+

Feeding for Children 0-3

Elizabeth Medwick
Chatham University

What physiological and/or sensory feeding

interventions support positive outcomes of early
intervention for infants ages 0-3?

Why feeding?
n

As many as 50% of infants and young children are estimated to

have feeding problems (Howe & Wang, 2013)

Problems with feeding include:

n

overeating or under eating, packing food into the mouth, delays in

developing the mechanics of eating, issues regarding behaviors at
mealtime, and picky eaters.

Occupational therapists in early intervention settings directly

address these issues through behavioral, parent-directed, or
physiological-based interventions to improve eating and
mealtime performance.

Feeding is important not just to live, but for learning cultural and
social norms during family meals

Research Strategy
n

Keywords:
n

Databases:
n

CINAHL, American Journal of Occupational Therapy, Google

Scholar, OT Seeker

Inclusion Criteria:
n

Pediatrics, occupational therapy, early intervention, feeding,

feeding interventions, feeding difficulties, SOS approach

0 3 years old, articles in English, occupational therapy,

feeding strategies

Exclusion Criteria:
n

Adults, 5+ age

Levels of Evidence
n

Level I:

Level II:

Level III:

Level IV:

Level V:

Review of Best Evidence

1. Effectiveness of Cheek and Jaw Support
to Improve Feeding Performance of Preterm Infants
n

Objectives:
n Aimed to examine the effects of oral support more thoroughly
than previous studies and throughout the entire feeding.

Methods:
n

20 infants recruited from NICU. Outcome measures were:

feeding duration, volume % consumed, leakage %, intake rate,
sucking frequency, and mean volume ingested per suck. The
researchers also monitored the infants level of alertness
according to the Neonatal Behavioral Assessment Scale, and
physiological changes via pulse oximeter. Each infant was fed
either with oral support (intervention) or without (control). The
order of the conditions was randomly assigned.

Review of Best Evidence

1. Effectiveness of Cheek and Jaw Support
to Improve Feeding Performance of Preterm Infants
n

(cont)

Outcomes
n The final analysis included data from 17 infants. Results of this
study indicated that oral support may improve the feeding
performance of preterm infants by increasing intake rate and
decreasing leakage during feeding. Infants with the intervention
of oral support showed it had a moderate effect on intake rate
during the first 5 minutes feeding and throughout. No
significant effects were found on the infants level of alertness
or physiological status during feeding. Surprising to the
authors, oral support did not affect sucking frequency rates or
volume ingested per suck, but did decrease percentage of
leakage.

Review of Best Evidence

2. Systematic Review of Interventions Used in or Relevant to
Occupational Therapy for Children With Feeding Difficulties Age
Birth 5 Years.
n

Objectives:
n To determine the evidence for the effectiveness of interventions
used in occupational therapy to improve feeding, eating, and
swallowing for children from birth to age 5?

Methods:
n Articles were found using Medline, CINAHL, PsycInfo, ERIC, the
Campbell Corporation, and OTseeker, and hand searching
through bibliographies. Articles included had interventions
performed by OTs in various settings; children with diagnoses
of developmental delay, disability, or condition that affects
development; articles must evaluation effects of interventions;
and studies must be recent and pass scientific rigor. The
authors individually reviewed the articles, then came together
to discuss and determine themes.

Review of Best Evidence

2. Systematic Review of Interventions Used in or Relevant to
Occupational Therapy for Children With Feeding Difficulties Age
Birth 5 Years (cont)
n

Outcomes:
n Thirty-four studies met the inclusion criteria after analysis. The
authors identified behavioral, parent-directed/educational, and
physiological interventions as themes. For this scholarly
agenda, the physiological interventions were examined.
Subcategories are preparatory behaviors, feeding skills, and
environmental support. Skin-to-skin contact and its positive
effects on infants physiological profiles and breastfeeding was
supported by moderate to strong evidence. Oral stimulation
(such as through non-nutritive sucking) can be used to promote
and improve feeding performance. Positioning, adaptive feeding
equipment, and environmental support has strong to moderate
evidence backing for varied diagnoses.

Review of Best Evidence

3. A Retrospective Analysis of the Sequential Oral Sensory
Feeding Approach in Child with Feeding Difficulties
n

Objective:
n

To examine the outcomes of the sequential oral sensory (SOS)

approach in children with feeding dysfunction.

Methods:
n

The authors analyzed progress over a maximum of three years for

34 children of varying diagnoses for improvement in feeding. The
SOS approach uses a 12-week schedule to deliver therapy but was
adapted to meet the need to encompass the entire school year.
After being referred, each child had an individualized program
created for him or her. Foods used during the sessions were labeled
into one of four categories: hard munchable, meltable solid, pure,
or drink. Based on the 25-step scale used in SOS therapy, each
food item was scored from 1 to 25 based on the level of interaction
the child had with the food. Using this data, the authors created
graphs to plot each childs response over time to the therapy
sessions.

Review of Best Evidence

3. A Retrospective Analysis of the Sequential Oral Sensory
Feeding Approach in Child with Feeding Difficulties (cont)
n

Outcomes:
n Data showed that the average age of a child who showed
improvements (59.00 months) was not statistically significant
from the age of children who did not have a positive trend
(55.06 months). Additionally, there was no significant trend
regarding diagnoses and outcomes, although it is worth noting
that 69% of children diagnosed with a neurological impairment
had a positive trend compared to 39% of children with ASD. A
statistically significant trend was discovered regarding the
gender of the patient as more males than females showed
positive trends. The results showed that almost half of the
children showed no positive trend and the other half showed
varying degrees of improvement. Through their research, the
authors determined that using the SOS approach to feeding
can be beneficial for children with neurological impairments
who demonstrate consistency in response to intervention.

References
n

Article 1
n

Article 2
n

Hwang, Y., Lin, C., Coster, W., Bigsby, R., & Vergara, E. (2010). Effectiveness of
cheek and jaw support to improve feeding performance of preterm infants.
American Journal of Occupational Therapy, 64(6), 886-894.

Howe, T., & Wang, T. (2013). Systematic review of interventions used in or

relevant to occupational therapy for children with feeding difficulties ages
birth-5 Years. American Journal of Occupational Therapy, 67(4), 405-412.

Article 3
n

Benson, J.D., Parke C.S., Gannon C., Muoz D. (2013). A retrospective analysis of
the sequential oral sensory feeding approach in children with feeding
difficulties.Journal of Occupational Therapy, Schools, & Early Intervention,6(4),
289-300.

Additional References
Bazyk, S. (1990). Factors associated with the transition to oral feeding in infants fed by nasogastric
tubes. American Journal of Occupational Therapy, 44(12), 1070-1078.
Imms, C. (2001). Feeding the infant with congenital heart disease: An occupational performance
challenge. American Journal of Occupational Therapy, 55(3), 277-84.
Ross, E., & Browne, J. (2003). Developmental progression of feeding skills: An approach to
supporting feeding in preterm infants. Seminars in Neonatology, 469-475.
Snider, L., Majnemer, A., & Darsaklis, V. (2011). Feeding interventions for children with cerebral palsy:
A review of the evidence. Physical & Occupational Therapy in Pediatrics, 31(1), 58-77.
Surfus, J., & Lynch, A. (n.d.) Typical feeding development [Powerpoint slides]. Retrieved from http://
www.fireflykids.org/storage/resource.library.docs/ENG.resource.library/ENG.Feed.Swall/
js_al_11_11_typical_feed_devlp_eng.pdf