Nursing Perspective on Feeding Evaluation and Treatment. Cyndi Chapman, APRN,MSN,MHCL August 2017

Transcription

1 Nursing Perspective on Feeding Evaluation and Cyndi Chapman, APRN,MSN,MHCL August 2017

2 OBJECTIVES: Participant will understand the nursing assessment regarding feeding issues Participant will be able to verbalize the nurse s role in the interdisciplinary team for feeding plans Participant will learn different tools from a nursing perspective for feeding evaluation.

3 Different stages of newborn/pediatrics Prematurity Newborn Specific diagnosis Developmental disabilities Infant Toddlers Adolescents Pre teen Teenager

4 Prematurity Assessment Gestational age Specific diagnosis Breast feeding strengthening Feeding readiness Feeding cues

5 Feeding Cues

6

7 Categories Structural Abnormalities-anatomic abnormalities of the structures associated with eating and feeding. Examples: defects associate with Pierre-Robin syndrome, retrognathic jaw, cleft palate, posterior tongue placement, macroglossia, tracheotomy, esophageal strictures or stenosis. Neurological conditions- feeding problems associated with central nervous systems insult or musculoskeletal disorders. Example, CP, muscular dystrophies, cranial nerve dysfunctions, mental retardation/develo0pmental disabilities, brain stem injury, pervasive developmental disorders Behavioral Issues-feeding difficulties resulting from psychosocial difficulties (poor environmental stimulation, dysfunctional feeder-child interaction), negative feeding behaviors shaped and maintained by internal and/or external reinforcement (selective food refusal, rumination) and/or emotionally based difficulties (phobias, conditioned emotional reactions, depression).

8 Categories, cont. Cardiorespiratory Problems-feeding difficulties associated with diseases and symptoms which compromise the cardiovascular and respiratory systems, complicating the coordination of sucking, swallowing and breathing during feeding. Ex tachypnea associated with bronchopulmonary dysplasia Metabolic dysfunctions-feeding difficulties associate with metabolic diseases and syndromes which interfere with the development and/or maintenance of normal feeding patterns. Ex hereditary fructose intolerance, dumping syndrome.

9 Complex pediatric feeding problems Normal development Pediatric difficulties either medical or developmental 25-35%of normal developing have issues 33-80% of development delay 50-70% of premature infants born before 36 weeks require significan feeding support Biobehavioral conditions Need to assess biological aspects Need to assess behavioral aspects Nonorganic vs organic origins Non-disruptive social and environmental emotional antecedents and consequences for feeding Organic-structural, neuromuscular,or other physiologic reasons

10 Feeding observations are best done in natural environments* Assessments should include: Manifestation of problem Thorough medical/developmental history Data on growth and weight Emotional climate during meals Family Stressors Motor skills, posture and tone Antenatal and perinatal history Feeding routines and environments Oral motor skills and swallowing Sensory processing Feeding routines/environments Child behavior prior to and during meals Self-regulation/level of alertness Strategies previously used

11 Quality and timing of oral motor skills Strength Coordination Sensory function Tone Asymmetry Cranial nerve function Motor planning Gag, cough, quality of voice, watery eyes/nose may be indicators of aspiration 6/

12 After Assessment Oral Motor Stimulation and Exercise Positioning Behavioral Strategies Medications Altered Diets Sensory Strategies Feeding Tubes Vital Stim

13 Team discipline Pediatric Gastroenterology Nursing Nutrition Occupational Therapy Psychology Speech pathology Pediatricians Case Management

14

15 Nursing as a part of the interdisciplinary team Assessing family situation Assessing current situation Assessing patient- age dependent Social situation Eating is learned, not instinctual History of negative experiences Gastrointestinal issues Neurological problems

16 Congenital malformation Allergies Cardiac and/or respiratory problems Abnormal muscle tone Disordered child-caregiver relationships KIDS DON T EAT IF THEY DON T FEEL WELL

17 Feeding is a science Feeding is evidence based Studies are done based on everything we talk about Physiology plays a part Breast feeding Textures or something else It s all about the baby/child

18 Persistent problem with eating, feeding, and/or swallowing* Chronic food refusal Feeding tube dependence Food selectivity Poor oral intake Swallowing disorder TPN Oral Aversion Hirschsprungs etc

19 Positioning Infants Key factors for positioning infants*(fair evidence) Positioning should be first intervention Overall feeling of flexion Head aligned with trunk, elevated Most feed optimally semi-upright, with side-tilt positioning May also position in front of you with head/neck supported to facilitate eye contact Swaddling provides additional support

20 Position older children Key factors for positioning older children***(good evidence) Goal Most function with the least support/restriction Stable pelvis in neutral position Supported feet! Neutral or slightly flexed head Arms forward and free to move

21 Babbitt RL, Hoch TA, Coe DA, Cataldo MF, Kelly KJ, Stackhouse C, Perman JA. Behavioral assessment and treatment of pediatric feeding disorders. Developmental and Behavioral Pediatrics 1994;15(4): Troughton KE, Hill AE. Relation between objectively measured feeding competence and nutrition in children with cerebral palsy. Developmental Medicine and Child Neurology 2001;43(3): Sharp W G, Jaquess D L, Morton J F, Herzinger C V. Pediatric feeding disorders: A quantitative synthesis of treatment outcomes. Clinical Child and Family Psychology Review Burklow,KathleenA, Phelps, Anne N, Schultz, Janet R, McConnell, Keith, Rudolph, Colin. Classifying Complex Pediatric Feeding Disorders. Journal of Pediatric Gastroenterology& Nutrition Volume 27. Issue 2 pp Schwarz,Steven M, Corredor, Julissa, Fisher-Medina,Julie, Cohen, Jennifer and Rabinowitz, Simon. Diagnosis and of Feeding Disorders in Children with Developmental Disabilities. Pediatrics 2001: 108:671. Babbitt, Roberta L, Hoch, Theodore A., Coe, David A., Cataldo, Michael F., Kelly, Kevin J., Stackhouse, Claire, Perman, Jay A. Journal of Developmental and Behavioral Pediatrics. August 1994.

22 THANK YOU Questions??