The role of the speech language pathologist in the diagnosis and multidisciplinary treatment of children with feeding difficulties: a new vision

The article reports the case study of a two year and six month old female patient, attended by a multidisciplinary team. Patient presented feeding difficulties such as food refusal, long lasting meals, oral-sensory defensiveness, anterior vomiting reflex and difficulties in chewing. She did not feed herself nor took part in family mealtimes. Presented gastro esophageal reflux, allergy to cow's milk protein and coughs followed by vomiting, without impairment of weight or height. The Mealtime Partners Program was method of treatment choice. After treatment of medical issues, the working method was established and initiated with oral sensory development, followed by chewing development and associated to family counseling. Patient started having meals with the family and taking part in social mealtime routines. Duration of meals diminished and food refusal was eliminated. Motor-oral system patterns improved significantly. Reassessment in 3 months showed reduction in gastroesophageal reflux symptoms and medication was removed. The nutritionist introduced dairy products with good acceptance. The Mealtime Partners Program, proved to be effective in the diagnosis and treatment of the feeding difficulties presented. The multidisciplinary team had a broad view of feeding difficulties presented by the patient, comprising motor, oral, organic and nutritional issues of feeding regarding the child's family background.本文报告了一例由多学科团队（multidisciplinary team）接诊的2岁6个月女性患者的病例研究。该患者存在多项进食困难症状，包括食物拒绝、进餐时长过长、口腔感觉防御（oral-sensory defensiveness）、前位呕吐反射（anterior vomiting reflex）及咀嚼困难；既无法自主进食，也未参与过家庭进餐活动。患者同时合并胃食管反流（gastro esophageal reflux）、牛乳蛋白过敏，以及咳嗽后呕吐的症状，但体重与身高未受明显影响。本次治疗选用进餐伙伴计划（Mealtime Partners Program）。在完成内科病症的处理后，团队确立并启动了工作方案：首先开展口腔感觉发育训练，继而进行咀嚼功能训练，并配合家庭咨询辅导。此后患者开始与家人共同进餐，参与社交性进餐日常活动；进餐时长显著缩短，食物拒绝行为完全消除，口部运动系统模式得到明显改善。3个月后的随访复查显示，患者胃食管反流症状有所减轻，遂停用相关药物；营养师为其引入乳制品，患者耐受情况良好。综上，进餐伙伴计划在该患者的进食困难诊疗中被证实具有显著效果。多学科团队结合患儿的家庭背景，全面涵盖了进食相关的运动、口腔、器质性及营养层面的问题，对患者的进食困难形成了整体性认知。