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

项目摘要/摘要 在新生儿重症监护出院后，早产儿和足月儿的风险将会增加 妥协的发展。据估计，这些婴儿中有40%-70%在出生后第一天会出现喂养问题。 24个月。因为有问题的喂养可能会升级为慢性喂养障碍，早期症状 身份识别是至关重要的。喂养问题的早期生理症状与随后的行为 需要症状来加快检测，增强有效的症状管理，并中断 对慢性喂养障碍的喂养有问题。缺乏可解释正常变化的有效评估 在儿童的早期发育中喂养阻碍了支持向更早的转变的证据的发展 检测和有针对性的护理。为了解决这个问题，我们团队开发了一套渐进的、有效的、可靠的 衡量有问题的喂养和进食技能发展的症状，从出生到 早期儿童，有按年龄标准化的评分系统。儿童的两个家长报告测量 饲养环境配套齐全。在拟议的研究中，我们将使用同时解释混合- 方法采用纵向设计，前瞻性跟踪285名有喂养问题风险的婴儿。 新生儿重症监护至24个月。将评估集中在第一年，并在 第二年，我们将在发育的关键时期研究问题喂养的症状。 对足够的营养敏感，婴儿预后不良的风险最高。目标1：描述儿童的特征 喂养问题的症状和从NICU出院到24岁的症状轨迹 月份。目的2：确定出院时儿童生物功能明显的关系(新生儿生物 风险、喂养技巧、心肺稳定性、胃肠功能、自主神经系统调节) 以及在接下来的24个月里出现症状特征和轨迹的儿童性行为。目标3：描述 儿童的喂养环境(父母/家庭人口统计；父母管理有问题的喂养的战略 症状；接受喂养专门服务；喂养对父母/家庭的影响)及其与 在出院后的24个月中出现问题喂养症状。对样本子集的采访将允许 对儿童的喂养环境有更多的背景了解。目标4：确定两者之间的关系 喂养问题的症状和儿童进食技能、发育和发育的结果 神经发育。通过提高对问题喂养早期症状特征的认识 在喂养障碍出现期间，通过更好地了解家庭动态 与喂养问题的发展有关，我们可以确定儿童常见的生物行为途径 慢性喂养障碍的发展，这将为精密技术的发展奠定基础 对未来研究的干预。

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.