PEDIATRIC FEEDING PROBLEMS: CONCEPT ANALYSIS AND FAMILY MANAGEMENT

Background: Pediatric feeding problems occur in 25% of the general pediatric population and up to 80% of those who have developmental delays. When feeding problems place the child at nutritional risk, families are typically encouraged to increase their child’s intake. As pressures to eat increase, children’s aversive behaviors can worsen, extending the time of under nutrition, and limiting developmental potential. Family mealtime may become a battle with entrenched inappropriate mealtime behaviors. To add to the challenge this presents to healthcare and families, there is no interdisciplinary consensus on terms to describe feeding problems. Lack of common language is a barrier to effective interdisciplinary, family-centered care. Purpose: This dissertation is comprised of three studies. Chapter 2 presents an evolutionary concept analysis of pediatric feeding problems. Chapter 3 describes family conceptualization of feeding problems. Chapter 4 is a descriptive study of family management of child feeding difficulty. Methods: In Chapter 2 an evolutionary concept analysis was conducted with 100 post-2000 published reports representing several different disciplines of authorship and additional pre-2000 exemplar manuscripts provide historical perspective. Chapter 3 is a concept analysis of pediatric feeding problems from parental perspectives using interview data from nine families of children with feeding difficulty. Based on qualitative interview data and information about child and family, Chapter 4 presents the results of parents’ reports of their efforts to manage their child’s feeding problems. A within-and-across family-case analysis was conducted. Results: Chapter 2 illustrates divergent conceptualizations within and between disciplines. Emphasis is given to areas of consensus. Chapter 3 highlights shared and discrepant ways of writing and speaking about the problem from interviewed parents and references Chapter 2 for comparison to literature on provider perspectives. Chapter 4 describes family management of feeding problems and parental perceptions of the child, using within and across family thematic analysis. Conclusion: A new conceptualization for feeding problems as a phenotype condition manifesting along a spectrum of severity is presented. This conceptualization lends itself to interdisciplinary collaboration and pragmatic research by defining the problem as one of function. A family nurse role is suggested for working with families of children with feeding problems.Doctor of Philosoph