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Parent-report instruments for assessing feeding difficulties in children with neurological impairments: a systematic review

Jaafar NH, Othman A, Majid NA, Harith S, Zabidi-Hussin Z

Dev Med Child Neurol, 2019 02;61(2):135-144.
PMID: 30079517 DOI: 10.1111/dmcn.13986

AIM: This study aimed to review the psychometric properties and clinical application of parent-report instruments that assess feeding difficulties in children with neurological impairments.
METHOD: Papers were identified through five electronic databases based on 15 keywords and were included if they met the following criteria: published in English, described the implementation of parent-report instruments, and included children with neurological impairments (either in the report or a related study population).
RESULTS: In total, 1220 relevant abstracts were screened and 22 full-text articles were evaluated. The following six parent-report instruments met the inclusion criteria: (1) Screening Tool of Feeding Problems applied to children, (2) Paediatric Eating Assessment Tool, (3) Paediatric Assessment Scale for Severe Feeding Problems, (4) Montreal Children's Hospital Feeding Scale, (5) Children's Eating Behaviour Inventory, and (6) Behavioural Paediatric Feeding Assessment Scale (BPFAS). Based on comprehensive psychometric testing and consistently good results, the BPFAS was considered the most valid and reliable instrument. The BPFAS also showed good clinical applicability because it was readily available, required a short administration time, and used a simple scoring system.
INTERPRETATION: We reviewed the available parent-report instruments for assessing feeding difficulties in children with neurological impairments. The BPFAS had the best psychometric properties and clinical applicability.
WHAT THIS PAPER ADDS: Six parent-report instruments were suitable for assessing feeding in children with neurological impairments. The Behavioural Paediatric Feeding Assessment Scale (BPFAS) has the strongest psychometric properties. The BPFAS also has good clinical applicability.
Fulltext A Review of Spatial Analysis Application in Childhood Malnutrition Studies

Shamsuddin AS, Mohd Abu Bakar WA, Syed Ismail SN, Jaafar NH, Mohd Yassin W, Norhizat M

Malays J Med Sci, 2022 Oct;29(5):24-38.
PMID: 36474532 DOI: 10.21315/mjms2022.29.5.4

Approximately 230 million children under 5 years old of age suffer from malnutrition and over half of the children below 5 years old deaths are due to malnutrition nowadays. To gain a better understanding of this problem, the application of spatial analysis has risen exponentially in recent years. In this review, the present state of information on the use of spatial analysis in childhood malnutrition studies was evaluated using four databases of digital scientific journals: ScienceDirect, Scopus, PubMed and CINAHL. We chose 2,278 articles from the search results and a total of 27 articles met our criteria for review. The following information was extracted from each article: objective of study, study area, types of malnutrition, subject, data sources, computer software packages, spatial analysis and factors associated with childhood malnutrition. A total of 10 spatial analysis methods were reported in the reviewed articles and the Bayesian geoadditive regression model was the most common method applied in childhood malnutrition studies. This review highlights the importance of the application of spatial analysis in determining the geographic distribution of malnutrition cases, hotspot areas and risk factors correlated with childhood malnutrition. It also provides implications for strategic initiatives to eradicate all forms of malnutrition.
Fulltext A Review of Food Texture Modification among Individuals with Cerebral Palsy: The Challenges among Cerebral Palsy Families

Kamal S, Kamaralzaman S, Sharma S, Jaafar NH, Chern PM, Hassan NI, et al.

Nutrients, 2022 Dec 09;14(24).
PMID: 36558401 DOI: 10.3390/nu14245241

Individuals with cerebral palsy (CP) frequently present with multiple feeding problems, which may require food texture modification to ensure safe feeding. This review aims to explore the challenges individuals with CP and their caregiver's face and recommend modified food textures to ensure safety and improve the quality of life and nutritional status. A systematic search was carried out through four databases (i.e., EBSCO (Medline), PubMed, Science Direct, and Web of Science) between January 2011 and May 2022. Out of 86 articles retrieved, seven were selected based on keywords and seven other studies through manual search-five cross-sectional studies, two qualitative studies, one correlational study, one mixed method study, one case-control study, two sections of books, and two educational materials. The findings suggest that preparation and intake of food with modified texture play a necessary role in the safety of swallowing in addition to physical, social, and environmental aspects. Safety was found to be the crucial part of the food texture modification provision besides considering the stress of the caregivers and the nutritional status of individuals with CP. Currently, there are no standard guidelines available pertaining to food texture modification. This led to uncertainties in the dietary provision among caregivers, which may lead to undernourishment. Hence, standard guidelines relating to food texture modification that focuses on food preparation and menus with calorie and nutrient information are timely to be developed.
Fulltext Nutritional status as predictors for quality of life among caregivers of children with severe cerebral palsy

Kamal S, Hamzaid NH, Kamaralzaman S, Sharma S, Jaafar NH, Chern PM, et al.

Transl Pediatr, 2023 Sep 18;12(9):1601-1618.
PMID: 37814717 DOI: 10.21037/tp-23-195

BACKGROUND: Individuals with severe cerebral palsy (CP) often experience various health issues, including feeding difficulties, which can adversely affect their nutritional status and caregivers' quality of life, e.g., more time spent for feeding rather than own selfcare. This study aimed to determine the prevalence of poor nutritional status among individuals with severe CP and explore its role as predictors for caregivers' quality of life.
METHODS: This cross-sectional study was conducted in a government hospital (Cheras Rehabilitation Hospital), Community-Based Rehabilitation (CBR) Program, and Spastic Centre [non-profit organization (NGO)] in Klang Valley, Malaysia. Seventy-one participants with Gross Motor Function Classification System (GMFCS) level IV and V were recruited. Sociodemographic data, health-associated data, and anthropometric data were collected. Caregivers' quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL) CP module version 3.0 which included domains such as Movement and Balance, Eating Activities, and School Activities.
RESULTS: Most participants were males (60.6%), with 61 classified as level IV in the GMFCS classification. According to the Eating and Drinking Ability Classification System (EDACS), 59 children were at level IV. In total, 40.8% were underweight according to CP growth chart and 49.3% had mid-upper arm circumference (MUAC) readings below the 5th percentile. The lowest scores in the PedsQL CP module version 3.0 were observed in the Daily Activities (5.34±10.87), and School Activities domains (8.15±18.65). Sociodemographic and anthropometric data, including body mass index (BMI)-for-age, MUAC, body fat, triceps, and subscapular skinfold measurement, were predictors for the School Activities domain [F (11, 44)=3.981, P<0.005, R2=0.499].
CONCLUSIONS: Poor nutritional status in individuals with severe CP has been shown to negatively impact caregivers' quality of life. Therefore, a multidisciplinary approach involving nutritional intervention is essential to improve dietary provision and the nutritional status of children with CP.