Question 1 - Gina
Before reading
the article, what challenges do you foresee in properly assessing and treating
or managing GI symptoms and related nutritional concerns in pediatric
populations with food acceptance challenges and limitations in communication,
such as Autism Spectrum Disorder (ASD)? How might you work through those
challenges? What additional considerations might you take?
posted by Unknown @ 8:07 PM
10 comments
10 Comments:
Having worked with kids at the Boys and Girls Club in the past, I can forsee a number of problems that might arise in working with children with limited food acceptance and limitations in communication. One challenge may be in coordinating with parents. I have frequently heard of parents treating their child’s Autism or Aspergers with restrictive diets, such as gluten free diets. I think working with parents who are convinced that such diets are best for their child might be a challenge in itself. The parents may not be as receptive to your suggestions. In addition, any child who is a “picky eater”, regardless of limitations in communication, is a challenge. One thing that we used to do at the Boys and Girls Club was try and increase the exposure and acceptibility of a wider variety of foods to the kids who participated in our programming. I’ve always learned that kids need to be exposed to a new food many times (I’ve heard 15 times in the past) before they are open to it. Therefore, I might consider trying something like that with an Autistic kid and see how it goes.
I think one of the greatest challenges with the pediatric population in general is communication between the child and the health care team to understand symptoms of what the child is experiencing. Verbiage and questions relayed by clinicians and other medical staff need to be modified so that the child can relate and comprehend what is being asked of him/her. This can be especially challenging for GI symptoms and any form of pain or discomfort that the healthcare team may be unaware of unless the child can communicate either verbally or with actions that something is wrong. Depending on the severity, children with ASD may struggle to communicate adverse symptoms or feelings to others which can significantly complicate effective treatment and care. Therefore, there is a large need for involved and observant guardians to communicate changes in behavior and observations of symptoms on the child's behalf.
As Amanda stated, however, the parents/guardians of these children can pose a major challenge when working with the pediatric population. Many parents with sick children often turn to books, websites, and various media to find methods to assist with management of the disease/disorder. Although these may not be credible sources, most of us as humans are willing to try just about anything if we feel it could cure us or help us feel better. Parents of pediatric patients, and particularly those with ASD, should certainly be involved with decisions regarding the health of their child; however, it is the parents who are likely the most resistant to trying new methods/interventions with their child, especially if recommendations from the health care team challenge previous interventions, such as a restrictive diet, that the parent has previously implemented.
A challenge I foresee in properly assessing and treating or managing GI symptoms and related nutritional concerns in pediatric populations in general is that many children are resistant to change and have trouble communicating how they feel to adults. Even further children on the Autism Spectrum may have even more difficult communicating their feelings and GI symptoms to an adult. I think having a way to describe generic GI symptoms in an over simplified way to children might be beneficial to accurately diagnose GI symptoms.
I agree with Amanda that whenever you work with the pediatric population it is important to consider their parents. Since most children are incapable or not allowed to make their own decisions their parents will be in charge of their care plans.
Jenn also mentioned it is important that a child has an observant guardian to pick up on their adverse symptoms. I agree that having an observant guardian is crucial for a child’s health, however I think that some parents might not know what symptoms or adverse effects to look for. I think it would be helpful to educate parents on how to spot adverse GI symptoms to help detect these issues earlier.
The challenge I think that would be most difficult is properly communicating with the child and understanding what they are experiencing. From what I have learned about ASD (which isn't a lot) is verbal communication can be challenging for many autistic individuals while written/computerized modes of communication are not as tasking. Realizing the best form of communication for the client would be my first consideration.
I also agree with the comments previously about working with parents to care for an autistic child. I like what Carly suggested about educating parents on how to spot adverse GI symptoms. Ensuring parents understand what to look for will be crucial in caring for a autistics child nutritional concerns.
I think the biggest challenge that can occur when working with a population such as pediatric ASD is getting to the root of the individual's issues. ASD is so broad and unique to each individual I think it is important to first figure out what specifically is going on with the client and how your expertise is needed (are there physical symptoms that need to be managed? food restriction or rejection issues? nutritional deficiencies? less than ideal eating behaviors and attitudes towards food?). ASD is such as complex disorder that actually being able to communicate with the person (child) to begin to figure out an assessment and treatment plan is most likely going to be the most difficult initial task.
I think to work through these challenges you must first invest time. I think that comes in the form of building rapport with the child and caretakers and also just being around to observe the child's nutritional environment if at all possible. I think another step you can take as a part of the child's care team is to be open minded and pay attention. Do your best to turn off preconceived notions and not jump to conclusions before you spend time getting to know the people involved in the situation. As a nutrition expert it is likely that you'll be able to pick up on important details of the case that many others haven't thought of, but that is hard to do if you aren't listening and paying attention because you feel like you've already got it all figured out.
Great points everyone. Teaming up with the parent(s) or guardian is crucial in any pediatric case. GI symptoms can be hard to discern if the child is uncomfortable for another reason. Symptoms are not always cut an dry. Time and patience, as Des pointed out, will be key. Excellent with using the computer interface to communicate Sophie. There are likely some other tools, resources, or approaches we could use to assist with communication or make the child more comfortable. Any thoughts?
I agree with Amanda, Jenn, and Carly that communication with the child will be a challenge. I don’t have much experience working with ASD children, but I can imagine how challenging it could be. I think patience is crucial, and you must listen to what the parents are telling you and work with them to discover a realistic plan for the child. The parents are more familiar with their child’s health and eating habits more than anyone else, so getting their feedback is a must. I liked Carly’s suggestion of educating the parents, so then they know what to be concerned about and what is normal.
I thought Jenn made a good point about the challenges that are encountered with communication in general. As we know, communication with a child is much different than that with our colleagues. Therefore, finding ways to explain things to both children and their parents so that the point is being communicated effectively is of utmost importance. I also liked the point Carly made about the challenges in children with ASD communicating their GI symptoms. That is a challenge in itself.
Difficulty communicating is the major challenge I think of. GI symptoms is not observable or measurable so I imagine it might be difficult for children, especially those with limitations in communication, to tell us what their symptoms are accurately for assessment. Additionally food acceptance challenge will make it even harder for this population to follow the proper diet to ease and manage their GI symptoms. Some children with Autism struggle to accept certain textures. This greatly limits what the child is willing to eat to help manage their symptoms. Like others mentioned above, the best way to work with children and food is to keep exposing them to new foods. If they don't like it or didn't try it the first few times, keep offering it to improve their acceptance of that food. It's also important to work with the parents so they practice encouraging their children to try new foods at home or eat certain foods such as eating fruits and vegetables. I have seen a lot of parents voicing concerns that their children don't eat vegetables, but it turns out the parents usually refuse to eat vegetables too. So it's very important to work with the parents to be a good model and encourage their children to eat by exposure not by force. Working with children with limitations in communication and other barriers including those with autism requires extra patience and creativity to find foods they are willing to accept.
As several others have said previously, I think that communication is the key to treating or managing GI symptoms in children with ASD. Getting the parents involved will be extremely beneficial as they are the key providers for the child majority of the time. They observe what they eat, when they eat and how they eat and the reactions they have after eating. Encouraging the parents to keep a journal of the time the kid is eating and what they eat and as well as when any symptoms occur and the a description of the symptoms they observe would be very beneficial to pinpoint the overall scenario that is occurring at home. Working with the parent/guardian and the child to find foods/eating patterns that will lessen their symptoms is the main objective, so working together will be very important.
For children, a major concern is obtaining all of the necessary nutrients needed for optimal growth. So children who are selective eaters presents a challenge for an RD. As Vivian mentioned, exposing them to new foods is important because children tend to mimic their parents' habits for the rest of their life, so having lots of fruits, vegetables, and other healthy foods in the house regularly will promote healthy eating for when they grow older.
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