Consensus Definition: Eating
Eating is the ability to keep and manipulate food or fluid in the mouth and swallow it (Alberta College of Occupational Therapy, 2009).
Consensus Definition: Feeding
From an occupational performance perspective, feeding is the process of setting up, arranging and bringing food to the mouth. It is sometimes referenced as self-feeding (Alberta College of Occupational Therapy, 2009); (American Occupational Therapy Association, 2014b). From anatomical and physiological perspectives, “feeding is the process involving any aspect of eating or drinking, including gathering and preparing food and liquid for intake, sucking or chewing, and swallowing”. (Arvedson & Brodsky, 2002); (American Speech-Language-Hearing Association, 2019).
In the pediatric population, feeding also includes a relationship between an infant, child or youth, and a parent or caregiver. Feeding provides children and their parents or caregivers with opportunities to communicate and interact with each other to create a positive social experience that informs future interactions (Lefton-Greif M., 2008). Children benefit from a responsive feeding environment (Black & Aboud, 2011) where the parent responds to the child’s actions in a prompt, emotionally supportive, developmentally appropriate manner (Canadian Paediatric Society, Dietitians of Canada, Health Canada & Breastfeeding Committee for Canada, 2015).
Consensus Definition: Swallowing
From an occupational performance perspective, swallowing is moving food, fluid, medication or saliva from the mouth through the pharynx and esophagus into the stomach (Alberta College of Occupational Therapy, 2009); (American Occupational Therapy Association, 2014b).
From an anatomical and physiological perspective, “swallowing is a complex process during which saliva, liquids, and foods are transported from the mouth into the stomach while keeping the airway protected. Swallowing is commonly divided into the following four phases:
- Oral Preparatory—voluntary phase during which food or liquid is manipulated in the mouth to form a cohesive bolus—includes sucking liquids, manipulating soft boluses, and chewing solid food.
- Oral Transit—voluntary phase that begins with the posterior propulsion of the bolus by the tongue and ends with initiation of the pharyngeal swallow.
- Pharyngeal—begins with the initiation of a voluntary pharyngeal swallow which in turn propels the bolus through the pharynx via involuntary peristaltic contraction of the pharyngeal constrictors.
- Esophageal—“involuntary phase during which the bolus is carried to the stomach through the process of esophageal peristalsis” (Arvedson & Brodsky, Pediatric swallowing and feeding: Assessment and management, 2002); (Logemann J. , 1998); (American Speech-Language-Hearing Association, 2019).
Consensus Definition: Pediatric Feeding Disorder
Pediatric Feeding Disorder (PFD) is defined as impaired oral intake that is not age-appropriate, lasting at least two weeks, and associated with one or more disturbance of: medical, nutritional, feeding skill, and/or psychosocial function, and the absence of the cognitive processes consistent with eating disorders and pattern of oral intake that is not due to a lack of food or congruent with cultural norms (Goday, et al., 2019).
Diagnostic Criteria: Pediatric Feeding Disorder
- A disturbance in oral intake of nutrients, inappropriate for age, lasting at least two weeks and associated with one or more of the following:
- Medical dysfunction, as evidenced by any of the following:
- cardiorespiratory compromise during oral feeding
- aspiration or recurrent aspiration pneumonitis
- Nutritional dysfunction, as evidenced by any of the following:
- specific nutrient deficiency or significantly restricted intake of one or more nutrients resulting from decreased diet diversity
- reliance on enteral feeds or oral supplements to sustain nutrition and, or hydration
- Feeding skill dysfunction, as evidenced by any of the following:
- need for texture modification of liquid or food
- use of modified feeding position or equipment
- use of modified feeding strategies
- Psychosocial dysfunction, as evidenced by any of the following
- active or passive avoidance behaviors by child when feeding or being fed
- inappropriate parent or caregiver management of child’s feeding and, or nutrition needs
- disruption of social functioning within a feeding context
- disruption of parent-child relationship associated with feeding
- Medical dysfunction, as evidenced by any of the following:
- Absence of the cognitive processes consistent with eating disorders and pattern of oral intake that is not due to a lack of food or congruent with cultural norms (Goday, et al., 2019).
Consensus Definition: Pediatric Swallowing (Dysphagia) Disorder
Dysphagia is the term used to refer to a disruption, impairment, or disorder of the process of deglutition (the action or process of swallowing) that compromises the safety, efficiency, or adequacy of the oral intake of nutrients (Dodrill & Gosa, Pediatric Dysphagia: Physiology, Assessment, and Management, 2015); (Alberta College of Speech-Language Pathologists and Audiologists, 2013). Dysphagia may involve the oral cavity, pharynx, or esophagus, and affect the oral, pharyngeal, and, or esophageal phases of swallowing (American Speech-Language-Hearing Association, 2019). It affects an infant, child, or youth’s ability to safely suck, drink, chew, eat, control saliva, take medication, or protect the airway.
Dysphagia is a skill-based disorder not to be confused with a behaviourally based feeding disorder. It can occur at any time during the lifespan and may be short or extended in duration. Dysphagia is not a disease but rather a symptom or secondary consequence of an underlying neurogenic, oncologic, structural, psychogenic, surgical, congenital, or iatrogenic pathology (Alberta College of Speech-Language Pathologists and Audiologists, 2013). The most common causes of dysphagia are related to underlying medical or physical conditions. However, it is recognized that dysphagia can also manifest in psychological or psychiatric conditions (Vaiman, Shoval, & Gavriel, 2008).
Diagnostic Criteria: Pediatric Swallowing (Dysphagia) Disorder
Pediatric Swallowing Disorder or Dysphagia is defined as compromised airway (e.g. laryngeal, tracheal, and/or bronchial) protection, aspiration, or laryngeal penetration in one or more of the four phases of swallowing; oral, oropharyngeal, pharyngeal, and/or pharyngoesophageal (American Speech-Language-Hearing Association, 2019); (Alberta College of Speech-Language Pathologists and Audiologists, 2013). Diagnosis includes description of the nature and severity of impairment.
A clinical feeding evaluation does not reliably diagnose oropharyngeal dysphagia and aspiration (Duncan, Mitchell, Larson, & Rosen, 2018). Presenting symptoms, including coughing, choking, wet voice, wet breathing, tearing or red eyes, or changes in colour with feeding, do not reliably predict aspiration risk in children. For children at high risk for aspiration, instrumental evaluations of swallowing are recommended. (Duncan, Mitchell, Larson, & Rosen, 2018).
Aspiration: “Entry of secretions, food, or any foreign material into the airway that travels below the level of the true vocal folds. Aspiration may occur before, during, or after the pharyngeal phase of swallowing. It can also occur from reflux of gastric contents.” (American Speech, Language, & Hearing Association, 2020)
Brain Architecture: Neurological structures and physiology that support brain function. The term brain architecture is a metaphor by the Harvard Centre on the Developing Child to describe the complex development of the brain.
Parent Responsiveness: Sensitive awareness with active monitoring and appropriate responses to the child’s verbal and non-verbal communication, and physiological needs.
Regulation: Individual’s capacity to sustain optimum health while shifting between sleep and wake cycles, and maintain a calm and attentive state (feeling “just right”) during the awake cycle (Lillas & Turnbull, 2009).
Co-Regulation: The supportive process between caring adults and children, youth, or young adults that fosters self-regulation development is called ‘co-regulation’ (Rosanbalm & Murray, 2017). Other terms in the literature for the same process: interactive or mutual regular.
Refer to: Co-Regulation From Birth Through Young Adulthood
Self-Regulation: The ability to maintain one’s own optimal state of arousal (Lillas & Turnbull, 2009).
Sensory Integration: The process by which people register, modulate, and discriminate sensations received through the sensory systems to produce purposeful, adaptive behaviors in response to the environment (Ayres, 2005).
Sensory Modulation: The capacity to balance the flow of sensory signals in a way that is appropriate to context (Lillas & Turnbull, 2009).
Sensory Preference: Information that provokes a response of pleasure, enjoyment or calm thereby naturally promoting self-regulation (Lillas & Turnbull, 2009).
Sensory Processing: The capacity to receive, translate, associate, and elaborate sensory signals within and across sensory modalities in a developmentally appropriate way (Lillas & Turnbull, 2009).
Sensory Trigger: Information that provokes a response of dislike or distress (Lillas & Turnbull, 2009).
Serve and Return: Metaphor developed by Harvard Centre on the Developing Child to explain the back and forth verbal and non-verbal and emotional reciprocity between a dyad of child and parent or caregiver.
Serve and Return
From Best Practices to Breakthrough Impacts
State of Arousal: A cluster of physiological and behavioral signals (sensory-motor transformations) that regularly occur together and reflect the degree and type of response to internal and external sensory stimuli (Lillas & Turnbull, 2009); (Barnard, 1999). The chart below presents descriptions of the calm alert state and three adaptive stress responses.
Refer to: Awake States with Stress Responses
Toxic Stress Patterns:
- over-reactivity: stress responses that occur too frequently and too quickly
- repeated reactivity: can’t adapt to “normal” challenges and transitions
- extended reactivity: prolonged stress responses that take too long to recover (more than 10 to 20 mins)
- dampened recovery: can’t recover from stress response back to baseline health (healthy sleep cycle, healthy awake state) (Lillas & Turnbull, 2009); (MacEwan, 2002).
- Collaborative practice is a process for communication and decision-making that enables the separate and shared knowledge and skills of healthcare providers to synergistically influence the patient care provided.1
- Collaborative practice in healthcare occurs when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, caregivers and communities to deliver the highest quality of care across settings.2
- Collaborative practice involves respecting patients, families, caregivers, and each healthcare provider (clinical and non-clinical) for their unique skills and ideas. The quality of patient care increases when everyone’s voice is heard. In other words, the whole is greater than the sum of its parts.3
Interdisciplinary practice is defined as a “dynamic process involving two or more healthcare providers with complementary backgrounds and skills, sharing common health goals and exercising concerted physical and mental effort in assessing, planning, or evaluating patient care. This is accomplished through interdependent collaboration, open communication and shared decision-making. This in turn generates value-added patient, organizational and staff outcomes”.4 An interdisciplinary approach analyzes, synthesizes and harmonizes links between disciplines into a coordinated and coherent whole.5
Interprofessional collaboration is the process of developing and maintaining effective interprofessional working relationships with learners, practitioners, patients, clients, families and communities to enable optimal health outcomes. Foundational elements of collaboration include respect, trust, shared decision making, and partnerships.6
Collaborative Care Competencies
These competencies have been highlighted by AHS to illustrate the knowledge, skills, attitudes and values deemed essential for collaborative practice:
1. Patient and family centred care – Healthcare providers seek out, work with, and value, the patient, their family and caregivers as partners in designing and carrying out care services.
2. Role clarification – Healthcare providers understand their own role and the roles of others, and apply this knowledge to support patients in setting and achieving their goals.
3. Team functioning – Healthcare providers have a solid understanding of the principles of team work. They know and support processes to foster collaboration among all team members.
4. Collaborative leadership – Healthcare providers understand and apply a leadership style that supports collaborative practice.
5. Communication – Healthcare providers talk with each other and work together in a collaborative, open and responsible way.
6. Conflict resolution – Healthcare providers work to engage those involved, including the patient and family, if disputes arise. This is done in a positive and proactive manner.6
- Adapted from Way, Jones & Busing, 2000
- World Health Organization [WHO], 2010, p. 13
- AHS Insite (staff login required):
Collaborative Practice Principles Supporting Patient and Family Centred Care
Overview of the Health Professions Act of Alberta: Implications for Clinical Practice
- Xyrichs A, Ream E: Teamwork: a concept analysis, J Adv Nursing 2008, 61:232-241
- Choi BC, Pak AW: Multidisciplinarity, interdisciplinarity and transdisciplinarity in health research, services, education and policy, Clin Invest Med 2008 Dec, 29(6):351-64
- National Interprofessional Competency Framework: Canadian Interprofessional Health Collaborative, 2010
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