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Investigation of Assessment Tools in the Area of Pediatric Feeding Evaluation: A Mixed-Methods Study
Paula A Rabaey1, Kate Barlow2, Hibak Jama3
1Paula A. Rabaey, PhD, MPH, OTR/L, is Associate Professor, Occupational Therapy, University of Minnesota, Minneapolis; rabae010@umn.edu.
Insights
Pediatric feeding disorder (PFD) assessment by occupational therapists and speech-language pathologists often relies on nonstandardized tools. This highlights a critical need for validated, reliable assessments across all PFD domains.
Area of Science:
- Pediatric feeding and swallowing disorders
- Clinical assessment and diagnostics
- Occupational therapy and speech-language pathology practices
Background:
- The International Classification of Diseases, 10th edition, Clinical Modification, introduced a new diagnostic code for Pediatric Feeding Disorder (PFD).
- This necessitates the use of valid and reliable assessment tools by occupational therapists (OTs) and speech-language pathologists (SLPs) to capture PFD's complexity.
- Current practices may not fully align with these requirements, impacting accurate diagnosis and treatment.
Purpose of the Study:
- To identify assessment tools currently utilized by clinicians for the four domains of PFD: medical, nutrition, feeding skills, and psychosocial factors.
- To gather clinicians' perspectives and perceptions regarding the assessment tools they employ.
- To inform the development and adoption of standardized assessment procedures.
Main Methods:
- A mixed-methods approach combining online surveys and virtual focus groups.
- Surveys were distributed to OTs and SLPs treating PFD.
- Focus groups provided qualitative insights to supplement survey data.
Main Results:
- The survey indicated that 65% of clinicians (N=445) used nonstandardized assessment tools across the four PFD domains.
- Focus groups (n=26) revealed themes including the inadequacy of single assessment tools, reliance on self-created assessments, the importance of interdisciplinary collaboration, and challenges with current PFD assessment.
- A significant gap exists between the need for standardized tools and current clinical practice.
Conclusions:
- There is a clear need for OTs and SLPs working with children with PFD to utilize assessment tools with strong psychometric properties.
- Entry-level education should emphasize reliable and valid assessment tools that comprehensively evaluate all domains of PFD.
- Standardized assessment procedures and tools are crucial for accurate evaluation and effective treatment of pediatric feeding disorders.
Importance:
The new diagnostic code for pediatric feeding disorder (PFD) in the International Classification of Diseases, 10th edition, Clinical Modification, requires that occupational therapists and speech-language pathologists (SLPs) use valid and reliable assessment tools that capture the complexity of PFD.
Objective:
To determine current assessment tools that clinicians are using across the four domains of PFD: (1) medical factors, (2) nutrition factors, (3) feeding skill factors, and (4) psychosocial factors. A secondary objective was to obtain clinicians' perceptions of the assessment tools.
Design:
A mixed-methods study using survey research and focus groups.
Setting:
Online survey and virtual focus groups.
Participants:
Occupational therapists and SLPs who identified as clinicians who treat PFDs.
Results:
The survey revealed that 65% of the clinicians (N = 445) used a nonstandardized assessment tool across the four domains of PFD. The focus groups (n = 26) revealed four resulting themes that expanded the survey results: (1) no one assessment tool works, (2) clinicians rely on self-created assessments, (3) it takes a team and collaboration, and (4) there are many issues with the current assessment of PFD.
Conclusions And Relevance:
This study reveals the need for clinicians working with children with PFD to use feeding assessment tools with sound psychometric properties. The requirement for occupational therapists and SLPs to evaluate and treat dysphagia and disorders of feeding indicates the need to provide entry-level education on reliable and valid assessment tools that thoroughly evaluate all the domains of PFD. What This Article Adds: This article highlights current assessment tools used by occupational therapists and SLPs treating PFD and the need for more standardized procedures and tools to evaluate children across the four domains of PFD.
