A Systematic Review of Feeding Interventions for Infants with Cleft Palate

Objective Various devices and techniques have been proposed to reduce feeding difficulties experienced by infants with cleft palate. The aim of this review is to identify and assess the scope and quality of evidence for these interventions. Methods A systematic review of published literature evaluating feeding interventions for infants with cleft palate (with or without cleft lip) from database inception to 2021 was conducted using Preferred Reporting Items for Systematic Reviews guidelines. Quality appraisal of included studies was conducted using a methodological index for nonrandomized studies, Cochrane, or a measurement tool to assess systematic reviews 2 instruments, according to study type. Results Fourteen studies met inclusion criteria, with the majority (71%) of studies consisting of second-level evidence. Included interventions were specialty bottles (21%), alternative feeding delivery systems (14%), obturators (14%), and educational programs (14%). Specialty bottles and palatal obturators did not appear to offer any substantial growth advantages compared to traditional bottles or no intervention, respectively. Designated education programs for the mothers of infants with clefts had a positive impact on infant growth. Conclusions Overall evidence evaluating feeding interventions for infants with cleft palate was moderate to low. While it does not appear that specialized feeding delivery systems or palatal obturators significantly improve growth in infants with clefts compared to children without cleft conditions, education programs do appear to be beneficial.

The Effects of a Partially Hydrolyzed Formula with Low Lactose and Probiotics on Mild Gastrointestinal Disorders of Infants: A Single-Armed Clinical Trial

Partially hydrolyzed formula (pHF) containing low lactose and probiotics may benefit the gastrointestinal health of infants. We aimed to assess the effects of pHF on mild gastrointestinal disorders (MGDs) of infants. In this single-armed trial, 80 full-term infants with MGDs were enrolled and fed a pHF for 14 consecutive days. The primary outcome resulted from the scores of gastrointestinal symptoms reported by parents using a validated Infant Gastrointestinal Symptom Questionnaire (IGSQ) at Day 0 (baseline), Day 7, and Day 14. The total IGSQ scores ranged from 13 to 65. Higher scores indicated worse gastrointestinal symptoms. The IGSQ scores (mean ± SD) decreased from Day 0 (36.0 ± 5.7) to Day 7 (28.7 ± 7.4) and Day 14 (26.5 ± 8.1 (p < 0.001), with corresponding digestive distress prevalence (IGSQ score > 30) decreasing from 87.5% to 35.0% and 28.8% (p < 0.001). In the first three days, vomiting and flatulence scores decreased at Day 1 versus Day 0, and the crying score decreased at Day 2, but no significant changes were observed for fussy and stool characteristics. All growth parameters increased and no parents reported adverse events. In conclusion, feeding with a pHF containing low lactose and probiotics may comfort infants with MGDs, and the comforting effect likely manifests early in the first three days of the feeding interventions. Trial registration: ClinicalTrials.gov NCT04112056

Feeding Challenges in Children With Autism and the Relationship With Parent and Child Outcomes

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This study presents the relationships between different types of feeding challenges for children with autism spectrum disorder (ASD) to specific sensory patterns, parenting stress, and overall adaptive behaviors. The findings of this study suggest children with ASD demonstrate unique patterns of feeding challenges and sensory responses that are significantly connected to parenting stress and adaptive behavior and can inform the development of targeted family-centered feeding interventions. Primary Author and Speaker: Brittany St John Additional Authors and Speakers: Muhammad Al-Heizan, Molly Hamre, and Karla Ausderau Contributing Authors: Kate Dorrance, Colleen Althoff

Feasibility and Effectiveness of a Parent-Mediated In-Home Feeding Intervention for Families With Children With Autism Spectrum Disorder

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The purpose of the study was to examine the effectiveness of a parent-mediated, in-home feeding intervention (parent training, direct intervention, and parent coaching) over 6 months for families with children with autism spectrum disorder (ASD). The findings support preliminary evidence that the intervention improves eating skills and mealtime behaviors in children with ASD and the need for more targeted feeding interventions for children with ASD that involve the parents in the natural context of the home. Primary Author and Speaker: Karla Ausderau Additional Authors and Speakers: Brittany St John, Libby Hladik, Shannon Kant, Jessica Muesbeck, and Holly Romaniak

Enteral Feeding Interventions in the Prevention of Necrotizing Enterocolitis: A Systematic Review of Experimental and Clinical Studies

Necrotizing enterocolitis (NEC), which is characterized by severe intestinal inflammation and in advanced stages necrosis, is a gastrointestinal emergency in the neonate with high mortality and morbidity. Despite advancing medical care, effective prevention strategies remain sparse. Factors contributing to the complex pathogenesis of NEC include immaturity of the intestinal immune defense, barrier function, motility and local circulatory regulation and abnormal microbial colonization. Interestingly, enteral feeding is regarded as an important modifiable factor influencing NEC pathogenesis. Moreover, breast milk, which forms the currently most effective prevention strategy, contains many bioactive components that are known to support neonatal immune development and promote healthy gut colonization. This systematic review describes the effect of different enteral feeding interventions on the prevention of NEC incidence and severity and the effect on pathophysiological mechanisms of NEC, in both experimental NEC models and clinical NEC. Besides, pathophysiological mechanisms involved in human NEC development are briefly described to give context for the findings of altered pathophysiological mechanisms of NEC by enteral feeding interventions.

Parental feeding and childhood genetic risk for obesity: Exploring hypothetical interventions with causal inference methods

Parental feeding behaviors are common intervention targets for childhood obesity, but often only deliver small changes. Childhood BMI is partly driven by genetic effects, and the extent to which parental feeding interventions can mediate child genetic liability is not known. Here we aim to examine how potential interventions on parental feeding behaviors can mitigate some of the association between child genetic liability and BMI in early adolescence, using causal inference based methods. Data were from the Avon Longitudinal Study of Parents and Children and we quantified the interventional disparity measure of child genetic risk for BMI (PRS-BMI) on objectively BMI at 12 years, if we were to intervene on parental feeding styles measured when children were 10-11 years (n=4,248). Results are presented as Adjusted Total Association (Adj-Ta) between genetic liability and BMI at 12 years, versus the Interventional Disparity Measure Direct Effect (IDM-DE), which represents the association, that would remain, had we intervened on the parental feeding. For children with the top quintile of genetic liability, an intervention shifting parental feeding to the levels of children with lowest genetic risk, resulted in a difference of 0.81 kg/m2 in BMI at 12y (Adj-Ta= 3.27, 95%CI: 3.04, 3.49; versus IDM-DE=2.46, 95%CI: 2.24, 2.67). Findings suggest that parental feeding interventions have the potential to buffer some of the genetic liability for childhood obesity. Further, we highlight a novel way to analyze potential interventions for health conditions only using secondary data analyses, by combining methodology from statistical genetics and social epidemiology.

Feeding intervention potentiates the effect of mechanical loading to induce new bone formation in mice

The benefits of increased human lifespan depend upon duration of healthy, independent living; the healthspan. Bone-wasting disorders contribute significantly to loss of independence, frailty and morbidity in older people. Therefore, there is an unmet need globally for lifestyle interventions to reduce the likelihood of bone fractures with age. Although many mechanisms are involved in disorders of bone loss, there is no single regulatory pathway and, therefore, there is no single treatment available to prevent their occurrence. Our aim in these studies was to determine whether fasting/feeding interventions alter the effect of mechanical loading on bone anabolic activities and increase bone mass. In young 17-week-old mice, 16-hour fasting period followed by reintroduction of food for 2 hours increased markedly the potency of mechanical loading, that mimics the effect of exercise, to induce new cortical bone formation. Consistent with this finding, fasting and re-feeding increased the response of bone to a loading stimulus that, alone, does not stimulate new bone formation in ad-lib fed mice. Older mice (20-months) experienced no potentiation of loading-induced bone formation with the same timing of feeding interventions. Interestingly, the pre-, prandial and postprandial endocrine responses in older mice were different from those in young animals. The hormones that change in response to timing of feeding have osteogenic effects that interact with loading-mediated effects. Our findings indicate associations between timing of food ingestion and bone adaptation to loading. If translated to humans, such non-pharmacological lifestyle interventions may benefit skeletal health of humans throughout life-course and in older age.

Applying Principles from Prevention and Implementation Sciences to Optimize the Dissemination of Family Feeding Interventions

Because families are the primary food socialization agent for children, they are a key target for nutrition interventions promoting healthy eating development. Although researchers and clinicians have developed and tested successful family nutrition interventions, few have gained widespread dissemination. Prevention and implementation science disciplines can inform the design, testing, and dissemination of feeding interventions to advance the goals of widespread adoption and population health impact. We review concepts and frameworks from prevention science and dissemination and implementation (D&I) research that are useful to consider in designing, implementing, and evaluating feeding interventions. Risk and protective factor frameworks, types of translation processes, and implementation dimensions are explained. Specifically, we address how research–practice partnerships can reduce time to dissemination, how designing for modularity can allow for contextual adaptation, how articulating core components can strengthen fidelity and guide adaptation, and how establishing technical assistance infrastructure supports these processes. Finally, we review strategies for building capacity in D&I research and practice for nutrition professionals. In sum, the research and knowledge bases from prevention and implementation sciences offer guidance on designing and delivering family interventions in ways that maximize the potential for their broad dissemination, reducing time to translation and optimizing interventions for real-world settings.