Full Course Description

Picky Eaters vs Problem Feeders vs Avoidant/Restrictive Food Intake Disorder

Program Information

Target Audience

Psychologists
Social Workers
Counselors
Pediatric Occupational Therapists
Pediatric Speech Pathologists
Pediatric Feeding Specialists
Physicians and/or Psychiatrists
Registered Dietitians
Day Care Providers
Teachers/Educators
Nurses

Objectives

Determine physical, motor, sensory, oral-motor, environmental, nutritional and behavior factors necessary to consider, to properly assess feeding problems.
Distinguish differential criteria for determining a child’s diagnosis as a typical eater, picky eater, problem feeder or a child with ARFID.
Evaluate the diagnosis of ARFID to discover sensory sensitivity, fear of aversive consequences and/or apparent lack of interest in eating or food.
Utilize practical treatment strategies to advance children’s feeding skills, improve family meal routines and increase children’s intake of more nutritious foods.
Conduct more thorough and accurate diagnoses, to implement the right treatment approaches for the distinct types of feeding/eating problems.
Discriminate when a child needs additional evaluation and intervention by specialists for more intense treatment.

Outline

Prevalence of the Problem

Picky eating
Problem feeding
ARFID

The Complexity of Feeding/Eating

7 areas of human function
How children learn to eat (or not)

How to Complete a Comprehensive Feeding Assessment

Medical/organs
Oral-motor skills
Sensory-motor skills
Postural and motor skills
Nutrition
Learning/cognition
Environment

Differential Diagnoses Criteria, Research and Limitations

Picky eating

Able to tolerate new foods on plate
Decreased range or variety of foods that will eat
Frequently eats a different set of foods than the rest of the family

Problem feeding

Restricted range or variety of foods
Refuses entire categories of food textures
Cries and “falls apart” when presented with new foods

ARFID

Accept a limited diet in relation to sensory features
Food refusal is related to aversive or fear-based experiences
Extreme pickiness; distractible and forgetful

Treatment Approaches – Align Treatment w/ Diagnosis

Systematic desensitization
Flooding/escape extinction
Eating disorders

Case Studies: When Assessments Go Well, and When They Don’t

Picky eating –

Case 1 = 2 ½ year old male with limited number of accepted foods he will eat, variable eating from one day to next, issues staying at the table
Case 2 = 2 ½ year old female with restricted food range, over reliance on liquids for calories and swallowing assistance
Case 3 = 9 year, 8-month-old male with lack of healthly proteins per parents, and no vegetables in his food range

Problem feeding –

Case 1 = 3 year, 10-month-old female with a G-tube, born at 26 weeks gestation, complicated medical history
Case 2 = 4.25-year-old female born with congenital Rubella, poor weight gain, restricted food range, episodes of gagging and coughing, episodes of refusing to eat

ARFID -

Case 1 = 15-year-old male with chronic “chok-y” sensation, significant weight loss, hospitalized in an Eating Disorders program
Case 2 = 13-year-old male with difficulties eating food at school, restricted food range per parental report, refusal to eat vegetables

Practical Feeding Strategies for Pediatric Feeding Disorder

Routines and environmental supports

Matching foods to a child’s skillset

Reinforcement

Management of maladaptive behaviors

When to Refer

Red Flags

Picky Eater vs Problem Feeder criteria

Copyright : 10/26/2018

Breathing, Digestion and Swallowing - Best Practices in Dysphagia Management

Program Information

Target Audience

Speech-Language Pathologists, Speech-Language Pathology Assistants, Occupational Therapists, Occupational Therapy Assistants, Respiratory Therapists, Nurses, Nursing Assistants , Restorative Nursing Staff, Dietitians, Dietary Managers, Long-Term Care Professionals

Objectives

Analyze the development and interrelationships between the respiratory and gastroesophageal systems
Determine the impact of respiratory and gastrointestinal functioning on swallowing
Analyze respiratory and gastroesophageal disease processes for which dysphagia is a symptom
Analyze the evidence to support various diagnostic tools such as reflex cough testing, pulse oximetry, and clinical and instrumental swallowing assessment
Evaluate common indicators of reflux and how they impact the treatment process
Determine which patients are most at risk for developing aspiration pneumonia

Outline

RESPIRATORY SYSTEMS

Overview of systems - anatomy/physiology
Breathing/Swallowing coordination
The apneic signal
The relationship of coordination to aspiration
Laryngeal Chemical Responses (LCRs)
Reflexive cough

GASTROESOPHAGEAL SYSTEMS

esophageal function
Barriers to reflux
Saliva swallows
Digestive acids
Reflux mechanisms
Relationship to feeding disorders
GERD signs and symptoms u
When does GER become GERD?
Reflux, feeding and swallowing behaviors
Relationship to dysphagia

GI/RESPIRATORY RELATIONSHIPS

Pressure relationships and their effect u
Asthma/gastroesophageal reflux connection
Laryngopharyngeal Reflux (LPR)

ASPIRATION

Pulmonary Clearance Mechanisms
Aspiration in infancy
How much is too much?
Predictors of pneumonia in various populations
Aspiration and oral hygiene

RESPIRATORY DISEASE PROCESSES

Infant Respiratory Distress Syndrome (IRDS)
Bronchopulmonary Dysplasia (BPD)
Respiratory Synctial Virus (RSV)
Congenital Heart defects
Obstructive Sleep Apnea (OSA) and dysphagia
Congestive Heart Failure (CHF)
Obstructive Conditions
Restrictive Conditions
Pneumonia vs Pneumonitis
Community Acquired Pneumonia
Healthcare Acquired Pneumonia
Aspiration Pneumonia

AIRWAY MANAGEMENT

Non-invasive positive pressure ventilation
High flow nasal cannula
Intubation
Post-extubation dysphagia
Tracheostomies
Physiological changes associated with tracheotomy

ASPIRATION ASSESSMENT

Clinical assessment – what are we looking for?
Cognitive assessment
Pitch elevation
Serial swallows
Oral mechanism
Respiratory factors
Cough
Respiratory muscle strength
Instrumental assessment
Modified Barium Swallow studies
Fiberoptic Endoscopic Evaluation of Swallowing
3 ounce water tests
Understanding lab values

ASPIRATION MANAGEMENT

Diet modifications
Implications of dietary changes
Compliance issues
Thick liquids
Complicating factors associated with thickening
Water protocols
Compensatory strategies
Sensory interventions
Principles of exercise physiology
Lingual strengthening
Effortful swallow
Mendolsohn maneuver
Masako maneuver
Shaker head lift
Chin tuck against resistance
Head extension exercise
Jaw opening exercise
Tongue pull back
Effortful pitch glide
Expiratory muscle strength training

REFLUX ASSESSMENT

Upper GI studies
Ph Monitoring
Esophagoscopy
Scintigraphy

REFLUX MANAGEMENT

Lifestyle modifications
Positioning
Diet modifications
Medications
Effects of acid suppression
Surgical interventions
New directions in reflux management
Endoscopic procedures
Melatonin
Acupuncture
Magnetic Sphincter Augmentation

Copyright : 07/26/2018

Eating with Ease: Managing Complex Feeding & Swallowing Problems in Children

Program Information

Outline

WHAT IS FOOD REFUSAL AND WHEN IS IT A PROBLEM?
SPECIAL POPULATIONS

Autism
Down syndrome
Cerebral Palsy

RESPIRATION

Development of the respiratory system
- respiration vs. ventilation
- coordination of breathing and swallowing
- homeostasis
- pulmonary clearance mechanism
Aspiration and aspiration pneumonia
Assessment
- respiratory rate
- dyspnea
- breathing/swallowing coordination
- cough
- stress behaviors

Interventions
- compensations
- positioning
- respiratory control
- exercise

PHARYNGEAL DYSPHAGIA

Clinical assessment
Instrumental assessment
Interventions
- diet modification
- thick liquids pros/cons
- strategies and compensations
- oral hygiene

THE GI SYSTEM

Development
Disorders of the GI system
- reflux and reflux disease
- constipation
- eosinophilic esophagitis

GI/Respiration inter-relationships
Assessment
Interventions
- dietary modifications
- medications
- positioning for sleep

INTERACTIVE CASE REVIEW

Potential treatment strategies for real life scenarios

ORAL MOTOR

Development of the oral motor system
Postural stability
Assessment
Interventions
- the role of exercise
- muscle tone interventions

SENSORY ISSUES

Development of the sensory system
State regulation
Taste and smell
Assessment
Interventions

BEHAVIOR

Assessment
Interventions
- the feeding environment
- hunger manipulation
- reinforcement
- shaping
- family education/involvement

Transition from tube feeding to oral feeding

INTERACTIVE CASE REVIEW

Potential treatment strategies for real life scenarios

NUTRITIONAL INTERVENTIONS

Special diets
Use of supplements

Objectives

Examine the interplay between oral-motor, gastrointestinal, and respiratory systems and their impact on food refusal in children in order to expand volume and variety of intake.
Analyze the signs and symptoms of pharyngeal dysphagia in children to prevent aspiration associated illnesses.
Evaluate advantages and challenges associated with dietary modifications and use of thickened liquids with a goal of increasing safe oral intake.
Apply rationale for various dietary recommendations currently being implemented with children in order to separate fact from fiction about special diets.
Determine the pros and cons of various oral-motor & sensory treatment approaches to maximize safe, pleasurable eating and drinking in children.
Develop a behavioral treatment plan to address problem feeding behaviors including food refusal, limited food repertoire, low volume of intake, and rigidity around foods and utensils.

Target Audience

Speech Language Pathologists
Occupational Therapists
Certified Occupational Therapy Assistants
Dietitians
Nurses
Pediatric Nurses
Pediatric Nurse Practitioners
Early Intervention Staff
Respiratory Therapists
Educators