Author/Editor		Korošec, Barbara; Marot, Valerija; Logar, Svetlana; Damjan, Hermina; Groleger Sršen, Katja
Title		Učinkovitost celostne obravnave otrok z motnjami hranjenja in s prevladujočo senzorno preobčutljivostjo
Translated title		Efficiency of comprehensive management of children with feeding disorder and predominant sensory impairment
Type		članek
Vol. and No.		Letnik 18, št. 1
Publication year		2019
Volume		str. 35-45
ISSN		1580-9315 - Rehabilitacija
Language		slv
Abstract		Izhodišča: Težave pri hranjenju so pogosto povezane s preobčutljivostjo na dražljaje okoli ust in v ustni votlini. Zaradi težav pri razvoju občutenja in sprejemanja posameznih dražljajev v področju ust in ustne votline taki otroci pogosto selektivno sprejemajo le določeno vrsto ali teksturo hrane. Leta 2015 smo na Oddelku za (re)habilitacijo otrok na Univerzitetnem rehabilitacijskem inštitutu Republike Slovenije - Soča uvedli subspecialistično ambulanto za motnje hranjenja in požiranja ter program stopenjskega senzornega pristopa pri učenju hranjenja. V raziskavi smo želeli preveriti, kakšni otroci so napoteni v naše programe, opredeliti njihove težave pri hranjenju in oceniti učinkovitost terapevtskega programa. Preveriti smo želeli tudi, kako so z obravnavo v ambulanti zadovoljni starši. Metode: V retrospektivno raziskavo smo vključili otroke, ki so bili zaradi težav pri hranjenju v ambulantno obravnavo napoteni od februarja 2016 do avgusta 2018. Pregledali smo dokumentacijo 123 otrok. Iz nadaljnje analize podatkov smo izločili podatke 36 otrok, ki so bili na posvetu v ambulanti le enkrat. Za dva otroka se je izkazalo, da hranjenje ni varno, dva sta zaradi dolgotrajne bolezni prekinila z obravnavami, štirje so s programom šele začeli. Zbrali smo podatke o težavah otrok pri hranjenju, številu obravnav in številu živil, ki jih jedo otroci ob zaključku obravnave. Staršem smo poslali vprašalnik o zadovoljstvu s programom in o tem, kako otroci napredujejo v domačem okolju. Rezultati: V raziskavo smo vključili podatke 79 otrok (44 dečkov, 35 deklic), s povprečno starostjo 2,5 let (SO 2,8). Med napotnimi diagnozami so prevladovali različni sindromi in genetske okvare (n = 33), nedonošenost (n = 29) in motnje hranjenja brez jasne etiologije (n = 25). Glede na težave pri hranjenju so prevladovali otroci, ki so bili selektivni pri sprejemanju hrane (65 %), ena četrtina je razvila strah pred hranjenjem, manjši delež otrok pa ni jedel dovolj. Polovica otrok je bila razvrščena v III. do V. stopnjo glede na oceno motenj hranjenja in požiranja (DMSS), ostali so imeli manj težav. Od 14 otrok, ki so bili hranjeni skozi perkutano gastrično sondo (PEGS), jih je sedem ob zaključku skozi usta sprejemalo vse obroke. Malo manj kot polovica staršev (n = 32) je po zaključku programa vrnila izpolnjene vprašalnike. Poročali so, da so otroci povečali število živil, ki jih pojedo. Starši so bili z vsebino programa v veliki meri zadovoljni. V veliki večini so menili, da je na napredek otroka najbolj vplivalo namensko in sistematično spoznavanje nove hrane v domačem okolju in pri obravnavah. Zaključek: Stopenjsko senzorni pristop se je pokazal kot učinkovit terapevtski program. Otroci so v programu pomembno povečali število živil, ki so jih bili pripravljeni pojesti. Nekaj manj kot polovica otrok, ki so bili na začetku programa hranjeni skozi PEGS, je ob koncu programa jedla vse obroke skozi usta. V splošnem je dobro tudi zadovoljstvo staršev, ki jim program olajša tudi skrbi in zmanjša stres, ki ga občutijo zaradi otrokovih težav pri hranjenju.Background: Feeding problems are often associated with hypersensitivity to oral stimuli. Because of difficulties in the development of sensation and tolerance of individual oral stimuli, such children often selectively accept only a particular type or food texture. In 2015, at the Department for Rehabilitation of Children at the University Rehabilitation Institute of the Republic of Slovenia in Ljubljana, an outpatient program for eating disorders was introduced, as well as the sequential oral sensory approach (SOS) therapy program. In this study, we wanted to check which children were referred to our programs, determine their feeding problems, and evaluate the effectiveness of the therapeutic program. We also wanted to check how parents are satisfied with the therapy program. Methods: In this retrospective study, we included 123 children who were referred because of eating disorders to our outpatient program in the period from February to August 2018. We excluded the data of 36 children who were only consulted at the outpatient clinic once. For two children it turned out that feeding was not safe, two halted treatments due to long-term illness, four children had only started the program. We collected data on the child's feeding problems, the number of treatments and the number of foods that children eat at the end of the program. We sent a questionnaire to the parents about their satisfaction with the program and how the children progress in their home environment Results: The survey included data on 79 children (44 boys, 35 girls), with an average age of 2.5 years (SD 2.8). Different syndromes and genetic defects (n = 33), preterm birth (n = 29) and eating disorders with no clear aetiology (n = 25) were the predominant diagnoses. Regarding feeding problems, the children who were selective in their acceptance of food (65 %) dominated, one quarter developed fear of feeding, and a smaller proportion of children did not eat enough. Half of the children were classified in level III V of the Dysphagia Management Staging Scale (DMSS), others had less problems. Of the 14 children who were fed through the percutaneous gastric tube (PEGS) at the beginning, seven of were able to eat orally all the meals at the end of the program. A little less than half of the parents (n = 32) returned the completed questionnaires at the end of the program. They reported that the children have increased the number of foods they eat. In general, the parents were very satisfied with the content of the program. The vast majority of them believed that the progress of the child was most influenced by the deliberate and systematic introduction of new food in the home environment and in the SOS therapy program. Conclusion: The SOS therapy program has proven to be effective. The children in the program significantly increased the number of foods they were willing to eat. In general, the satisfaction of parents was also good; the program made them feel less worried and stressed due to child's feeding problems.
Descriptors		Feeding and Eating Disorders of Childhood rehabilitation
Keywords		child eating disorders sensory sensitivity therapy sequential oral sensory approach otrok motnje hranjenja senzorna preobčutljivost terapija stopenjski senzorni pristop