‘Prevalence and severity of feeding and nutritional problems in children with neurological impairment: Oxford Feeding Study’

‘Prevalence and severity of feeding and nutritional problems in children with neurological impairment: Oxford Feeding Study’ SIR–There are many parallels between the paper by Sullivan and colleagues1 and a similar study published in 19962. Both highlight how common feeding problems are in children with neurological impairment and illustrate that nutritional and feeding problems in children with disabilities continue to be under recognized. There is, however, one interesting difference in the two studies which I feel is worth highlighting. In the above study, maternal stress was associated with increased duration of mealtimes. Twenty eight percent of the carers reported prolonged mealtimes (i.e. more than 3 hours per day). We reported similar findings2. However, we found there was a significant difference between parental reports of mealtime durations and the actual length of mealtimes observed by the researchers, even though parents described these as typical. Of concern was the fact that children with the most severe oral-motor dysfunction tended to have the shorter mealtimes. The finding that mealtimes were in reality far shorter than they were perceived to be by caretakers was surprising and, we felt, may have contributed to some of the chronic under-nourishment seen in some of these children, particularly those with severe oral-motor dysfunction. Sullivan and colleagues suggest that feeding time can be used as a reliable measure of the severity of feeding impairment. However, I would caution clinicians about relying solely on carers’ reports of mealtime durations, as we clearly showed a substantial discrepancy between the lengthy durations of mealtimes reported and those actually observed. This highlights the importance of always observing feeding, preferably in the home.