Mealtime energy intake and feeding behaviour in children who fail to thrive: a population-based case-control study

BACKGROUND: The essential link between energy needs and energy intake is feeding behaviour, yet few studies have directly observed feeding behaviour in children who have failed to thrive. A cohort of 961 term infants was screened to identify children with first year weight gain below the 5th centile in order to examine their feeding behaviour and food intake. METHODS: A nested case-control study was used with direct observation at 13-21 months over two lunchtime meals, one consisting of finger foods and the other of 'spoon foods'. Thirty children who failed to thrive and 57 controls were studied. The video-tapes were coded for feeding behaviour using a behavioural coding inventory which distinguishes between children feeding themselves and responding to being fed by their mother. The main outcome measures were counts of five feeding actions (give, accept, feedself, refuse, reject) and measures of energy intake, the weight of food eaten and meal duration. RESULTS: There were systematic differences in feeding behaviour between meal types, with mothers feeding their child more often at meals comprising spoon foods and children feeding themselves more often at meals comprising finger foods. By weight, more food was consumed at the spoon food meals, but energy intake was no higher, showing that the children compensated for the differing energy yields of the foods. Children who failed to thrive took in less energy than controls, and were less likely to sit in a highchair throughout the meal, but there were no clear differences in other aspects of feeding behaviour. CONCLUSIONS: Food type is an important variable when studying childhood feeding behaviour. Children who fail to thrive take in less energy than controls of the same age, despite there being no major differences in mealtime feeding behaviour.     

The parental experience and perceptions of blenderized tube feeding for children with medical complexity

ObjectivesParents of children with medical complexity are often expected to implement complicated plans of care, such as enteral tube feeding, to support the health of their child. Enteral feeding can have psychosocial implications for the parent, child, and family. Blenderized tube feeding (BTF) refers to the administration of pureed food and drinks through a feeding tube. Little is known regarding parents’ experiences with BTF. Therefore, the purpose of this qualitative study was to understand the lived experience of BTF from the parent’s perspective.MethodsThis qualitative study was a grounded theory analysis utilizing semi-structured interviews of parents who provided at least 50% of their child’s diet through BTF. Participants were recruited using purposive sampling from the Complex Care Program at a tertiary care paediatric centre. Interviews were conducted until thematic saturation was achieved. Themes were identified using constant comparative analysis of transcribed interviews.ResultsParents (n=10) felt that BTF positively affected the experience of tube feeding and enhanced their child’s health and wellbeing. Parents described BTF as a means of self-empowerment and a mechanism to normalize feeding and care for the entire family. Despite reporting BTF as more time consuming than formula feeding, all parents were satisfied with having made the change, and planned on continuing the diet.ConclusionBTFs can improve the experience of tube feeding and positively address some of the negative psychosocial implications of enteral tube feeding, providing a sense of normalcy and control for parents caring for a child with medical complexity.     

Cognitive development of children in poverty with failure to thrive: a prospective study through age 6

BACKGROUND: This study examined the cognitive development of children in poverty with normal growth and those with a history of failure to thrive (FTT) prospectively from infancy through age 6. METHOD: Participants were 226 low-income infants with normal birthweight and no perinatal complications, congenital problems, or chronic illnesses. One hundred and twenty-eight children experienced FTT and were treated in an interdisciplinary clinic, and 98 had normal growth. RESULTS: Cognitive development declined in both groups to 1.0-1.5 SD below the norm. Children with FTT had lower cognitive scores than children with adequate growth through age 4, followed by recovery. By ages 5 and 6, there were no differences in cognitive scores based on the children's growth history. Using hierarchical linear modeling, child-centered home environment and small family size were related to better cognitive performance. CONCLUSIONS: The low scores of both groups point to the need for programs promoting a child-centered home environment.     

Feeding problems,growth and nutritional status in children with cerebral palsy

Aim: The aim was to estimate the prevalence of feeding and nutritional problems in children with cerebral palsy (CP) in Norway. Methods: Data were abstracted from the Norwegian CP Register for 661 (368 boys) children born 1996–2003 (mean age 6 years 7 months; SD: 1.5). For children born from 1999 to 2003, weight and height were available. Body mass index (BMI) (kg/m²) was used to assess nutritional status. Results: One hundred and thirty‐two (21%) children with CP were completely dependent on assistance during feeding. The prevalence of gastrostomy tube feeding was 14%. Longer duration of gastrostomy tube feeding was associated with higher weight and BMI, but not with height. Only 63% of the children with CP had normal BMI, 7% had grade 3 thinness, while the prevalence of overweight and obesity in our study was 16%. In all, 20% of the children had mean z‐scores for weight and/or height below – 2 SD. Conclusion: Feeding problems in children with CP were common and associated with poor linear growth. A high proportion of the children were undernourished. Moreover, our results suggest that gastrostomy tube feeding may have been introduced too late in some children.     

Atresia of the submandibular duct orifices: an unusual cause of feeding problems and failure to thrive in an infant

Atresia of the submandibular duct orifice is a rare developmental anomaly, which causes swelling of the duct by accumulation of saliva. The cystic mass in the floor of the mouth can cause feeding problems, which can be treated by surgical opening of the duct. We report the first Swedish case in a male infant, who had severe difficulties to feed because of bilateral swellings of the submandibular ducts caused by orifice atresia. Conclusion:  This is the first case that has described failure to thrive because of this condition and catch up after treatment. It is important to remember that evaluation of feeding problem in an infant must include inspection of the oral cavity.     

The Montreal Children's Hospital Feeding Scale: A brief bilingual screening tool for identifying feeding problems

OBJECTIVE:

To establish the psychometric characteristics of a newly developed, brief bilingual 14-item parent report tool (The Montreal Children’s Hospital Feeding Scale [MCH-Feeding Scale]) designed to identify feeding problems in children six months to six years of age.

METHODS:

To establish construct validity, 198 mothers of children visiting community paediatrician’s offices (normative sample) and 174 mothers of children referred to a feeding clinic (clinical sample) completed the scale. Test-retest reliability was obtained by the re-administration of the MCH-Feeding Scale to 25 children in each sample.

RESULTS:

Excellent construct validity was confirmed when the mean [± SD] scores of the normative and clinical samples were compared (32.65±12.73 versus 60.48±13.04, respectively; P<0.01). Test-retest reliabilities were high for both groups (normative r=0.845, clinical r=0.92).

CONCLUSION:

The MCH-Feeding Scale can be used by paediatricians and other health care professionals for quick identification of feeding problems.     

Pros and cons of gastrostomy feeding in children with cerebral palsy

At least a third of children with moderate to severe cerebral palsy (CP) will have feeding difficulties. Malnutrition should not be considered normal in children with CP. Early, persistent, and severe feeding difficulties are a marker for subsequent poor growth and developmental outcomes. Growth patterns in children with cerebral palsy are associated with their overall health and social participation. Growth restriction increases progressively with age and thus mandates early nutritional intervention. In children with severe CP such nutritional intervention is increasingly being administered by gastrostomy feeding tube but controversy surrounds the evidence-base for this approach. Moreover, mothers' decisions about gastrostomy feeding are complex and difficult and must be taken into account in making therapeutic recommendations. This paper discusses the available research evidence and psychosocial issues around gastrostomy feeding in children with severe CP. It seeks to provide a basis for rational clinical decision-making based upon the integration of the best available research evidence with clinical experience and patient values.     

Development of perception in action in healthy and at-risk children

Devising effective assessment techniques and therapy for movement disorders in young children requires in-depth measures of the child's perceptuo-motor functioning. It is argued that the field of movement disorders can benefit from an ecological approach to perception and action, where perception subserves action and action influences perception. Three notions central to the ecological approach are described and illustrated with our recent research on infant and child perceptual and motor behaviour.     

Cognitive and Educational Attainments at School Age of Children Who Failed to Thrive in Infancy: A Population-based Study

A 1-year cohort of children born at term in Newcastle-upon-Tyne in 1987/8 was screened for failure to thrive in infancy using a conditional longitudinal standard which identified those whose weight gain was in the lowest 5%. A group of 136 cases and 136 controls (from the same GP practice and living in a neighbourhood with the same deprivation index) was followed up at 7-9 years of age, when 79% of cases and 87% of controls were successfully studied. Cases at 7-9 were significantly shorter (mean 126.0 cm, SD 5.6) than controls (mean 130.7 cm, SD 5.9); adjusted for parental heights a difference of 4.4 cm (95% CI 2.92 to 5.90 cm) remained. They had smaller head circumferences (mean 51.9 cm, SD 1.8) than controls (mean 52.8 cm, SD 1.7), were significantly lighter (medians 23.8 kg, IR 21.5 to 26.9 in cases, and 27.9 kg, IR 25.2 to 31.6 in controls) and had a lower body mass index (median 14.9, IR 14.1 to 16.0 in cases, and 16.3, IR 15.3 to 17.8 in controls). Despite these large growth differences, no statistically significant differences in cognitive outcomes were found. Mean IQ was 87.6 (SD 17.4) in cases and 90.6 (SD 17.1) in controls; after adjustment for organic cause and mother's IQ the mean difference was 1.7 IQ points (95% CI -5.2 to 1.9). There were no statistically significant differences in the reading, spelling, or reading comprehension scores; the mean standardised reading score was 93.5 (SD 16.2) for cases and 94.5 (SD 15.6) for controls. These results show that when carefully defined by velocity-based anthropometric criteria, nonorganic failure to thrive in infancy is followed by persisting stunting and wasting, and a reduced head circumference, but is not associated with cognitive or educational disadvantages at school age.     

Benefits of hippotherapy in children with cerebral palsy: A narrative review

Children with cerebral palsy display disorders in pelvic movement and require effective rehabilitation. There is evidence to support the hippotherapy due to improvements in balance. The aim of this narrative review was to summarise the grades of recommendation regarding the benefits of hippotherapy in children with cerebral palsy.

A comparison of infant and toddler feeding practices of mothers with and without histories of eating disorders

This preliminary study surveyed the feeding practices of mothers with eating disorder histories through evaluation of mothers' reported feeding styles, child diet composition and restrictive special approaches to feeding. For this non‐randomised cohort study, 25 mothers with eating disorder histories and 25 mothers with no history of an eating disorder with children ages 6–36 months were selected such that the groups were similar based on child age group and child sex. Mothers were compared on self‐reported feeding style using the Infant Feeding Styles Questionnaire and on child diet composition and special feeding approaches using a modified version of the Toddler Diet Questionnaire from the Women, Infants, and Children program. Mothers with eating disorder histories scored lower on the restrictive feeding style subscale than controls. No significant differences were detected between groups in child diet including the percentage of mothers who breastfed, duration of breastfeeding, age at solid food introduction, daily number of meals or snacks or daily frequency of consumption of fruits, vegetables or protein foods. Mothers with eating disorder histories were more likely to report taking a restrictive special approach to feeding such as limiting processed foods or feeding organic foods only. Although mothers with eating disorder histories may not differ greatly from control mothers in terms of child diet composition (smaller effects may not have been detected due to limited sample size), they may be more likely to take restrictive special approaches to feeding which mirror dietary rules common in individuals with eating disorders.     

Quality of life and functional outcome in early school-aged children after neonatal stroke: A prospective cohort study

BackgroundQuality of life (QoL) is recognized internationally as an efficient tool for evaluating health interventions. To our knowledge, QoL has not been specifically assessed in children after neonatal arterial ischemic stroke (AIS).AimTo study the QoL of early school-aged children who suffered from neonatal AIS, and QoL correlation to functional outcome.MethodWe conducted a multicenter prospective cohort study as part of a larger study in full-term newborns with symptomatic AIS. Participating families were sent anonymous QoL questionnaires (QUALIN). Functional outcome was measured using the Wee-FIM scale. Healthy controls in the same age range were recruited in public schools. Their primary caregivers filled in the QUALIN questionnaires anonymously. We used Student's t-test and a rank test to compare patients and controls' QoL and functional outcomes.Results84 children with neonatal AIS were included. The control group was composed of 74 children, of which ten were later excluded due to chronic conditions. Mean ages and QUALIN median scores did not differ between patients and controls. Median Wee-FIM scores were lower in hemiplegic children than in non-hemiplegic ones (p < 0.001). QoL scores did not seem correlated to functional outcome.InterpretationThose results could support the presence of a “disability paradox” in young children following neonatal AIS.     

A型肉毒毒素注射治疗9~36月龄脑瘫患儿腓肠肌痉挛的前瞻性研究

目的探讨A型肉毒毒素(BTX-A)注射对9~36月龄脑瘫患儿下肢腓肠肌痉挛的长期临床疗效及不良反应。方法选择9~36月龄腓肠肌痉挛脑瘫患儿80例,随机分为BTX-A注射组和常规治疗组,每组40例。BTX-A注射组在彩色多普勒超声仪引导下行BTX-A注射,注射后给予4疗程常规康复训练;常规治疗组仅给予4疗程相同常规康复训练。治疗前及治疗后1、2、3、6个月采用改良Tardieu量表(MTS)评定腓肠肌痉挛程度,采用表面肌电图(s EMG)被动状态数值评估肌张力,采用粗大运动功能测试(GMFM)评价粗大运动功能。结果在降低MTS评分和s EMG被动状态数值方面,BTX-A注射组优于常规治疗组(P0.05);在增大MTS踝关节角度R1、R2和提高大运动GMFM评分方面,BTX-A注射组优于常规治疗组(P0.05)。未见严重的BTX-A注射相关不良反应。结论 BTX-A注射治疗9~36月龄脑瘫患儿腓肠肌痉挛是有效和安全的。     

Understanding the relationship between brain and upper limb function in children with unilateral motor impairments: A multimodal approach

Atypical brain development and early brain injury have profound and long lasting impact on the development, skill acquisition, and subsequent independence of a child. Heterogeneity is present at the brain level and at the motor level; particularly with respect to phenomena of bilateral activation and mirrored movements (MMs). In this multiple case study we consider the feasibility of using several modalities to explore the relationship between brain structure and/or activity and hand function: Electroencephalography (EEG), both structural and functional Magnetic Resonance Imaging (sMRI, fMRI), diffusion tensor imaging (DTI), transcranial magnetic stimulation (TMS), Electromyography (EMG) and hand function assessments.

Sleep quality and respiratory function in children with severe cerebral palsy using night-time postural equipment: a pilot study

Background:  Night-time postural equipment (NTPE) prevents contractures and hip subluxation in children with severe physical disabilities. However, impact on sleep quality and respiratory function has not been objectively studied.
Methods:  Ten children with severe cerebral palsy (CP), mean age of 10.9 (range: 5.3–16.7) years, were recruited from a community population. Polysomnography was undertaken on two nights, once with the child sleeping in their NTPE and once sleeping unsupported. Randomization to first night condition controlled for first night effects.
Results:  Night-time postural equipment use was associated with higher mean overnight oxygen saturation for three children but lower values for six children compared with sleeping unsupported. There were no differences in sleep quality between the conditions. The study group had lower overnight oxyhaemoglobin saturation values, less rapid eye movement (REM) sleep and higher arousal indices compared with typically developing children.
Conclusion:  This pilot study indicated that children with severe CP risk respiratory compromise in sleep irrespective of positioning. Further study will determine if the observed trend for mean overnight oxygen saturation to be lower within positioning equipment reflects random night-to-night variation or is related to equipment use. We suggest that respiratory function is assessed when determining optimal positioning for children using night-time positioning equipment.     

Long-term use of botulinum toxin type A in children with cerebral palsy: Treatment consistency

At the University Hospital of Pellenberg (Belgium), more than 1000 patients have been treated with Botulinum toxin type A (BTX-A) over the last decade. Ten percent of these patients (n = 106) received multiple (at least four times), multi-level, high-dosage treatments. The aim of this study was to evaluate the stability of dosage and treatment intervals in long-term, multi-level, high-dosage treated children with cerebral palsy and to evaluate the evidence for a safe and stable response to this treatment. Data on disease, age, dosage and target muscles were extracted for each treatment session of 106 patients who received multiple BTX-A treatment sessions. Patients had a follow-up of 4 y 6 mo (range 1 y 8 mo–8 y 9 mo) on average and received 4 to 12 BTX-A treatments within the period of January 1996 and December 2005. Patients received a mean dosage of 23.5 ± 5.2 U/kg bw at first treatment with stable subsequent values. Mean dosages for children with diplegia, hemiplegia and quadriplegia were 24.5 ± 4.7 U/kg bw, 15.9 ± 3.7 U/kg bw and 22.0 ± 4.8 U/kg bw, respectively. Mean age at first treatment was 4 y 6 mo (range 1 y 11 mo–18 y 10 mo) with a majority of patients (76.4%) first treated within 2 and 4 y of age. Treatment intervals of approximately 1 y remained stable within four, five and six subsequent treatments. Long-term, high-dosage, multi-level BTX-A applications can be considered as a safe and stable treatment option for children with cerebral palsy and the formation of antibodies, responsible for secondary non-response, can be indirectly precluded.