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Background: Pediatric feeding disorder (PFD) is increasingly common and is often treated by speech language pathologists (SLPs) and occupational therapists (OTs) in the community setting. However, the preparedness of these disciplines to effectively address PFD is relatively unknown., Methods: A national (US), online survey was disseminated to providers who assess and treat PFD. For the present analysis, the responses of SLPs (N = 418) and OTs (N = 195) related to their clinical background, educational background, post-graduate training, and self-rated clinical effectiveness were statistically analyzed and compared across the two disciplines., Results: Both SLPs and OTs report feeling underprepared to work with PFD clients immediately following their academic training, but time spent in post-graduate training and years of clinical practice both significantly (p < 0.0001) increased feelings of effectiveness in assessing and treating PFD. Most SLPs and OTs pursued self-directed learning activities to increase competence, with the most common activities being article review, podcasts, and peer case review, although SLPs were significantly more likely to use podcasts (p < 0.0001) and peer review (p = 0.0004) than OTs. The most common barriers for providers were financial, time, travel, and institutional support barriers., Conclusions: While PFD is a key practice area of both SLPs and OTs, both provider groups feel unprepared and under-supported in providing competent care to these patients upon graduation. Future research and policy should support advancements in training for current SLPs and OTs related to PFD and address current barriers to a specialized educational pathway., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: As diagnoses covering dysfunctional feeding and eating in pediatrics, avoidant/restrictive food intake disorder (ARFID) and pediatric feeding disorder (PFD) contain inherent areas of overlap in their diagnostic criteria. Areas of overlap include criteria regarding nutritional consequences associated with feeding/eating dysfunction and shared emphasis on possible psychosocial impairment associated with restricted food intake. Complicating the differential diagnosis process is a lack of guidance regarding when the two conditions occur independently, co-qualify, and/or transition into the other. Feeding Matters' Research Initiatives Task Force planned and hosted a PFD-ARFID consensus meeting, with the aim of reaching a consensus regarding diagnostic clarity on PFD and ARFID., Method: Criteria for participation focused on US residents who either: (a) served as an author on the ARFID workgroup or PFD consensus papers, or (b) provided community representation via board or committee roles. The consensus process followed three stages: prework, the meeting, and post-work/writing. Twelve participants were present for the meeting, with 14 involved in pre- and post-work/writing., Results: The final panel included four psychologists representing the ARFID community and seven multidisciplinary members representing PFD's four domains (medical, nutrition, skill, and psychosocial) plus a Zero-to-Three community representative and two representatives from Feeding Matters. Results yielded 10 consensus statements and visuals to support the consensus statements., Discussion: The consensus process and results underscore an ongoing need to improve diagnostic systems and reinforce calls for strengthening healthcare expertise for both PFD and ARFID. Community-based participatory research is recommended to advance both diagnoses and reduce ambiguity in practice settings., (© 2024 The Author(s). International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Aim: The aim of this study was to develop an outcome measure for caregivers of children with food allergy., Methods: A community-informed measure development process was utilised to generate a novel parent-reported outcome tool for caregivers of children with food allergy. We conducted focus groups with parents and caregivers of food-allergic (n = 18) children, following which a team of coders identified themes and generated an initial set of candidate items. These items were reviewed by content-area experts (n = 10) using content validity indices. We then conducted a series of cognitive interviews with parents of children with food allergy (n = 12) validating the instrument draft., Results: We describe the results of these development steps as well as future steps to produce the final, validated form of the measure. The resultant 91-item measure is intended for parents of children ages two to 12 years., Conclusion: This measure fills a unique need in the field by leveraging key stakeholders' perspectives to develop and subsequently validate a novel parent-reported measure of parent and family food allergy impacts of children ages two to 12 years old., (© 2024 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Background: Although intensive multidisciplinary interventions (IMIs) provide benefits for patients with pediatric feeding disorders (PFD), access to these programs is limited and challenges faced by the programs remain unclear., Objective: To better understand the barriers faced by existing day programs that provide IMI, disparities in patient care, and areas for improvement to better inform policy and improve access to treatment for PFD., Methods: Semi-structured interviews were conducted with a leader of outpatient programs providing IMI in the United States. Data regarding leader's perspectives on disparities in patient care, barriers faced by the intensive multidisciplinary feeding day programs, and future goals and directions for their programming were collected. Afterward, a qualitative content analysis was conducted to consolidate and categorize information related to patient care, access, and barriers faced by day programs and patients with PFD., Results: Barriers and challenges were identified at the patient, program, and systems levels. Patient-level barriers included familial resources or socioeconomic status, geographic distance from the program site, and difficulty with the time commitment, whereas program-level barriers included limited site personnel and capacity and long wait times. System-level barriers primarily center on insurance, with inconsistent coverage of services and limited payer knowledge about PFD and IMI., Conclusion: IMIs are effective in managing PFD; however, a variety of patient-level, program-level, and systems-level factors serve as barriers for patient access to care and program success. Further research, improved reimbursement, and consensus statements on effective treatments can help improve access to and coverage for care, allowing for the development and sustainability of more programs., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Food allergy (FA) affects around 5.6 million children in the United States, conferring risk for negative impacts on growth and psychosocial functioning. While evidence suggests a higher prevalence of feeding difficulties in children with FA, the link between FA and feeding dysfunction remains unclear., Objective: To investigate feeding problems in children with parent-reported IgE-mediated FA and/or pediatric feeding disorder (PFD) compared with healthy children in a community-based sample and explore factors associated with feeding problems in children with FA., Methods: A matched cross-sectional cohort study used survey data from 352 parents of children aged 6 months to 7 years who reported a diagnosed IgE-mediated FA and/or PFD (50 with FA only, 67 with FA and PFD, and 235 with PFD only). Healthy children were matched based on age, sex, race, and socioeconomic factors. Feeding problems were assessed using the Pediatric Eating Assessment Tool. Matched-pairs generalized linear regressions compared each cohort and explored factors associated with feeding problems in children with FA., Results: Children with FA exhibited significantly higher feeding problems compared with healthy children. Children with a diagnosed PFD had more severe feeding problems, irrespective of comorbid FA. Factors linked with feeding problems in children with FA included older age, non-White race, increased medical comorbidity, and limited dietary variety., Conclusions: This study adds to evidence indicating a higher prevalence of feeding problems in children with FA. Clinicians treating FA patients should routinely screen for feeding and growth concerns and consider referral to multidisciplinary feeding programs as needed., (Copyright © 2024 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Paediatric feeding disorder (PFD) is a common childhood condition, estimated to impact one in 37 American children under the age of five. Such high prevalence occurs against a backdrop of limited understanding of the community treatment landscape in the United States., Method: To better understand the community treatment landscape for PFD in the United States and identify provider and treatment delivery characteristics, we collected primary data through a web-based survey targeting providers from all four PFD domains (i.e., medical, nutritional, feeding skill, and/or psychosocial) between January 2022 and March 2022. The 71-item cross sectional survey focussed on patient, provider and treatment characteristics. We distributed the survey using an electronic survey tool through Feeding Matters listserv followed by solicitation to discipline specific listservs and professional networks. The analytic approach involved descriptive statistics compared across settings and provider types, focussing on respondents within the United States., Results: Eighty-three percent of respondents reported practicing in the United States. Most of the US sample (74.3%) involved providers from the feeding skill domain (speech-language pathologist - SLP, occupational therapist - OT) who reported delivering care through early intervention or outpatient settings using responsive and sensory based approaches. These approaches lack rigorous empirical evaluation., Conclusions: Survey results suggest a need to support community providers in engagement with research activity to promote a better understanding of treatment approaches and outcomes associated with a large cohort of providers delivering care (i.e. SLPs, OTs) to patients with PFD., (© 2023 John Wiley & Sons Ltd.)

Background & Aims: Pediatric feeding disorder (PFD) is defined as impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction. As PFD is prevalent and increasing, so are publications on the topic; however, the research literature is often disparate in terminology used and siloed by discipline. Greater understanding of the current research concerning PFD will help identify areas in need of further study. The purpose of this scoping review is to examine the extent, range, and nature of research activities concerning PFD and to identify gaps in the empirical literature., Methods: Three electronic databases (PubMed/Medline, CINAHL, PsycINFO) were searched using terms related to pediatric feeding disorder, which include, but not limited to, "feeding disorder/problem/difficulty", "avoidant restrictive food intake disorder (ARFID)", "dysphagia", "selective/picky eating", "problematic mealtime behaviors" or "food refusal". The following limits were placed on the search: full text, humans, English, and age limit (up to 18 years old), and publication date (last 10 years). Covidence software was used to facilitate a systematic data management/analysis. Two people in the research team independently reviewed each result (screening titles and abstracts first, then moving to the full texts) to identify studies that met our inclusion/exclusion criteria and conflicts were resolved through a team discussion. Data were charted regarding disciplines of the authors, study purposes, study settings/locations, study methodologies, and study participants. Descriptive statistics and thematic analyses were used to summarize the characteristics of the studies., Results: The initial search resulted in 5354 articles after removing duplicates between the databases. With a final set of articles (n = 415), data charting was completed. The majority of studies were completed by authors from Psychology (n = 171) and Medicine (n = 123). The most studied aims were to examine attributes of feeding problems (n = 168) and/or factors associated with feeding problems (n = 183). Sample size median was 53. A total of 166 of the 415 studies examined the effect of an intervention, treatment, or program, but dose of the intervention was difficult or impossible to report across studies. Feeding was studied as an outcome in 400 out of the 415 studies. A closer accounting of the systematically developed parent-report tools revealed 50 distinct parent report tools used across the subset of studies utilizing parent report outcomes (n = 123)., Conclusions: The results of this scoping review highlight the designs and methods used in research on PFD. This reveals critical gaps in knowledge generation and barriers to intervention replication., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to report., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background and Purpose: Families of children with feeding disorder face significant challenges in supporting their child's feeding, growth, and development. The Feeding Impact Scales were developed to assess how child feeding impacts parent and family., Methods: Items were adapted from an existing scale. Parents of children with feeding difficulty completed the online survey. Item response theory (IRT) analyses were used to evaluate and reduce items. Internal consistency reliability, convergent validity, and readability were tested., Results: IRT analyses ( n = 317) identified 12 items for the Parent Impact and 13 items for the Family Impact. Internal reliability for the scales were acceptable. Convergent validity was supported., Conclusions: The Feeding Impact Scales have evidence of reliability and validity. They can be utilized in practice and research., (© Copyright 2022 Springer Publishing Company, LLC.)

Pediatric feeding problems occur in 25% of the general pediatric population and up to 80% of those who have developmental delays. When feeding problems place the child at nutritional risk, families are typically encouraged to increase their child's intake. Family mealtime can become a battle, which further reinforces problematic feeding behaviors from the child and intensifies well-intentioned but unguided parental mealtime efforts. Family has an essential influence on feeding; however, studies to date neglect to address the family context of feeding difficulty. In this study we describe, in the context of everyday life, family management of feeding when a child had a significant feeding problem. Parents of children with feeding problems were interviewed with the Family Management Style Framework components as a guide. Twelve parents participated, representing nine families of children with feeding disorder. Description of family management of feeding provides a foundation for development of family feeding interventions., (Copyright © 2017 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)

Background: Feeding difficulties are common in infancy. There are currently no valid and reliable parent-report measures to assess bottle-feeding in infants younger than 7 months. The Neonatal Eating Assessment Tool (NeoEAT)-Bottle-feeding has been developed and content validated., Purpose: To determine the factor structure and psychometric properties of the NeoEAT-Bottle-feeding., Methods: Parents of bottle-feeding infants younger than 7 months were invited to participate. Exploratory factor analysis was used to determine factor structure. Internal consistency reliability was tested using Cronbach α. Test-retest reliability was tested between scores on the NeoEAT-Bottle-feeding completed 2 weeks apart. Construct validity was tested using correlations between the NeoEAT-Bottle-feeding, the Infant Gastroesophageal Reflux Questionnaire-Revised (I-GERQ-R), and the Infant Gastrointestinal Symptoms Questionnaire (IGSQ). Known-groups validation was tested by comparing scores between healthy infants and infants with feeding problems., Results: A total of 441 parents participated. Exploratory factor analysis revealed a 64-item scale with 5 factors. Internal consistency reliability (α= .92) and test-retest reliability (r = 0.90; P < .001) were both excellent. The NeoEAT-Bottle-feeding had construct validity with the I-GERQ-R (r = 0.74; P < .001) and IGSQ (r = 0.64; P < .001). Healthy infants scored lower on the NeoEAT-Bottle-feeding than infants with feeding problems (P < .001), supporting known-groups validity., Implications for Practice: The NeoEAT-Bottle-feeding is an available assessment tool for clinical practice., Implications for Research: The NeoEAT-Bottle-feeding is a valid and reliable measure that can now be used in feeding research.Video Abstract Available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.

The purpose of this study was to identify the factor structure of the Neonatal Eating Assessment Tool-Breastfeeding (NeoEAT-Breastfeeding) and to assess its psychometric properties, including internal consistency reliability, test-retest reliability, and construct validity as measured by concurrent and known-groups validity. Exploratory factor analysis conducted on responses from 402 parents of breastfeeding infants younger than 7 months old showed a 62-item measure with seven subscales and acceptable internal consistency reliability (Cronbach's α = .92). Test-retest reliability was also acceptable (r = .91). The NeoEAT-Breastfeeding has evidence of concurrent validity with the Infant Gastroesophageal Reflux Questionnaire (r = .69) and Infant Gastrointestinal Symptoms Questionnaire (r = .62). The NeoEAT-Breastfeeding total score and all subscale scores were higher in infants with feeding problems than in typically feeding infants (p < .001, known-groups validity). The NeoEAT-Breastfeeding is a parent-report assessment of breastfeeding in infants from birth to 7 months old with good initial evidence of reliability and validity., (Copyright © 2018 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

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).

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 MeSH 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., (© 2016 John Wiley & Sons Ltd.)

Infants with hypoplastic left heart syndrome often experience difficulty with oral feeding, which contributes to growth failure, morbidity, and mortality. In response to feeding difficulty, clinicians often change the bottle nipple, and thus milk flow rate. Slow-flow nipples have been found to reduce the stress of feeding in other fragile infants, but no research has evaluated the responses of infants with hypoplastic left heart syndrome to alterations in milk flow. The purpose of this study was to evaluate the physiological and behavioural responses of an infant with hypoplastic left heart syndrome to bottle feeding with either a slow-flow (Dr. Brown's Preemie) or a standard-flow (Dr. Brown's Level 2) nipple. A single infant was studied for three feedings: two slow-flow and one standard-flow. Oral feeding, whether with a slow-flow or a standard-flow nipple, was distressing for this infant. During slow-flow feeding, she experienced more coughing events, whereas during standard-flow she experienced more gagging. Disengagement and compelling disorganisation were most common during feeding 3, that is slow-flow, which occurred 2 days after surgical placement of a gastrostomy tube. Clinically significant changes in heart rate, oxygen saturation, and respiratory rate were seen during all feedings. Heart rate was higher during standard-flow and respiratory rate was higher during slow-flow. Further research is needed to examine the responses of infants with hypoplastic left heart syndrome to oral feeding and to identify strategies that will support these fragile infants as they learn to feed. Future research should evaluate an even slower-flow nipple along with additional supportive feeding strategies.

Purpose: Feeding difficulties in early childhood are common, affecting approximately 25% of typically developing children and up to 80% of children with developmental disabilities. There is no interdisciplinary consensus on the definition of a feeding problem and there is no input from families in the conceptualization. Lack of common language is a barrier to effective communication between clinicians, researchers, and caregivers, and inhibits collaboration. The purpose of this study was to examine the conceptualization of pediatric feeding problems by family caregivers (parents)., Study Design and Methods: This study reports an empirical phase of a concept analysis. Data from interviews with 12 parents of children with feeding problems were coded for related concepts, attributes, antecedents, and consequences of feeding problems, and then analyzed for themes within conceptual categories., Results: Conceptual elements across interviews are presented with an emphasis on shared perspectives. Parents related pediatric feeding problems to be a process or journey on which they found themselves for an unknown duration. Common themes of attributes were problematic feeding behaviors of the child, restrictive or selective intake, and child weight or growth concerns., Clinical Implications: Parents conceptualize feeding problems as a condition with symptoms experienced by the child and family that need to be incorporated into family life. In contrast, prior literature coming from providers' point of view presents this problem to be of the child. Nurses can improve care of families with children who have feeding problems by coordinating interdisciplinary, family-centered care.