Paediatric feeding disorders (PFDs) are common. Earlier studies have shown an association between PFD and caregiver stress, but these studies have been hampered by insufficient power. This study reports stress for caregivers of children diagnosed with PFD. These caregivers were then compared to community norms of the Parental Stress Index–Short Form. Caregivers also completed the Mealtime Behaviour Questionnaire, Child Behaviour Checklist and Child Development Inventory. Linear regression and hierarchical regression analyses assessed the relationship among the variables. Caregivers of 840 children with PFD responded. Negative child behaviours and lower child developmental function predicted higher levels of total parenting stress, parental distress, parent–child dysfunctional interaction and caregiver perceptions of their child as difficult. Higher rates of child internalizing and externalizing problems and child mealtime aggression were associated with parent perceptions of their child as difficult and contributed to total parental stress. Parents of older children reported higher levels of stress, whereas parents of younger children were more likely to be defensive responders. Overall, parents of children with PFD have more caregiver-related stress. These caregivers may benefit from consultations with mental health professionals to provide the most appropriate care to affected families.
Summary
Background
Adverse childhood experiences (ACEs) and obesity are independently associated with brain/neurocognitive health. Despite a growing emphasis on the importance of early life adversity on health, the relationship between ACEs and neurocognition in adults with overweight/obesity is unclear. The objective was to examine associations between self‐reported ACEs and measured neurocognitive domains in a sample of adults with overweight/obesity.
Methods
Participants were 95 predominantly white, highly educated adult women (76% female, 81% Caucasian, and 75% ≥ bachelor's degree) with excess adiposity enrolled in the Cognitive and Self‐regulatory Mechanisms of Obesity Study. ACEs and fluid/crystallized neurocognitive domains were measured at baseline using the Adverse Childhood Experiences Scale and the NIH Toolbox Cognition Battery and Automated Neuropsychological Assessment Metric, respectively.
Results
Higher ACEs scores were negatively correlated with fluid cognition (r = −.34, P < .001) but not crystallized cognition (r = .01, ns). Individuals with 3 and 4+ ACEs displayed significantly lower fluid cognition scores than those with fewer ACEs F4,89 = 3.24, P < .05. After accounting for body mass index (BMI), age, sex, race, and education, higher ACEs scores were still associated with poorer performance on overall fluid cognition (β = −.36, P < .01), along with the following subtests: Stroop Colour/Word test (β = −.23, P < .05), Go/No‐Go omissions (β = .29, P < .01), and Picture Sequence Memory task (β = −.30, P < .01).
Conclusions
The role of ACEs in health may be related to their associations with executive function and episodic neurocognitive domains essential to cognitive processing and self‐regulation. Obesity science should further examine the role of ACEs and neurocognition in obesity prevention, prognosis, and treatment using more rigorous, prospective designs and more diverse samples.
Background
We aimed to describe feeding dysfunction in a group of children with tracheostomy.
Methods
Single‐center, retrospective chart review of all children with a tracheostomy who were evaluated by our interdisciplinary feeding program. Demographic and diagnostic data, nutrition variables, acceptance of food consistencies, as well as 2 validated psychometric instruments for assessment of feeding dysfunction were analyzed.
Results
Thirteen tracheostomy‐dependent children (5/13; 38% ventilator dependent) were evaluated at a median age of 51 months (interquartile range [IQR], 26–69). The majority of children (8/13; 62%) underwent evaluation after decannulation. Four children (30%) had a history of a cuffed tracheostomy tube. Eleven children (85%) used a speaking valve prior to decannulation, only 2 of whom started before initial discharge with a tracheostomy. Children with a tracheostomy had low‐median weight‐ and height‐for‐age z‐scores (−1.27 and −1.73, respectively), with normal‐median body mass index (BMI)–for‐age z‐score (0.175). Children received 75% of feedings via tube feeding (IQR, 13%–97%). Compared with other children with feeding disorders, children with tracheostomy had delays in initial acceptance of most food textures and general diet, and the Mealtime Behavior Questionnaire showed significantly worse overall scores (P = .01), and the About Your Child's Eating survey showed significantly higher parental perception of resistance to eating (P = .0001).
Conclusion
Requirement of enteral nutrition, poor oral‐feeding skills, chronic malnutrition, and worse mealtime behaviors are associated with tracheostomy. A history of ventilator dependence, cuffed tracheostomy, and inpatient speaking valve–use were infrequently associated with interdisciplinary feeding‐program evaluation.
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