Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2017 Feb:181:116-124.e4.
doi: 10.1016/j.jpeds.2016.10.002. Epub 2016 Nov 8.

A Systematic Review and Meta-Analysis of Intensive Multidisciplinary Intervention for Pediatric Feeding Disorders: How Standard Is the Standard of Care?

William G Sharp  1 , Valerie M Volkert  2 , Lawrence Scahill  2 , Courtney E McCracken  3 , Barbara McElhanon  2
Affiliations
Meta-Analysis

A Systematic Review and Meta-Analysis of Intensive Multidisciplinary Intervention for Pediatric Feeding Disorders: How Standard Is the Standard of Care?

William G Sharp et al. J Pediatr. 2017 Feb.

Abstract

Objective: To assess models of care and conduct a meta-analysis of program outcomes for children receiving intensive, multidisciplinary intervention for pediatric feeding disorders.

Study design: We searched Medline, PsycINFO, and PubMed databases (2000-2015) in peer-reviewed journals for studies that examined the treatment of children with chronic food refusal receiving intervention at day treatment or inpatient hospital programs. Inclusion criteria required the presentation of quantitative data on food consumption, feeding behavior, and/or growth status before and after intervention. Effect size estimates were calculated based on a meta-analysis of proportions.

Results: The systematic search yielded 11 studies involving 593 patients. Nine articles presented outcomes based on retrospective (nonrandomized) chart reviews; 2 studies involved randomized controlled trials. All samples involved children with complex medical and/or developmental histories who displayed persistent feeding concerns requiring formula supplementation. Behavioral intervention and tube weaning represented the most common treatment approaches. Core disciplines overseeing care included psychology, nutrition, medicine, and speech-language pathology/occupational therapy. The overall effect size for percentage of patients successfully weaned from tube feeding was 71% (95% CI 54%-83%). Treatment gains endured following discharge, with 80% of patients (95% CI 66%-89%) weaned from tube feeding at last follow-up. Treatment also was associated with increased oral intake, improved mealtime behaviors, and reduced parenting stress.

Conclusions: Results indicate intensive, multidisciplinary treatment holds benefits for children with severe feeding difficulties. Future research must address key methodological limitations to the extant literature, including improved measurement, more comprehensive case definitions, and standardization/examination of treatment approach.

Keywords: avoidant/restrictive food intake disorder; behavioral intervention; feeding; nutrition; pediatric feeding disorders; tube weaning.

PubMed Disclaimer

Comment in

  • A Problem That Is Difficult to Swallow.
    Noel RJ, Silverman AH. Noel RJ, et al. J Pediatr. 2017 Feb;181:7-8. doi: 10.1016/j.jpeds.2016.11.052. Epub 2016 Dec 6. J Pediatr. 2017. PMID: 27931824 No abstract available.
  • Reply.
    McCracken CE, Sharp WG. McCracken CE, et al. J Pediatr. 2017 Sep;188:313-314. doi: 10.1016/j.jpeds.2017.05.044. Epub 2017 Jun 7. J Pediatr. 2017. PMID: 28601361 No abstract available.
  • Intensive multidisciplinary intervention for pediatric feeding disorders.
    Marinschek S, Pahsini K, Scheer P. Marinschek S, et al. J Pediatr. 2017 Sep;188:313. doi: 10.1016/j.jpeds.2017.05.041. Epub 2017 Jun 9. J Pediatr. 2017. PMID: 28606369 No abstract available.