Browsing by Subject "feeding and swallowing difficulties"

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    Open Access
    Interventions used by health care professionals to transition preterm infants and neonates from enteral feeds to full-oral feeds: A Scoping review
    (2021) Rabbipal, Yajna; Norman, Vivienne; Pascoe, Michelle
    Background: Preterm infants and neonates may present with dysphagia due to immaturity or the presence of medical conditions. Enteral feeds are used to ensure optimal nutrition is achieved while the neonates are developing appropriate oral feeding skills. Varied interventions may be used to transition neonates to full oral feeds as oral feeding is often a prerequisite for discharge from hospital. Aims: The main aim of this study was to summarize, interpret and analyse the literature on the different interventions used for the transition to full oral feeds in preterm infants and neonates to identify research gaps and to inform clinical practice on the best intervention options. A secondary aim was to validate the findings of the scoping review for the South African context. Methods: A scoping review was conducted. Relevant studies were identified by searching six databases, Google and Google scholar. Inclusion criteria included studies written in English, peer reviewed and published between 1998–2018, that described the interventions used to transition preterm infants and neonates to full oral feeds. Data were extracted from the articles using a data charting form and analysed descriptively and thematically. The findings were shared with health care professionals who work with premature infants and neonates who then participated in a semi-structured interview to provide feedback relevant to the South African context. Results: Forty-seven articles were included. Six broad intervention categories were identified: oral-motor, oral-sensory, other senses, timing, cue-based and utensils. Non-nutritive sucking (NNS) interventions were reported most frequently across single and combined interventions. Outcome measures reported included: time taken to full oral feeds, earlier hospital discharge, long-term feeding outcomes, weight and sucking proficiency. Improved outcomes were associated with NNS and NNS with oral stimulation. Nine health care professionals were interviewed. They confirmed using a number of the interventions, with NNS reported the most. Health care professionals also provided insight into the challenges of implementing some interventions due to limited resources and staffing in the South African context. Conclusions: There are a range of interventions reported in the literature and many of them are used in South Africa. Positive outcomes such as earlier transition to full oral feeds; earlier hospital discharge; improved weight gain and improved sucking proficiency have been reported with NNS and combined NNS and Oral Stimulation interventions, however further studies are needed.
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    Open Access
    The validation of a screening tool for the identification of feeding and swallowing difficulties in the paediatric population aged 0-2 years admitted to general medical wards
    (2019) Sibanda, Cynthia; Norman, Vivienne; Morrow, Brenda
    Background: Feeding and swallowing difficulties (FSD) have been found in typically developing children as well as in children with complex medical conditions and developmental disabilities. These difficulties cause negative health consequences such as aspiration pneumonia, chronic lung disease, failure to thrive, prolonged hospital stay and even death. The early identification and management of feeding and swallowing difficulties is important as it prevents the negative effects on health and quality of life. Hence, there is a need for a validated screening tool to use in the general hospitalized paediatric population. Research Aims: The aim of this study was to validate the Feeding and Swallowing Questionnaire as a screening tool, in the paediatric population aged 0 – 2 years admitted to general medical wards. The secondary aim was to describe the FSD presenting in the paediatric population aged 0 - 2 years who are hospitalized in the general medical wards. Methodology: A prospective, descriptive, clinimetric design was utilized. A sample of 107 participants admitted to the general medical wards at Steve Biko Academic Hospital were included in the study. Participants’ feeding and swallowing was screened by a research assistant using the Feeding and Swallowing Questionnaire. After the screening, a clinical feeding and swallowing assessment was conducted for comparison, the assessment was conducted by the student researcher using the Clinical Feeding and Swallowing Assessment Tool. Results: There was a 27% FSD prevalence, with the majority of cases (92%) occurring in children under one year of age. One hundred and three children (63% male; median (IQR) age 5.2 (2.1 – 12.8) months) underwent screening and clinical assessment for feeding and swallowing disorders. The criterion validity of the Feeding and swallowing Questionnaire was established with a sensitivity of 88% and a specificity of 32%. Internal consistency was achieved with an acceptable Cronbach’s alpha of 0.79, and good inter-rater reliability (80%). Participants presented with feeding difficulties in all the phases of swallowing, while some participants had behavioural feeding difficulties. Those who had FSD had the following medical conditions: cardiorespiratory, neurological and gastrointestinal disorders namely acute gastroenteritis and liver disease. Feeding and swallowing difficulties were associated with increased mealtime duration (p=0.005) and supplementary oxygen support (p=0.03). Conclusion: The results confirm that the Feeding and Swallowing Questionnaire shows promising findings as a reliable and valid tool for the identification of FSD in the general hospitalized paediatric population. However, further research in other setting with general paediatric medical wards is required to increase the robustness of the screening tool.