title: A Systematic Review and Meta-Analysis of Intensive Multidisciplinary Intervention for Pediatric Feeding Disorders: How Standard Is the Standard of Care?
abstract: To assess models of care and conduct a meta-analysis of program outcomes for children receiving intensive, multidisciplinary intervention for pediatric feeding disorders.
  
  
  
  We searched Medline, PsycINFO, and PubMed databases (2000-2015) in peer-reviewed journals for studies that examined the treatment of children with chronic food refusal receiving intervention at day treatment or inpatient hospital programs. Inclusion criteria required the presentation of quantitative data on food consumption, feeding behavior, and/or growth status before and after intervention. Effect size estimates were calculated based on a meta-analysis of proportions.
  
  
  
  The systematic search yielded 11 studies involving 593 patients. Nine articles presented outcomes based on retrospective (nonrandomized) chart reviews; 2 studies involved randomized controlled trials. All samples involved children with complex medical and/or developmental histories who displayed persistent feeding concerns requiring formula supplementation. Behavioral intervention and tube weaning represented the most common treatment approaches. Core disciplines overseeing care included psychology, nutrition, medicine, and speech-language pathology/occupational therapy. The overall effect size for percentage of patients successfully weaned from tube feeding was 71% (95% CI 54%-83%). Treatment gains endured following discharge, with 80% of patients (95% CI 66%-89%) weaned from tube feeding at last follow-up. Treatment also was associated with increased oral intake, improved mealtime behaviors, and reduced parenting stress.
  
  
  
  Results indicate intensive, multidisciplinary treatment holds benefits for children with severe feeding difficulties. Future research must address key methodological limitations to the extant literature, including improved measurement, more comprehensive case definitions, and standardization/examination of treatment approach.
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Marcus Autism Center, Atlanta, GA. Electronic address: wgsharp@emory.edu.
authors.forename: William G
authors.initials: WG
authors.lastname: Sharp
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Marcus Autism Center, Atlanta, GA.
authors.forename: Valerie M
authors.initials: VM
authors.lastname: Volkert
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Marcus Autism Center, Atlanta, GA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Scahill
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
authors.forename: Courtney E
authors.initials: CE
authors.lastname: McCracken
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Marcus Autism Center, Atlanta, GA.
authors.forename: Barbara
authors.initials: B
authors.lastname: McElhanon
mesh_terms: D002648:Child; D002675:Child, Preschool; D001068:Feeding and Eating Disorders / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D009751:Nutritional Requirements; D009752:Nutritional Status; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D059039:Standard of Care
keywords: avoidant/restrictive food intake disorder; behavioral intervention; feeding; nutrition; pediatric feeding disorders; tube weaning