Parent Training for teatimes without tantrums

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Parent Training for teatimes without tantrums

• Evidence Based Practice, Feeding Disability

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Presentation overview

• Orientation videos
• The paediatric feeding caseload of community
  speech pathologists.
• Development of clinical question
• Qualitative literature- parents and professional
  perspectives of feeding intervention and
  management.
• Critically appraised papers
• Clinical conclusions and applications
• Clinical practice of feeding speechies
• Where to from here.

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Peadiatric feeding (disability caseload)

• Who? Children with a range of feeding
  difficulties. From birth through to adulthood.

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Development of clinical question

• Interest in best utilising the time we have with
  parents to help them develop confidence and
  skills to manage their childrens feeding
  difficulties.
• Is parent training effective? Will it improve
  feeding outcomes? What type of parent training?

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Clinical question

• For children with feeding difficulties does
  parent (or carer) training improve feeding
  outcomes?
• Can parent training be an isolated intervention
  strategy?
• Which methods?
• How?
• For how long?
• For which types of client?

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Placing the evidence within our clinical
practice.

• Survey distributed to 30 ADHC speech pathologists
  from across Sydney metro.
• Qualitative information to allow comparisons to
  findings in the literature with everyday clinical
  practice.
• A range of clinical caseloads and therapist
  experience in survey results.
• Identifying what SPs feel works and doesnt works
  in terms of

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What strategies do we already use to train
parents around mealtime skills?
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Search results

• Search terms
• Where we looked
• What we found
• CAP for 4 articles (to follow)

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What does qualitative research tell us about the
effectiveness of dysphagia/feeding intervention?

• Behavioural modification training is cited widely
  in the psychology literature. For example,
  Training included teaching reinforcement and
  prompting strategies for 10 kill components
  through using verbal explanations, demonstrations
  of appropriate and inappropriate responses and
  role plays the children's' fast-food restaurant
  skills improves and were maintained for 4 mths
  and training program influenced the parents'
  teaching interactions with their children

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ARTICLE 1Turner, K.M.T., Sanders, M.R., Wall,
C.R. (1994). Behavioural parent training versus
dietary education in the treatment of children
with persistent feeding difficulties. Behaviour
Change, 11(4), 242-258.

• Method
• Randomised group-comparison design.
• 2 treatment conditions (Behaviour Parent Training
  and Standard Dietary Education).
• Results
• Behavioural Parent Training is more effective at
  increasing positive mother-child interactions
  than Dietary Education and leads to increased
  parental satisfaction with treatment. However,
  there is no significant difference between the
  interventions at improving childrens mealtime
  behaviours, their dietary intake or
  anthropometric measures.

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ARTICLE 2

• Aim To determine if using preferred foods
  motivates children in consuming less preferred
  foods and, in turn, improve food refusal.
• Method -parents taught to teach a consistent
  procedure when presenting the new foods He was
  told he would have to eat a small amount of the
  new food before he could have his preferred food
  Verbal praise was used   
•     
• Results -The subject immediately ate small
  quantities of the new food that he was presented
  with. He then accepted increased quantities of
  the first two foods and new flavours with the
  third.  At 3 mth follow up, he was continuing to
  eat increasing amounts of the presented foods.

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ARTICLE 3Stark L J et al (1994). Modifying
Problematic Mealtime Interactions of Children
with Cystic Fibrosis and their Parents via
Behavioural Parent Training.

• Method
• Pre and Post measures.
• Baseline measures
• weight
• - calorie intake
• - Global Rating Scale for Feeding Situations
  (GRSFS).
• Parents kept weight and food diaries.
• Sessions were provided once/week for 90mins,
  with twice weekly video-taped home meals. Review
  of vignettes from families, vivo practice in
  behaviour management techniques.
• Parents were instructed to provide verbal praise
  of appropriate child eating behaviours and to
  ignore complaints about foods, inappropriate
  behaviours and food refusal.
• Follow up sessions at 3 and 8 months post
  treatment for younger childs family and 1 and 12
  months post treatment for older childs family.

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ContARTICLE 3Stark L J et al (1994). Modifying
Problematic Mealtime Interactions of Children
with Cystic Fibrosis and their Parents via
Behavioural Parent Training.

• Results
• Child one Appropriate eating behaviours
  immediately improved an disruptive behaviours
  reduced. Over time behaviours varied but always
  stayed rated as high.
• Caloric intake increased and was maintained. His
  weight percentile improved from 55 to 93 at the
  review.
• Child two Appropriate eating behaviours also
  immediately improved but over time had decreased
  to moderate and at follow up was rated again as
  high. Disruptive behaviours reduced and over time
  had increased, but at follow up was rated as low.
  Caloric intake initially increased for one
  client, followed by a small increase at first
  follow up, then small decrease at second follow
  up.
• Caloric intake slightly decreased (bottle
  reduced, and solid intake increased). Weight
  percentile slightly decreased from 90 to 88.

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Stark L J et al (1994). Modifying Problematic
Mealtime Interactions of Children with Cystic
Fibrosis and their Parents via Behavioural Parent
Training.

• Method
• Results

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In 2011

• Meetings will take place at Rosebery ADHC office.
  
• Level 3, 61 Dunning Avenue, Rosebery 2018
• Please contact Emma Chapple
• emma.chapple_at_dhs.nsw.gov.au
• phone [phone]

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Next year for paed feeding (disability)

• Fussy eaters
• Dysphagia and schools
• Group therapy for problem feeders

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• Laura Mobbs (ADHC, Hornsby)
• Tsen Levsen (ADHC, Rosebery)
• Jo Scaltrito (Kogarah DA)
• Rachel Cummins (ADHC, Campbelltown)
• Kylie Ryan (ADHC, Campbelltown)
• Carmen Newton (ADHC, Hurstville)

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References

• Stark L J et al (1994). Modifying Problematic
  Mealtime Interactions of Children with Cystic
  Fibrosis and their Parents via Behavioural Parent
  Training.
• Turner, K.M.T., Sanders, M.R., Wall, C.R.
  (1994). Behavioural parent training versus
  dietary education in the treatment of children
  with persistent feeding difficulties. Behaviour
  Change, 11(4), 242-258.