児童および青少年の行動

抽象的な

Multiple Case Study to Describe Influencing Factors on Effectiveness of an Interdisciplinary In-Patient Intervention for Feeding Problems in Children

Lianne Remijn, Renée Speyer, Pétri CM Holtus, Jacques van Limbeek and Maria WG Nijhuis - van der Sanden

Abstract In children with chronic feeding problems diagnoses and physical, cognitive and behavioral impairments vary enormous. In addition to these variables, we hypothesize that personal and environmental factors also contribute to the success of intervention for feeding problems. This exploratory study describes the effectiveness and influencing factors of an intensive, multidisciplinary child and parent centered intervention on calorie intake and solid food consumption. The intervention included a behavioral program, oral motor training, parental coaching and dietary support. The children participating in the intervention could be separated into three groups: tube-fed (n=12), selective food refusal by texture (n=6) and unpredictable food refusal (n=11). For each group we present a descriptive representative case study. Outcome measures were calorie intake and amount of solid food consumed. The average duration of the in-patient feeding intervention was 4.3 weeks (SD 1.4 weeks). Three months after discharge, 50% of the children receiving tube feeding had complete oral intake. Children with selective food refusal by texture made small progresses during the intervention but solid food intake had increased at follow-up. Children with unpredictable food refusal increased their oral intake already during the intervention and maintained these gains at home. The intensive interdisciplinary intervention showed increased calorie and oral intake in most children and reduced tube feeding, but was less successful in children with metabolic dysfunction. Recovery time was longest in the tube feeding group but results varied considerably per child. Successful feeding intervention in children needs to take into account a child's underlying physical and behavioral and environmental factors.