Symptom Trajectories in Infants and Toddlers at Risk for Chronic Feeding Problems

项目总结/摘要 从新生儿重症监护室出院后，早产儿和足月儿的一部分将有较高的风险， 妥协的发展。据估计，这些婴儿中有40-70%在第一次喂养期间会有问题。 24个月因为有问题的喂养可能会升级为慢性喂养障碍， 身份识别至关重要。将喂养问题的早期生理症状与随后的行为联系起来 症状，以加快检测，加强有效的症状管理，并中断进展， 有问题的喂养到慢性喂养障碍。缺乏解释正常变化的有效评估 在儿童的早期发展喂养阻碍了证据的发展，以支持转向早期 检测和有针对性的护理。为了解决这个问题，我们的团队已经制定了一套渐进的，有效的，可靠的 从出生到成年，可用于测量有问题的喂养和饮食技能发展的症状。 幼儿期，评分系统按年龄标准化。两个家长报告的措施，儿童的 饲养环境完善。在本研究中，我们将使用一个并行的解释性混合- 方法采用纵向设计，前瞻性随访285例有喂养问题风险的婴儿， 新生儿重症监护至24个月。通过将评估集中在第一年，并在第二年进行随访， 第二年，我们将研究在发展的关键时期有问题的喂养症状， 对充足的营养敏感，婴儿的不良结局风险最高。目标1：描述儿童的 从NICU出院到24岁的喂养问题症状和症状轨迹 个月目的2：确定出院时明显的儿童生物学功能（新生儿生物学功能） 风险、喂养技能、心肺稳定性、胃肠功能、自主神经系统调节） 和儿童性行为与未来24个月出现的症状特征和轨迹。目标3：描述 儿童的喂养环境（父母/家庭人口统计资料;父母管理喂养问题的策略 症状;接受喂养专业服务;喂养对父母/家庭的影响）及其与 从出院到24个月的喂养问题症状。与样本子集的访谈将允许 对孩子的喂养环境有更多的上下文理解。目标4：确定 问题喂养的症状和儿童饮食技能、生长发育的结果， 神经发育通过提高对问题喂养早期症状特征的认识， 在出现喂养障碍的时期，通过更好地了解家庭动态， 与喂养问题的发展有关，我们可以确定儿童的常见生物行为途径， 慢性喂养障碍的发展，这将奠定基础， 在未来的研究干预。

Project Summary/Abstract After discharge from neonatal intensive care, a subset of preterm and full-term infants will have elevated risk for compromised development. An estimated 40-70% of these infants will have problematic feeding during the first 24 months. Because problematic feeding may escalate into a chronic feeding disorder, early symptom identification is critical. Linking early physiologic symptoms of problematic feeding with subsequent behavioral symptoms is needed to speed detection, enhance effective symptom management, and disrupt progression from problematic feeding to chronic feeding disorders. A lack of valid assessment that accounts for normal variation in feeding in children’s early development has impeded development of evidence to support a shift to earlier detection and targeted care. To address this problem, our team has developed a set of progressive, valid, reliable measures of symptoms of problematic feeding and eating skill development that can be used from birth through early childhood, with scoring systems that are standardized by age. Two parent-report measures of the child’s feeding environment complete the set. In the proposed study, we will use a concurrent explanatory mixed- methods longitudinal design to prospectively follow 285 infants at risk for feeding problems from discharge from neonatal intensive care through age 24 months. By concentrating assessments in the 1st year with follow-up in the 2nd year, we will study symptoms of problematic feeding across a critical period of development highly sensitive to adequate nutrition and with infants at highest risk for poor outcomes. Aim 1: Characterize children’s symptoms of problematic feeding and trajectories of symptoms from the time of NICU discharge through age 24 months. Aim 2: Determine the relationship of child biological function evident at discharge (neonatal biological risk, feeding skills, cardio-respiratory stability, gastro-intestinal function, autonomic nervous system regulation) and child sex with symptom characteristics and trajectories emerging across the next 24 months. Aim 3: Describe the child’s feeding environment (parent/family demographics; parent strategies to manage problematic feeding symptoms; receipt of feeding specialty services; feeding impact on the parent/family) and its relationship with problematic feeding symptoms from discharge through 24 months. Interviews with a sample subset will allow a more contextual understanding of the child’s feeding environment. Aim 4: Determine the relationship between symptoms of problematic feeding and child outcomes of the development of eating skills, growth, and neurodevelopment. By improving understanding of characteristics of early symptoms of problematic feeding during the period when feeding disorders are emerging, and through better understanding of the family dynamic related to feeding problem development, we can determine common biobehavioral pathways in children’s development of chronic feeding disorders, which will lay the groundwork for development of precision interventions in future research.