Predicting feeding outcomes in infants with oral-motor impairments
The ability to swallow and feed efficiently is a key milestone of infant oral motor development. Feeding difficulties and less-than-optimal oral-motor skills are common among infants and children with severe neurodevelopmental disabilities, including severe outcomes of extreme preterm birth, neurological diseases, genetic and malformative disorders and perinatal injuries. In these conditions, the acquisition of autonomous feeding needs to be supported by specialized and relatively intensive interventions. As for the intervention to be timely and effective, objective and well-conducted early assessment of oral-motor skills is crucial in these infants.
The Functional Evaluation of Eating Difficulties Scale (FEEDS) has been specifically developed for the assessment of infants' oral-motor skills in the presence of neurodevelopmental disabilities by a multidisciplinary team at the Scientific Institute IRCCS E. Medea (Cavallini et al., 2017). The FEEDS has proved to be valide and reliable and includes the evaluation of different domains related to oral-motor skills plus specific scales to assess aspects of neurobehavioral maturation and behavioral stability.
Lower FEEDS scores significantly predicted infants' feeding modality up to 12 months after hosptial discharge and a 1-point increase in FEEDS score was associated with increased 6-to-14% risk of being non-autonomous feeders.
In a recent paper from Cavallini and colleagues (in press), the FEEDS has been applied to a large cohort of infants with neurodevelopmental disabilities hospitalized at the IRCCS E. Medea from 2004 to 2017. The score obtained from the FEEDS administration - which has a clinical cut-off for identifying at-risk conditions - was found to be significantly predictive of the short- and long-lasting outcome in oral-motor skills and autonomous feeding in these infants. Despite the complex needs and phenotype of infants with neurodevelopmental disabilities might need a multi-component assessment and there is no stand-alone tool to estimate the prognosis, the FEEDS emerged as a valid and reliable assessment procedure to guide clinical decision making and to inform early interventions, such as adoption of nasogastric tube, percutaneous endoscopic gastrostomy (or jejunostomy) or investment in oral stimulation and behavioral therapy.
Find more on our research project on the Functional Evaluation of Eating Difficulties Scale (FEEDS) here.
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Key references
Cavallini A, Provenzi L, Sacchi D, Longoni L, Borgatti R (2017). The Functional Evaluation of Eating Difficulties Scale: Study Protocol and Validation in Infants with Neurodevelopmental Impairments and Disabilities. Frontiers in Pediatrics, 5, 273.
Cavallini A, Provenzi L, Scotto di Minico, Sacchi D, Gavazzi L, Amorelli V, Borgatti R (2019). Functional Evaluation of Eating Difficulties Scale (FEEDS) to predict oral motor skills in infants with neurodevelopmental disorders: A longitudinal study. Dev Med Chi Neurol. doi: 10.1111/dmcn.14154