This document discusses feeding problems in children and eating disorders. It defines feeding problems as difficulties consuming food due to physical, behavioral, or both issues. Feeding problems are classified as oral-motor, positioning, self-feeding, or behavioral. The document also lists common pediatric conditions associated with feeding problems. It provides examples of ways to modify foods and positioning to address different feeding problems in school settings. The document then defines eating disorders and describes the three most common types: anorexia nervosa, bulimia nervosa, and binge eating disorder. Finally, it discusses potential biological, psychological, and environmental causes of eating disorders.
Presentation at GI Rounds of McMaster Children's Hospital on June 24th, 2019.
Pediatric Feeding Disorder: "Impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction."
Presentation at GI Rounds of McMaster Children's Hospital on June 24th, 2019.
Pediatric Feeding Disorder: "Impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction."
Eating difficulties in younger children and when to worryPooky Knightsmith
A short presentation for information or training which explores the common eating difficulties seen in younger children along with guidance as to when we should be concerned.
For more support, guidance and resources visit http://www.inourhands.com
N.B. this is guidance I developed to as part of a face to face training session rather than to stand alone. If you require further explanations or would like me to deliver similar training to your colleagues, please email me - pooky@inourhands.com
Review the prevalence of eating disorders
Identify assessment areas
Identify risk and protective factors
Explore complications
Explore potential guidelines for treatment
Based on APA Guidelines for Eating Disorders and the NICE Guidelines for Eating Disorder Recognition and Treatment
A direct link to the CEU course is https://www.allceus.com/member/cart/index/product/id/56/c/
Will be released as part of the Counselor Toolbox Podcast
DEFINITION
FTT is defined as attained growth Weight of < 3rd percentile on standard growth chart or Weight for height < 5th percentile on standard growth chart or Weight 20% or more below ideal weight for height. OR
Rate of growth less than 20 g/day from birth to 3 months of age or less than 15 g/day from 3 months to 6 months of age or falloff from previously established growth curve or downward crossing of > 2 major percentiles.
ETIOLOGY
The etiology of FTT has traditionally been divided into organic, inorganic and mixed.
Organic FTT; Is a growth symptom of virtually all serious pediatric physical illnesses, such as gastro esophageal reflux, malabsorption syndrome, cystic fibrosis and congenital heart disease.
Nonorganic FTT; Is a failure of growth without diagnosable organic disease. It is caused by a psychosocial problem between the infant or child and the mother or other primary caregiver.
Mixed FTT; has both organic and nonorganic causes and cannot be described as either alone.
NOTE:-
The standard classification of dividing the causes of FTT as organic and non-organic is probably not very appropriate. Whether the condition is primarily organic or non-organic in origin, all children who fail to thrive suffer the physical and psychological consequences of malnutrition and are at a significant risk for long-term physical and psycho developmental sequelae. Organic diseases are responsible for less than 20% of cases with FTT. The causes of FTT are as;-
1. INADEQUATE CALORIC INTAKE
• Incorrect formula preparation
• Neglect
• Excessive juice consumption
• Poverty
• Behavioral problem affecting eating
• Non-availability of food
• Misperceptions about diet and feeding practices
• Errors in formula reconstitution
• Dysfunctional parent-child interaction, child abuse and neglect
• Behavioral feeding problem
• Mechanical problems with sucking, swallowing and feeding
• Primary neurological diseases
• Chronic systemic disease resulting in anorexia, food refusal and neurological problems
2. INADEQUATE ABSORPTION
• Cystic fibrosis
• Celiac disease
• Vitamin deficiencies
• Hepatic diseases.
3. INCREASED CALORIC REQUIREMENT
• Hyperthyroidism
• Congenital heart disease
• Chronic immunodeficiency
• Chronic respiratory disease
• Neoplasm
• Chronic or recurrent infection
4. EXCESSIVE LOSS OF CALORIES
• Persistent vomiting
• Gastro esophageal reflux disease
• Gastrointestinal obstruction
• Increased intracranial pressure
• Renal losses - renal tubular acidosis
• Diabetes mellitus
• Inborn errors of metabolism
Eating Disorder In Teens M Jacob 2008 Mda TestMelanieJacob
Promising approaches in the treatment of eating disorders.
This presentation was done at the Michigan Dietetics Association meeting to an audience of registered dietitians.
Inpatient case study on the Multifactorial Conditions of Failure to Thrive in adulthood. Outlines the literature review, hospital course, and nutrition care plan, including the nutritional assessments and educations conducted. This case study was presented at Johns Hopkins Bavyiew Medical Center.
Improving the lives of those suffering from psychiatric and behavioral disorders is what we strive to achieve at the CNS Center of Arizona. Our psychiatrists specialize in severe and dual neuropsychiatric disorders. They understand and care for the patient medically, emotionally, socially, and spiritually. They teach what they know to patients and their families. This approach, we have found, helps empower patients to manage their lives, over time, and achieve the best outcome possible. Our approach at CNS Center of Arizona is a collaborative model of care involving other professionals and therapists. We expect patients who are currently in therapy to maintain contact with their primary therapist. CNS Center AZ
http://www.cnscenteraz.com
Eating Disorder A Threat To Life | Solh Wellness.pdfSolh Wellness
Eating disorders are caused due to uncontrollable eating habits that harm your health, emotions, and ability to perform in day-to-day activities. Solh Wellness explains about its types, causes and risk factors.
Eating Disorders: Symptoms, Causes, Diagnosis and TreatmentEPIC Health
March is National Nutrition Month, and a perfect time to spread awareness about Eating Disorders including its symptoms, causes, diagnosis and treatment.
Eating difficulties in younger children and when to worryPooky Knightsmith
A short presentation for information or training which explores the common eating difficulties seen in younger children along with guidance as to when we should be concerned.
For more support, guidance and resources visit http://www.inourhands.com
N.B. this is guidance I developed to as part of a face to face training session rather than to stand alone. If you require further explanations or would like me to deliver similar training to your colleagues, please email me - pooky@inourhands.com
Review the prevalence of eating disorders
Identify assessment areas
Identify risk and protective factors
Explore complications
Explore potential guidelines for treatment
Based on APA Guidelines for Eating Disorders and the NICE Guidelines for Eating Disorder Recognition and Treatment
A direct link to the CEU course is https://www.allceus.com/member/cart/index/product/id/56/c/
Will be released as part of the Counselor Toolbox Podcast
DEFINITION
FTT is defined as attained growth Weight of < 3rd percentile on standard growth chart or Weight for height < 5th percentile on standard growth chart or Weight 20% or more below ideal weight for height. OR
Rate of growth less than 20 g/day from birth to 3 months of age or less than 15 g/day from 3 months to 6 months of age or falloff from previously established growth curve or downward crossing of > 2 major percentiles.
ETIOLOGY
The etiology of FTT has traditionally been divided into organic, inorganic and mixed.
Organic FTT; Is a growth symptom of virtually all serious pediatric physical illnesses, such as gastro esophageal reflux, malabsorption syndrome, cystic fibrosis and congenital heart disease.
Nonorganic FTT; Is a failure of growth without diagnosable organic disease. It is caused by a psychosocial problem between the infant or child and the mother or other primary caregiver.
Mixed FTT; has both organic and nonorganic causes and cannot be described as either alone.
NOTE:-
The standard classification of dividing the causes of FTT as organic and non-organic is probably not very appropriate. Whether the condition is primarily organic or non-organic in origin, all children who fail to thrive suffer the physical and psychological consequences of malnutrition and are at a significant risk for long-term physical and psycho developmental sequelae. Organic diseases are responsible for less than 20% of cases with FTT. The causes of FTT are as;-
1. INADEQUATE CALORIC INTAKE
• Incorrect formula preparation
• Neglect
• Excessive juice consumption
• Poverty
• Behavioral problem affecting eating
• Non-availability of food
• Misperceptions about diet and feeding practices
• Errors in formula reconstitution
• Dysfunctional parent-child interaction, child abuse and neglect
• Behavioral feeding problem
• Mechanical problems with sucking, swallowing and feeding
• Primary neurological diseases
• Chronic systemic disease resulting in anorexia, food refusal and neurological problems
2. INADEQUATE ABSORPTION
• Cystic fibrosis
• Celiac disease
• Vitamin deficiencies
• Hepatic diseases.
3. INCREASED CALORIC REQUIREMENT
• Hyperthyroidism
• Congenital heart disease
• Chronic immunodeficiency
• Chronic respiratory disease
• Neoplasm
• Chronic or recurrent infection
4. EXCESSIVE LOSS OF CALORIES
• Persistent vomiting
• Gastro esophageal reflux disease
• Gastrointestinal obstruction
• Increased intracranial pressure
• Renal losses - renal tubular acidosis
• Diabetes mellitus
• Inborn errors of metabolism
Eating Disorder In Teens M Jacob 2008 Mda TestMelanieJacob
Promising approaches in the treatment of eating disorders.
This presentation was done at the Michigan Dietetics Association meeting to an audience of registered dietitians.
Inpatient case study on the Multifactorial Conditions of Failure to Thrive in adulthood. Outlines the literature review, hospital course, and nutrition care plan, including the nutritional assessments and educations conducted. This case study was presented at Johns Hopkins Bavyiew Medical Center.
Improving the lives of those suffering from psychiatric and behavioral disorders is what we strive to achieve at the CNS Center of Arizona. Our psychiatrists specialize in severe and dual neuropsychiatric disorders. They understand and care for the patient medically, emotionally, socially, and spiritually. They teach what they know to patients and their families. This approach, we have found, helps empower patients to manage their lives, over time, and achieve the best outcome possible. Our approach at CNS Center of Arizona is a collaborative model of care involving other professionals and therapists. We expect patients who are currently in therapy to maintain contact with their primary therapist. CNS Center AZ
http://www.cnscenteraz.com
Eating Disorder A Threat To Life | Solh Wellness.pdfSolh Wellness
Eating disorders are caused due to uncontrollable eating habits that harm your health, emotions, and ability to perform in day-to-day activities. Solh Wellness explains about its types, causes and risk factors.
Eating Disorders: Symptoms, Causes, Diagnosis and TreatmentEPIC Health
March is National Nutrition Month, and a perfect time to spread awareness about Eating Disorders including its symptoms, causes, diagnosis and treatment.
The topic is "Eating disorders" which has many psychological causes and impacts on the mental condition of the patient. Moreover, the presentation covers the psychological treatment of such conditions along with other treatment plans.
Eating disorders are complex, bio-psycho-social conditions, with multiple causes. Eating disorders arise from a combination of established social, psychological, biological, and interpersonal factors. While they may begin with preoccupations with food and weight, they are most often about much more than food. It is important to understand that the factors that contribute to eating disorders are complex and multifaceted; they are not simply about weight and they are certainly not choices.
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How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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ACCORDING TO apic.org,
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ACCORDING TO pewtrusts.org,
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According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
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VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
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2. What Is a Feeding
Problem?
A feeding problem occurs when a child has difficulty consuming solid foods or
liquids due to a physical impairment, behavioral issue, or both. Some conditions
that may disrupt feeding include oral cavity, neuromuscular, or neurologic defects. If
special accommodations are not made for feeding, it can have a detrimental impact
on the nutritional status of these children.
Feeding problems are usually classified as oral-motor, positioning, self-feeding, or
behavioral. These issues may begin in infancy and can sometimes be treated
through early intervention. However, when such conditions are present in a school
setting, feeding these children will require understanding and cooperation between
parents, teachers, therapists, and school nutrition personnel.
3. Pediatric Conditions
Associated With Feeding
Problems and Feeding
Disorders• Temperamental traits that complicate feeding and overwhelm parents
• Prematurity (especially neonates who require prolonged respiratory
support or enteral feeds or with delayed introduction of oral feeds)
• Genetic or chromosomal abnormalities (eg, Down syndrome and inherited
neuromuscular disease)
• Craniofacial anomalies (eg, Pierre-Robin sequence and cleft palate)
• Acquired brain impairment (eg, cerebral palsy, stroke, and traumatic brain
injury)
• Gastrointestinal disorders (eg, gastroesophageal reflux disease and chronic
constipation)
• Neurodevelopmental disorders (eg, autism spectrum disorder, global
developmental delay, and intellectual disability)
5. Children with oral-motor problems are unable to suck, swallow, or
chew their food properly. For these children, school nutrition staff
may need to provide foods that are modified in texture so that
children can meet their intake needs and avoid the risk of choking.
Some examples of modifications likely to be requested by a physician,
therapist, dietitian, or parent include the following:
• Chopped–Food needs to be chopped into bite-sized pieces using a
food chopper, knife, or food processor.
• Ground–Food should be soft or small enough to swallow with little
or no chewing. Food can be ground using a food processor or blender.
Oral-Motor
Problems
6. • Pureed–Food must have a smooth texture, similar to pudding, but
should not be runny. Food can
be pureed in a food processor or blender, sometimes adding a small
amount of liquid to make it
smooth.
• Thickened–Thickened beverages may be required for children
with difficulty swallowing. This can
be done using commercial thickeners or pre-thickened products.
7. Children with physical impairments or muscle control problems may be
unable to sit up or hold their head up to eat, or they may have difficulty
holding utensils and feeding themselves.
Children with positioning problems may need to lie down or stand up to eat,
which may require they be fed outside of the cafeteria. Some children may
have specially designed wheelchairs to position them for feeding, and
arrangements should be made to accommodate such chairs at a table in the
cafeteria.
For children who have difficulty with self-feeding, various devices and
adaptive utensils are available to aid them in feeding themselves. Children
must be taught how to use these items effectively. Typically, the washing and
sanitizing of the equipment is the responsibility of the school nutrition staff.
Positioning and Self-Feeding Problems
8. Behavioral Problems
Some children have behavioral issues that can
disrupt feeding, such as being easily distracted,
difficulty sitting through mealtimes, refusing to eat,
spitting out food, or knocking food and utensils on
the floor.
Although addressing these issues is the
responsibility of the child’s teacher or therapist,
school nutrition
staff can help by
9. • providing small, easy-to-eat servings;
• limiting the number of foods served;
• finding a place in the cafeteria where the child can eat
free from distractions; and
• attending Individualized Education Program meetings
held for the child. (This applies mainly to the
School Nutrition Director.)
10. What is an Eating
Disorder?
Eating Disorders describe illnesses that are characterized by irregular
eating habits and severe distress or concern about body weight or
shape. Eating disturbances may include inadequate or excessive
food intake which can ultimately damage an individual’s well-being.
The most common forms of eating disorders include Anorexia
Nervosa, Bulimia Nervosa, and Binge Eating Disorder and affect both
females and males.
11. Types of Eating
Disorders
The three most common types of Eating
Disorders are as follows:
Anorexia Nervosa-The male or female suffering from
anorexia nervosa will typically have an obsessive fear of
gaining weight, refusal to maintain a healthy body weight,
and an unrealistic perception of body image. Many people
with anorexia nervosa will fiercely limit the quantity of
food they consume and view themselves as overweight,
even when they are clearly underweight. Anorexia can
have damaging health effects, such as brain damage, multi-
organ failure, bone loss, heart difficulties, and infertility.
The risk of death is highest in individuals with this disease.
12. Bulimia Nervosa-This eating disorder is characterized by
repeated binge eating followed by behaviors that
compensate for the overeating, such as forced
vomiting, excessive exercise, or extreme use of laxatives
or diuretics. Men and women who suffer with Bulimia
may fear weight gain and feel severely unhappy with
their body size and shape. The binge-eating and purging
cycle is typically done in secret, creating feelings of
shame, guilt, and lack of control. Bulimia can have
injuring effects, such as gastrointestinal problems,
severe hydration, and heart difficulties resulting from
an electrolyte imbalance.
13. Binge Eating Disorder- Individuals who suffer from Binge
Eating Disorder will frequently lose control over his or
her eating. Different from bulimia nervosa however,
episodes of binge-eating are not followed by
compensatory behaviors, such as purging, fasting, or
excessive exercise. Because of this, many people
suffering with binge-eating disorder may be obese and
at an increased risk of developing other conditions, such
as cardiovascular disease. Men and women who struggle
with this disorder may also experience intense feelings
of guilt, distress, and embarrassment related to their
binge-eating, which could influence further progression
of the eating disorder.
14. Causes of Eating
Disorders
Eating Disorders are complex disorders, influenced by a facet of factors.
Though the exact cause of eating disorders is unknown, it is generally
believed that a combination of biological, psychological,and/or
environmental abnormalities contribute to the development of these
illnesses.
Examples of biological factors include:
• Irregular hormone functions
• Genetics (the tie between eating disorders and one’s genes
is still being heavily researched, but we know that genetics
is a part of the story).
• Nutritional deficiencies
15. Examples of psychological factors include:
• Negative body image
• Poor self-esteem
Examples of biological factors include:
• Irregular hormone functions
• Genetics (the tie between eating
disorders and one’s genes is still being
heavily researched, but we know that
genetics is a part of the story).
• Nutritional deficiencies
16. Examples of environmental factors that would contribute to the
occurrence of eating disorders are:
• Dysfunctional family dynamic
• Professions and careers that promote being thin and weight
loss, such as ballet and modeling
• Aesthetically oriented sports, where an emphasis is placed
on maintaining a lean body for enhanced performance.
Examples include: rowing, diving, ballet, gymnastics,
wrestling, long distance running.
• Family and childhood traumas: childhood sexual abuse,
severe trauma
• Cultural and/or peer pressure among friends and co-workers
• Stressful transitions or life changes