varones y 4 hembras) eran completamente normales.

To standardize and evaluate the psychometric properties of the Thai version of the Montreal Children's Hospital Feeding Scale (MCH-FS).The MCH-FS was translated and the cultural effects of the Thai version (Thai.MCH-FS) were reviewed. Caregivers of 200 children between the age of12 and 48 months were interviewed and completed the Thai.MCH-FS. In addition to demographic information, each child had a physical exam and anthropometric measures were taken. Each child was classified with or without feeding problems by at least two of three pediatricians who were blind to the results of the feeding scale.Internal consistency for reliability was high (Cronbach's alpha at 0.835). The area under the ROC curve was 0.864. With a discrimination score of 40, both sensitivity (72%) and specificity (80.67%) were at acceptable levels. Factor analysis resulted in three factors accounting for 52.3%. Of the 200 children, 150 children were classified with nofeedingproblems and 50 with feeding problems. There were no significant differences in the characteristics of the two groups; however the Thai.MCH-FS scores were significantly different for the two groups.The Thai version of the MCH-FS has been shown to be a valid and reliable short scale for detecting feeding problems in a pediatric care setting.

A critical overview of failure to thrive and feeding disorder is followed by a presentation of the physiology of the feeding process in infants. The relationship between impaired feeding and behavioral and interactional difficulties is explored. A comprehensive assessment and treatment model is illustrated by a case presentation.

Failure to thrive (FTT) is a term used to describe inadequate growth in infants. The immediate cause is undernutrition. Ghrelin is a potent orexigenic hormone that induces a positive energy balance and enhances appetite. There is no information regarding the possible role of ghrelin in infants with FTT. The aim of this study was 2-fold: 1) to examine circulating ghrelin levels in FTT infants, compared with those of normally growing infants; and 2) to evaluate appetitive behaviors in the two groups. Plasma acylated and total ghrelin concentrations were measured in nine FTT and five normally growing infants (age range, 9-18 mo). Appetite was assessed using three novel appetite measures. Both acylated and total ghrelin levels were significantly elevated in FTT infants compared with controls (p = 0.03 or less). Infants with FTT scored significantly lower than control infants on all appetite measures (p = 0.002 or less). Ghrelin levels were inversely related to appetite, weight velocity, weight/length z-scores, and weight z-score. These findings provide the first evidence that infants with FTT have higher circulating ghrelin concentrations but paradoxically lower appetite scores. Increased ghrelin secretion may reflect an adaptive mechanism attempting to increase appetite and preserve energy balance in response to poor nutritional state.

This prospective study examined the relation of neonatal sucking to later feeding, postnatal growth, maternal postpartum depression, and feeding practices. Healthy infants of at least 37 weeks gestational age were recruited. At 1 week of age, a strain-gage device was attached to the infant's cheeks during sucking to identify sucking efficiency. Two-hundred and two infants (100 males, 102 females; mean age 39.6 weeks, SD 1.1 weeks) with efficient sucking and 207 (101 males, 106 females; mean gestational age 39.4 weeks, SD 1.2 weeks) with inefficient sucking were identified. Growth was measured at 2, 6, 10, and 14 months. Mothers completed a feeding questionnaire and the Edinburgh Postnatal Depression Scale at the same testing points. While 18 infants (5%) showed a downward shift in growth, their clinical picture did not present as non-organic failure to thrive (NFTT). Inefficient neonatal sucking did not predict postnatal growth, later feeding difficulties, nor maternal feeding practices, but concurrent inefficient feeding did. Maternal depression did not affect feeding practices, infant feeding abilities, nor growth, suggesting that the importance of maternal postpartum depression in association with feeding may be less than previously assumed. The term NFTT, therefore, merits reexamination and a more focused definition.

Feeding problems occur in 25% to 50% of healthy infants and toddlers, representing a significant issue in the paediatric population (1–3). Although some feeding problems are relatively common and transient in nature, 3% to 10% of children present with more severe forms of feeding problems that, if left untreated, place them at risk for malnutrition, failure to thrive, and behavioural and developmental disturbances (4,5). Although feeding problems tend to be nonmedical in nature, they may well be the result of medical disorders or interventions that interfere with the normal development of feeding skills. Today, most clinicians agree that feeding problems are biopsychosocial in nature (6) because both physiological and psychosocial factors contribute to their initiation and maintenance. The causes of feeding difficulties may be skill based (oral sensory-motor disorders [7–9]) and/or motivation based (inherent or acquired), which is likely to result in poor weight gain (10–12) and influence the willingness to try new food tastes and textures. These physiological factors tend to trigger altered mealtime behaviours and interactions with parents, which subsequently maintain or increase the severity of feeding problems (8,13). A number of standardized psychometric tools have been developed over the past 25 years to assess feeding problems. The earlier tools were observational scales of mother-child interactions during a mealtime (14,15), whereas more recent scales such as the Children’s Eating Behaviour Inventory (CEBI [16]), the Behavioral Pediatrics Feeding Assessment Scale (BPFAS [17]), and the Children’s Eating Behaviour Questionnaire (18) use parental report to assess child mealtime behaviours. The development of both the CEBI and the BPFAS was based on the assumption that both child and parental characteristics contribute to childhood eating and mealtime problems. The CEBI consists of 40 items pertaining to the child and parent behaviours, as well as interactions between family members. For each item, the respondent indicates how often the behaviour occurs on a five-point Likert scale, and whether the item is perceived to be a problem. The scale, applicable to children two to 12 years of age, has good validity and reliability (16). The BPFAS is a 35-item parent report measure of the child’s mealtime behaviours and related parental reactions. The scale includes new items and reworded items from the CEBI. The scale, developed for children nine months to eight years of age, has adequate reliability. More importantly, results of their validity study (19) showed that children with feeding difficulties engage in the same type of feeding behaviours as children in a nonclinical sample, but at an increased frequency. Although these two scales are reliable and valid tools for the assessment of feeding problems, they do not lend themselves to quick identification of these problems. Paediatricians and other clinicians need access to a valid and reliable instrument that can quickly verify parental complaints about their child’s feeding problems; otherwise, parental complaints may go unnoticed (20,21). Therefore, the purpose of our study was to develop and evaluate a one-page, easily administrable feeding scale that could help clinicians identify feeding problems within a couple of minutes in their offices. In addition, given the bilingual nature of the paediatric population in several hospitals in Canada, the development of a bilingual feeding scale was deemed to be desirable.

In this article the authors propose that non-organic failure to thrive (FTT) is a growth failure secondary to feeding-skills disorder, and that this disorder is neurophysiological in origin. The symptoms of feeding-skills disorder were suggestive of an oral sensorimotor impairment which is usually present from birth or early life, but tends to go unrecognized. Data from 38 infants with non-organic and 22 infants with organic FTT demonstrated that early clinical symptoms of feeding impairment, and observed maternal and infant feeding behaviours and interactions, were similar for both groups, suggesting a need to redefine the term 'non-organic'.

Les aspects organiques et developpementaux, en particulier les difficultes d’ordre physiologique associees au comportement alimentaire, devraient etre envisages lorsqu’on evalue des bebes et de tres jeunes enfants qui presentent un refus de s’alimenter. L’auteur en indique les trois principales causes : appetit faible ou fluctuant, problemes lies a la reactivite sensorielle et a la coordination motrice au niveau oral et enfin coordination au niveau du pharynx. Le refus de nourriture et les difficultes interactionnelles au cours du repas doivent etre compris comme les consequences plutot que les causes du probleme alimentaire. Ces difficultes risquent toutefois de faire perdurer le probleme initial si elles ne sont pas traitees. L’illustration qu’en fait l’auteur permet de mieux saisir les enjeux a l’œuvre dans de tels cas. Les interventions suggerees pour faire face a divers problemes d’alimentation dans un cadre de soin primaire visent a aider les parents a normaliser le comportement alimentaire de leur enfant.

50 high-risk infants consecutively selected from the population of a Neonatal Follow-up Clinic were tested using both the Bayley and the Griffiths Scales on the same day by the same psychologist without prior knowledge of the medical history. The mean age at testing was 13.1 mth with a range of 12--15 mth. Scores obtained from the Griffiths Scale were consistently higher than those obtained from either of the Bayley Scales (P less than 0.001). Intercorrelations between the Griffiths and the Bayley test were high at pH 0.01. These results suggest that, although the two tests may be used interchangeably, their numerical scores are not equivalent when administered at this age.

A prospective, randomized, controlled trial was conducted to assess the effects of early physical therapy on infants at risk for neurologic sequelae and to evaluate the impact of such early treatment on the prevention or minimization of future handicaps. A cohort of 134 infants who had received care in two Montreal inborn neonatal intensive care units was identified prospectively. Infants were stratified according to prognosis and birth weight and were randomly assigned to either an experimental or control group. Babies assigned to the experimental group received early physical therapy, whereas those allocated to the control group received conventional follow-up care. Outcome measures were administered by independent evaluators at 12 months and included measures of neurologic status, motor and overall development, and physical growth. No statistically significant differences on any of the measured outcomes at 12 months were found between the experimental and control groups. Infants weighing less than 750 g at birth, regardless of group assignment, consistently demonstrated significant delays in their growth and development when compared with their heavier peers. The early physical therapy program investigated in this study was not efficacious in altering the pattern of motor development in those high-risk infants participating in the trial.

35 sets of developmental scores were obtained on Down syndrome children by administering the Griffiths Mental Developmental Scale and the Bayley Scales of Infant Development in one testing session. The mean age at testing was 14.3 months, with a range of 3–30 months. The developmental scores of the two tests were similar for the 3—7-month-olds, but became significantly different for the 8–30-month-olds, the Griffiths scores being consistently higher. In addition, the Griffiths scores provided more detailed profiles of the developmental status of children with Down syndrome.

The rapid mental changes taking {dace in a 17-year-old female patient suffering from myxoedema psychosis were investigated using the Holt scoring system for measuring primary process from Rorschach responses. As is typical for this condition, treatment with desiccated thyroid resulted in almost immediate improvement. Two examiners independently scored for primary process the three Rorschachs which were administered over a seven-month period. Results indicated satisfactory reliability between the two scorers. The most important finding was a drop in the amount of over-all formal level primary process thinking. This drop in the objective measures of pathological thinking reflected the improvement in the patient's clinical physical and mental state. Thyriod deficiency may precipitate a personality disorder ranging from mild anxiety and depression to the severe schizophrenic-like and manic states characterizing myxoedema psychosis. It is generally agreed that while the metabolic changes associated with myxoedema set off the psychotic reaction, the pattern of this reaction is determined by the preexisting personality structure. In many cases, treatment with desiccated thyroid results in almost immediate improvement. While some authors who describe such cases are impressed by their relative frequency (Berris & Owen, 1965), there are no adequate figures available which note the incidence in the general population or in the psychiatric institution. On the other hand, an estimate has been made that only 10 per cent of patients develop a psychosis when myxoedematous (Hollander et al., 1965). Certainly when a case does appear in the psychiatry department of a general hospital, interest is immediately aroused because of the infrequency with which this condition is diagnosed in such settings and especially because treatment gives us the opportunity to investigate extremely rapid personality changes over a short time span. The development of a scoring system for determining primary process thinking from Rorschach responses (Holt, 1962) provides us with an instrument for objectively measuring such rapid mental changes over a * We wish to express our appreciation to Dr. Robert R. Holt for his critique and helpful ideas, some of which have been incorporated in this article. f Present address: Jewish General Hospital, 3755 Cote St. Catherine Rd., Montreal 26, P.Q.

A cohort of 78 infants weighing less than 1500 g at birth was followed prospectively to determine the impact of birth weight, age of assessment, and skill area on their developmental performance. Five skill areas were tested using the Griffiths Mental Scales of Development at 6, 12, 24, and 36 months of age. Infants were divided into three birth weight groups: less than 750 g, 750-1000 g, and 1001-1500 g. A significant age and skill interaction was found, with the locomotor and eye-hand skills decreasing consistently over time, and the personal-social and hearing and speech skills initially decreasing and then rising from 12 to 36 months. Infants born at less than 1000 g consistently performed more poorly than those born at 1001-1500 g. Explanations for the variation in scores and the implications of these findings to the evaluation of low birth weight infants are discussed.

Twelve infants received hydrocortisone intravenously in the first 24 hours of life as therapy for RDS. They were paired with 12 similar infants who received a lactose placebo. Comparison follow-up studies were done on the two groups for one year and showed no difference in rate of growth or in ultimate size at 1 year of age. Steroid therapy was not associated with an increased rate of infection. Tests for immune competence were normal at one year in both groups. Infants who received the steroid tended to have a slightly increased incidence of gross neurological and electroencephalographic abnormalities. The developmental quotient was normal in both groups although subtests showed a significant lowering of the gross motor development in the study group.

SUMMARY 115 high-risk infants were identified and followed prospectively over the first 24 months of life. All infants underwent neurological assessments at 12 and 24 months and developmental assessments at six and 12 months. Approximately one-quarter of the infants were considered to be ‘neurologically suspicious’ at 12 months of age, of whom slighly more than one-half were deemed normal by 24 months. Children who were classified as being either normal or abnormal at 12 months were highly likely to have their classification confirmed at 24 months. Abnormal and suspicious neurological outcomes at 12 and 24 months were inversely correlated with birthweight and were not affected by the infants being given early physical therapy. Children who were suspicious at 12 months and who either remained suspicious or became abnormal at 24 months had lower personal–social quotients at six and 12 months and lower hearing–speech quotients at 12 months than the suspicious children who became normal. RESUME Reolution des symptomes neurologiques durant les deux premieres annees de vie chez les nourrissons a haut risque Cent quinze nourrissons a haut risque ont ete identifyes et suivis prospectivement durant leurs 24 premiers mois. Tous les nourrissons beneficierent d'une evaluation neurologique a 12 et 24 mois et d'une evaluation du developpement a six et 12 mois. Aproximativement un quart des nourrisson etaient consideres comme ‘neurologiquement suspects’a l'âge de 12 mois et parmi eux, un peu plus de la moitie paraissaient normaux a 24 mois. Les enfants classes normaux ou anormaux a 12 mois avaient toute chance de voir leur classification confirmee. a 24 mois. Les devenirs Neurologiques anormaux ou suspects a 12 et 24 mois etaient inversement correles avec le poids de naissance et le devenir n'etait pas affecte pour les nourrissons ayant beneficie d'une reeducation kinesitherapique. Les enfants suspects a 12 mois restant suspects ou devenant anormaux a 24 mois avaient des quotients socio-personnels plus bas a six et 12 mois et des quotients audio-verbaux plus bas a 12 mois que les enfants suspects devenant ulterieurement normaux.

Summary The main goal of this study was to measure longitudinally change in thought processes and reality testing of a prepsychotic adolescent undergoing psychotherapy. The Holt scoring system for measuring primary process from Rorschach responses was the main measuring instrument. Four Rorschachs were administered over a period of three years. The results of the latter were compared with the clinical ratings of two psychiatrists. While clinical change in response to treatment was slight, there did appear to be a shift from primary to more secondary forms of formal thought processes as determined by the Rorschach.