Feeding Matters launched its small grants program in 2019 to support the growing need for research on Pediatric Feeding Disorder (PFD). The initiative was led by the Granting Research Committee as a part of Feeding Matters’ Pediatric Feeding Disorder Alliance. The committee’s goal was to advance the PFD field by granting funds to researchers who proposed studies that fill the gaps in PFD research. The committee is delighted to support researchers Paula Rabaey, Ph.D., OTR/L and Kate Barlow, OTD, OTR/L on their project. Their study seeks to address two specific research questions: (1) To what extent do current assessments by feeding clinicians address the four domains of PFD? (Medical, Nutritional, Feeding Skills, and Psychosocial Factors). (2) What are feeding clinicians’ perceptions of current assessment tools used in evaluation and treatment of PFD?

Researcher Bios

Paula Rabaey, Ph.D., is an Assistant Professor at St. Catherine University in St. Paul, MN.  She has 25+ years clinical experience in pediatric occupational therapy including early intervention and feeding, eating, and swallowing.  She is a feeding technical expert for SPOON Foundation (http://www.spoonfoundation.org/) and has developed curriculum to train caregivers in orphanages around the world in safely feeding children with disabilities. She recently presented in Tula, Russia on feeding strategies and at the 2^nd Annual OT conference in Morocco on pediatric feeding in January 2020.

Kate Barlow, OTD is an Assistant Professor of occupational therapy at American International College and a feeding consultant for THOM early intervention. She is also the current ambassador for the CDC’s Learn the Signs. Act Early. Program for the state of Massachusetts. She has over 20 years of clinical practice and her area of expertise is feeding, eating and swallowing.

Background

The high incidence of pediatric feeding problems is well documented, with a prevalence as high as 25% in typically developing children, 70% in pre-mature children, 80% in children with developmental disabilities (Korth & Rendell, 2015), and over 90% in children with cerebral palsy (Ju Ko, et al., 2011). With the movement to classify the range of feeding problems in the pediatric population into a unifying term “Pediatric Feeding Disorder” (PFD), there is a need for standard guidelines to choose the most appropriate assessment tool(s) that aligns with the four domains of PFD including: medical, nutritional, feeding skills, and psychosocial factors (Goday, 2019). There are many available non-instrumental assessment tools for clinicians to use; however many of the commonly used assessments are site-specific evaluations and parent questionnaires, such as the Sensory Profile and the PediEat. An issue faced by clinicians, is that the objective standardized assessments that are valid and reliable are lacking in the area of pediatric feeding and swallowing (Barton, Bickell & Fucile, 2018; Heckathorn, Speyer, Taylor & Cordier, 2016; Speyer, Cordier, Parsons, Denman & Kim, 2018). A recent systematic review on the psychometric characteristics of 10 non-instrumental pediatric feeding and swallowing assessments found missing, incomplete or conflicting psychometric data for all reviewed (Speyer, Cordier, Parsons, Denman & Kim, 2018). These assessments also were very specific to only one aspect of feeding. Assessment and treatment of PFD is critical in all domains to ensure inter-disciplinary collaboration and positive outcomes for both child and family. The purpose of this study is to investigate assessments currently used by feeding clinicians out in the field, and categorize them by the four domains of PFD in order to better understand current assessment practices and to inform future evidence-based assessment and treatment of PFD.

Methodology

This study will use a mixed methods research design in which both quantitative and qualitative data will be collected via survey research and focus groups in two areas of the United States (Midwest and East coast). The quantitative survey will examine the extent that current feeding assessments fit within the four domains of PFD and the qualitative focus groups will examine clinicians’ perspectives of current assessment tools being used for pediatric feeding problems. Mixed methods research provides a way to approach knowledge from multiple viewpoints, perspectives, and research approaches that allow for greater depth and breadth of understanding the problem (Johnson, Onwuegbuzie, & Turner, 2007). Appropriate sample size will be calculated for the survey research portion, and a smaller sample size of clinicians will be used in the qualitative portion using focus groups. Data will be analyzed by the Co-PI’s using NVivo software, which allows for greater validity of the results. Focus groups will be recorded, transcribed, and analyzed according to grounded theory methodology. Final data analysis includes comparing and contrasting the two data sets in order answer the research questions.

References

Barton, C. Bickell, M., & Fucile, S. (2018). Pediatric oral motor feeding assessments: A systematic review. Physical & Occupational Therapy in Pediatrics, 38(2), 190-209. DOI: 10.1080/01942638.2017.1290734

Goday, P.S., Huh, S.Y., Silverman, A. Lukens, C.T., Dodrill, P., Cohen, S.S…..Phalen, J.A. (2019). Pediatric feeding disorder-consensus definition and conceptual framework. Journal of Pediatric Gastroenterology and Nutrition, 68(1), 124-129.

Heckathorn, D., Speyer, R., Taylor, J., & Cordier, R. (2016). Systematic review: Non-instrumental swallowing and feeding assessments in pediatrics. Dysphagia, 31, 1-23.

Johnson, R.B., Onwuegbuzie, A.J., & Turner, L.A. (2007). Toward a definition of mixed methods research. Journal of Mixed Methods Research, 1(2), 112-133.

Ju Ko, M., Kang, M., Ko, K., Ki, Chang, H., Kwon, J. (2011). Clinical usefulness of Schedule for Oral-Motor Assessment (SOMA) in children with dysphagia. Annals of Rehabilitation Medicine, 35, 477-484.

Korth, K. & Rendell, L. (2015). Feeding Intervention. In J. Case-Smith & J. Clifford O’Brien (Eds.). Occupational therapy for children and adolescents, (7th ed., 389-414). St. Louis, MI: Elseview Mosby.

Speyer, R., Cordier, R., Parsons, L., Denman, D., & Kim, J. (2018). Psychometric characteristics of non-instrumental swallowing and feeding assessments in pediatrics: A systematic review. Dysphagia, 33, 1-14. https://doi.org/10.1007/s/00455-017-9835-x