General

Guideline Title

Best evidence statement (BESt). Behavioral and oral motor interventions for feeding problems in children.

Bibliographic Source(s)

  • Cincinnati Children’s Hospital Medical Center. Best evidence statement (BESt). Behavioral and oral motor interventions for feeding problems in children. Cincinnati (OH): Cincinnati Children’s Hospital Medical Center; 2013 Jul 15. 10 p. [54 references]

Guideline Status

This is the current release of the guideline.

Recommendations

Major Recommendations

The strength of the recommendation (strongly recommended, recommended, or no recommendation) and the quality of the evidence (1a-5b) are defined at the end of the “Major Recommendations” field.

  1. It is recommended that an intensive feeding program model that combines oral motor and behavioral interventions may be used with children with severe feeding problems to increase intake. (Byars et al., 2003 [3a]; Sharp, Odom, & Jaquess, 2012 [4a]; Sharp et al., 2011 [4a]; Laud et al., 2009 [4a]; Lamm, De Felice, & Cargan, 2005 [4a]; Clawson, Kuchinski, & Bach, 2007 [4b]; Clawson, Palinski, & Elliott 2006 [4b]; Gulotta et al., 2005 [4b]; Harding, Faiman, & Wright, 2010 [5a]; Sharp, Harker & Jaquess, 2010 [5a]; Sharp & Jacquess, 2009 [5a]; Gibbons, Williams, & Riegal, 2007 [5a]; Tarbell & Allaire, 2002 [5a]; Shore et al., 1998 [5a]).

Note : Programs ranged from 2 weeks to 8 weeks duration; treatments 4-11 times per day (Laud et al., 2009 [4a]; Lamm, De Felice, & Cargan, 2005 [4a]; Clawson, Kuchinski, & Bach, 2007 [4b]; Clawson, Palinski, & Elliott 2006 [4b]; Gulotta et al., 2005 [4b]; Gibbons, Williams, & Riegal, 2007 [5a]; Tarbell & Allaire, 2002 [5a]).

  1. It is recommended that the following behavioral interventions within a treatment package may be used to increase intake for children with feeding problems: 1. Differential attention* (Williams, Field, & Seiverling, 2010 [1b]; Kerwin, 1999 [1b]) 2. Positive reinforcement* (Williams, Field, & Seiverling, 2010 [1b]; Remington et al., 2012 [2a]; Cooke et al., 2011 [2a]; Byars et al., 2003 [3a]; Knox et al., 2012 [5a]; Kozlowski et al., 2011 [5a]; Binnendyk & Lucyshyn, 2009 [5a]; Gentry & Luisella, 2008 [5a]; Kelley et al., 2003 [5a]; Shore et al., 1998 [5a]; Larson, Ayllon, & Barrett, 1987 [5b]) 3. Escape extinction/escape prevention* (Williams, Field, & Seiverling, 2010 [1b]; Kerwin, 1999 [1b]; Byars et al., 2003 [3a]; Seiverling et al., 2012 [4a]; Sharp, Odom, & Jaquess, 2012 [4a]; Volkert et al., 2011 [4a]; Najdowski et al., 2010 [4a]; Williams et al., 2008 [4a]; VanDalen & Penrod, 2010 [4b]; Kozlowski et al., 2011 [5a]; Sharp, Harker, & Jaquess, 2010 [5a]; Valdimarsdottir, Halldorsdottir, & Sigurthardottir, 2010 [5a]; Sharp & Jacquess, 2009 [5a]; Girolami, Boscoe, & Roscoe, 2007 [5a]; Patel et al., 2007 [5a]; Shore et al., 1998 [5a]; Kern & Marder, 1996 [5a]; Najdowski et al., 2003 [5b]) 4. Stimulus fading* (Williams, Field & Seiverling, 2010 [1b]; Seiverling et al., 2012 [4a]; Sharp et al., 2011 [4a]; Knox et al., 2012 [5a]; Meier, Fryling, & Wallace, 2012 [5a]; Valdimarsdottir, Halldorsdottir, & Sigurthardottir, 2010 [5a]; Luiselli, Ricciardi, & Gilligan, 2005 [5a]; Patel et al., 2001 [5a]; Shore, et al., 1998 [5a]; Najdowski et al., 2003 [5b]) 5. Simultaneous presentation* (Piazza et al., 2002 [4a]; VanDalen & Penrod, 2010 [4b]; Gentry & Luisella, 2008 [5a]; Buckley & Newchok, 2005 [5a]; Mueller et al., 2004 [5a]; Ahearn, 2003 [5a]; Kern & Marder, 1996 [5a]) 6. Differential reinforcement of alternative behavior (DRA)* (Williams, Field, & Seiverling, 2010 [1b]; Sharp et al., 2011 [4a]; Najdowski et al., 2010 [4a]; Valdimarsdottir, Halldorsdottir, & Sigurthardottir, 2010 [5a]; Buckley & Newchok, 2005 [5a]; Mueller et al., 2004 [5a]; Patel et al., 2001 [5a]; Kahng, Boscoe, & Byrne, 2003 [5b]; Najdowski et al., 2003 [5b]) 7. Use of a flipped spoon as a presentation method* (Sharp, Odom & Jaquess, 2012 [4a]; Volkert et al., 2011 [4a]; Sharp, Harker, & Jaquess, 2010 [5a])

Note : Interventions listed above are in rank order, based on strength of evidence.

*Definitions for terms marked with * may be found in the Supporting Information section of the original guideline document.

  1. It is recommended that oral motor treatment for spoon-feeding, biting and chewing may be used to increase intake for children with cerebral palsy who have moderate feeding impairments (Snider, Majnemer & Darsaklis, 2011 [1b]; Davies, 2003 [1b]).
  2. It is recommended that a child be exposed 10-15 times to a previously unfamiliar or non-preferred food to increase intake for children (4 months-7 years) with feeding difficulties (Remington et al., 2012 [2a]; Cooke et al., 2011 [2a]; Wardle et al., “Increasing,” 2003 [2a]; Wardle et al., “Modifying,” 2003 [2a]; Birch et al., 1998 [2a]; Sullivan & Birch, 1990 [2b]; Sullivan & Birch, 1994 [4a]).

Note 1 : There was a gap in evidence concerning exposure for children ages 8-24 months.

Note 2 : For children with Autism Spectrum Disorders (ASD), variable patterns of exposure (from less than 10 exposures to more than 10) were needed to increase intake (Williams et al., 2008 [4a]; Paul et al., 2007 [5a]).

Note 3 : For sustained increase in intake, pairing exposure with reinforcement (rewards) may be needed (Cooke et al., 2011 [2a]).

Definitions:

Table of Evidence Levels

Quality Level Definition
1a† or 1b† Systematic review, meta-analysis, or meta-synthesis of multiple studies
2a or 2b Best study design for domain
3a or 3b Fair study design for domain
4a or 4b Weak study design for domain
5a or 5b General review, expert opinion, case report, consensus report, or guideline
5 Local Consensus

†a = good quality study; b = lesser quality study

Table of Language and Definitions for Recommendation Strength

Language for Strength Definition
It is strongly recommended that…

It is strongly recommended that…not… 		When the dimensions for judging the strength of the evidence are applied, there is high support that benefits clearly outweigh risks and burdens (or visa-versa for negative recommendations).
It is recommended that…

It is recommended that… not… 		When the dimensions for judging the strength of the evidence are applied, there is moderate support that benefits are closely balanced with risks and burdens.
There is insufficient evidence and a lack of consensus to make a recommendation…

Note : See the original guideline document for the dimensions used for judging the strength of the recommendation.

Clinical Algorithm(s)

None provided

Scope

Disease/Condition(s)

Feeding problems:

  • Oral feeding problems
  • Chronic food refusal
  • Selectivity
  • Failure to advance texture
  • Inappropriate mealtime behaviors

Guideline Category

  • Management
  • Treatment

Clinical Specialty

  • Family Practice
  • Nursing
  • Nutrition
  • Pediatrics
  • Psychiatry
  • Psychology
  • Speech-Language Pathology

Intended Users

  • Advanced Practice Nurses
  • Nurses
  • Occupational Therapists
  • Physician Assistants
  • Physicians
  • Psychologists/Non-physician Behavioral Health Clinicians
  • Speech-Language Pathologists

Guideline Objective(s)

To evaluate, in children with feeding problems, if oral motor interventions with or without behavioral interventions are effective at increasing intake (quantity, variety, texture)

Target Population

Infants and children (birth through adolescence) with feeding problems including oral feeding problems, chronic food refusal, selectivity, failure to advance texture, and inappropriate mealtime behaviors such as throwing food and temper tantrums

Note : Children with feeding problems such as anorexia, bulimia, and pre-term infants with oral motor immaturity are not included.

Interventions and Practices Considered

  1. Intensive feeding program model (combining oral motor and behavioral interventions)
  2. Behavioral interventions: * Differential attention * Positive reinforcement * Escape extinction/escape prevention * Stimulus fading * Simultaneous presentation * Differential reinforcement of alternative behavior * Flipped spoon food presentation method
  3. Oral motor treatment for spoon-feeding, biting and chewing
  4. Exposure of child 10-15 times to a previously unfamiliar or non-preferred food

Major Outcomes Considered

Treatment effectiveness at increasing intake (quantity, variety, texture)

Methodology

Methods Used to Collect/Select the Evidence

  • Searches of Electronic Databases

Description of Methods Used to Collect/Select the Evidence

Search Strategy

  • Databases : OVID MEDLINE, OVID CINAHL, OVID EBM Reviews (Cochrane), PubMed Clinical Queries, CAT Banks for OT, Center for Evidence-based Medicine, OT Evidence, National Guideline Clearinghouse, OT Exchange, OT Seeker, Pediatric Physical Therapy, PEDro, TRIP, University of Michigan Department of Pediatrics, The World Confederation of Physical Therapy, PsycINFO, Medlink
  • Search Terms : Feeding Difficulties, Feeding Challenges, Feeding Dysfunction, Feeding Disorder, Feeding Disturbance, Feeding Delay, Feeding Aversion, Feeding and Sensory, Feeding Intervention, Feeding Therapy, Feeding Plan, Feeding and Behavior, Food and Aversion, Food and Sensitivity, Failure to Thrive, Refusal to Eat, Behavioral Strategies and Reinforcement, Behavioral Strategies and Reward, Behavioral Strategies and Sensory, Occupational Therapy and Feeding; Texture and Eating; Sensation and Eating; Sensory and Eating; Tactile and Eating; Sensation and Feeding; Hypersensitivity and Feeding; Tactile and Feeding; Sensory Integration and Feeding; Sensory Strategies and Feeding; Sensory Processing and Oral Motor; Sensory Processing and Feeding
  • Limits and Filters : Published date from 1990 to February 2013; Human; Language: English; Age Groups: Child, Preschool 2-5 years, Child, 6-12 years, Adolescence, 13-18 years
  • Last search completed : February 2013

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence

  • Weighting According to a Rating Scheme (Scheme Given)

Rating Scheme for the Strength of the Evidence

Table of Evidence Levels

Quality Level Definition
1a† or 1b† Systematic review, meta-analysis, or meta-synthesis of multiple studies
2a or 2b Best study design for domain
3a or 3b Fair study design for domain
4a or 4b Weak study design for domain
5a or 5b General review, expert opinion, case report, consensus report, or guideline
5 Local Consensus

†a = good quality study; b = lesser quality study

Methods Used to Analyze the Evidence

  • Systematic Review

Description of the Methods Used to Analyze the Evidence

Not stated

Methods Used to Formulate the Recommendations

  • Expert Consensus

Description of Methods Used to Formulate the Recommendations

Not stated

Rating Scheme for the Strength of the Recommendations

Table of Language and Definitions for Recommendation Strength

Language for Strength Definition
It is strongly recommended that… It is strongly recommended that…not… When the dimensions for judging the strength of the evidence are applied, there is high support that benefits clearly outweigh risks and burdens (or visa-versa for negative recommendations).
It is recommended that… It is recommended that… not… When the dimensions for judging the strength of the evidence are applied, there is moderate support that benefits are closely balanced with risks and burdens.
There is insufficient evidence and a lack of consensus to make a recommendation…

Note : See the original guideline document for the dimensions used for judging the strength of the recommendation.

Cost Analysis

A formal cost analysis was not performed and published cost analyses were not reviewed.

Method of Guideline Validation

  • Peer Review

Description of Method of Guideline Validation

This Best Evidence Statement (BESt) has been reviewed against quality criteria by two independent reviewers from the Cincinnati Children’s Hospital Medical Center (CCHMC) Evidence Collaboration.

Evidence Supporting the Recommendations

References Supporting the Recommendations

  • Ahearn WH. Using simultaneous presentation to increase vegetable consumption in a mildly selective child with autism. J Appl Behav Anal. 2003 Fall;36(3):361-5. PubMed
  • Binnendyk L, Lucyshyn J. A family-centered positive behavior support aApproach to the amelioration of food refusal behavior: an empirical case study. J Posit Behav Interv. 2009;:1098300708318965v1.
  • Birch LL, Gunder L, Grimm-Thomas K, Laing DG. Infants’ consumption of a new food enhances acceptance of similar foods. Appetite. 1998 Jun;30(3):283-95. PubMed
  • Buckley SD, Newchok DK. An evaluation of simultaneous presentation and differential reinforcement with response cost to reduce packing. J Appl Behav Anal. 2005 Fall;38(3):405-9. PubMed
  • Byars KC, Burklow KA, Ferguson K, O’Flaherty T, Santoro K, Kaul A. A multicomponent behavioral program for oral aversion in children dependent on gastrostomy feedings. J Pediatr Gastroenterol Nutr. 2003 Oct;37(4):473-80. PubMed
  • Clawson EP, Kuchinski KS, Bach R. Use of behavioral interventions and parent education to address feeding difficulties in young children with spastic diplegic cerebral palsy. Neurorehabilitation. 2007;22(5):397-406. PubMed
  • Clawson EP, Palinski KS, Elliott CA. Outcome of intensive oral motor and behavioural interventions for feeding difficulties in three children with Goldenhar Syndrome. Pediatr Rehabil. 2006 Jan-Mar;9(1):65-75. PubMed
  • Cooke LJ, Chambers LC, Anez EV, Croker HA, Boniface D, Yeomans MR, Wardle J. Eating for pleasure or profit: the effect of incentives on children’s enjoyment of vegetables. Psychol Sci. 2011 Feb;22(2):190-6. PubMed
  • Davies F. Does the ends justify the means?. Asia Pac J Speech Lang Hear. 2003;8(2):146-52.
  • Gentry JA, Luiselli JK. Treating a child’s selective eating through parent implemented feeding intervention in the home setting. J Dev Phys Disabil. 2008;20(1):63-70.
  • Gibbons BG, Williams KE, Riegel KE. Reducing tube feeds and tongue thrust: combining an oral-motor and behavioral approach to feeding. Am J Occup Ther. 2007 Jul-Aug;61(4):384-91. PubMed
  • Girolami PA, Boscoe JH, Roscoe N. Decreasing expulsions by a child with a feeding disorder: using a brush to present and re-present food. J Appl Behav Anal. 2007 Winter;40(4):749-53. PubMed
  • Gulotta CS, Piazza CC, Patel MR, Layer SA. Using food redistribution to reduce packing in children with severe food refusal. J Appl Behav Anal. 2005 Spring;38(1):39-50. PubMed
  • Harding C, Faiman A, Wright J. Evaluation of an intensive desensitisation, oral tolerance therapy and hunger provocation program for children who have had prolonged periods of tube feeds. Int J Evid Based Healthc. 2010 Dec;8(4):268-76. PubMed
  • Kahng S, Boscoe JH, Byrne S. The use of an escape contingency and a token economy to increase food acceptance. J Appl Behav Anal. 2003 Fall;36(3):349-53. PubMed
  • Kelley ME, Piazza CC, Fisher WW, Oberdorff AJ. Acquisition of cup drinking using previously refused foods as positive and negative reinforcement. J Appl Behav Anal. 2003 Spring;36(1):89-93. PubMed
  • Kern L, Marder TJ. A comparison of simultaneous and delayed reinforcement as treatments for food selectivity. J Appl Behav Anal. 1996 Summer;29(2):243-6. PubMed
  • Kerwin ME. Empirically supported treatments in pediatric psychology: severe feeding problems. J Pediatr Psychol. 1999 Jun;24(3):193-214; discussion 215-6. [92 references] PubMed
  • Knox M, Rue HC, Wildenger L, Lamb K, Luiselli JK. Intervention for food selectivity in a specialized school setting: Teacher implemented prompting, reinforcement, and demand fading for an adolescent student with autism. Educ Treat Child. 2012;35(3):407-17.
  • Kozlowski AM, Matson JL, Fodstad JC, Moree BN. Feeding therapy in a child with autistic disorder: Sequential food presentation. Clin Case Studies. 2011;10(3):236-46.
  • Lamm NC, De Felice A, Cargan A. Effect of tactile stimulation on lingual motor function in pediatric lingual dysphagia. Dysphagia. 2005 Fall;20(4):311-24. PubMed
  • Larson KL, Ayllon T, Barrett DH. A behavioral feeding program for failure-to-thrive infants. Behav Res Ther. 1987;25(1):39-47. PubMed
  • Laud RB, Girolami PA, Boscoe JH, Gulotta CS. Treatment outcomes for severe feeding problems in children with autism spectrum disorder. Behav Modif. 2009 Sep;33(5):520-36. PubMed
  • Luiselli JK, Ricciardi JN, Gilligan K. Liquid fading to establish milk consumption by a child with autism. Behav Interv. 2005;20(2):155-63.
  • Meier AE, Fryling MJ, Wallace MD. Using high-probability foods to increase the acceptance of low-probability foods. J Appl Behav Anal. 2012 Spring;45(1):149-53. PubMed
  • Mueller MM, Piazza CC, Patel MR, Kelley ME, Pruett A. Increasing variety of foods consumed by blending nonpreferred foods into preferred foods. J Appl Behav Anal. 2004 Summer;37(2):159-70. PubMed
  • Najdowski AC, Wallace MD, Doney JK, Ghezzi PM. Parental assessment and treatment of food selectivity in natural settings. J Appl Behav Anal. 2003 Fall;36(3):383-6. PubMed
  • Najdowski AC, Wallace MD, Reagon K, Penrod B, Higbee TS, Tarbox J. Utilizing a home-based parent training approach in the treatment of food selectivity. Behav Interv. 2010;25(2):89-107.
  • Patel M, Reed GK, Piazza CC, Mueller M, Bachmeyer MH, Layer SA. Use of a high probability instructional sequence to increase compliance to feeding demands in the absence of escape extinction. Behav Interv. 2007;22(4):305-10.
  • Patel MR, Piazza CC, Kelly L, Ochsner CA, Santana CM. Using a fading procedure to increase fluid consumption in a child with feeding problems. J Appl Behav Anal. 2001 Fall;34(3):357-60. PubMed
  • Paul C, Williams KE, Riegel K, Gibbons B. Combining repeated taste exposure and escape prevention: an intervention for the treatment of extreme food selectivity. Appetite. 2007 Nov;49(3):708-11. PubMed
  • Piazza CC, Patel MR, Santana CM, Goh HL, Delia MD, Lancaster BM. An evaluation of simultaneous and sequential presentation of preferred and nonpreferred food to treat food selectivity. J Appl Behav Anal. 2002 Fall;35(3):259-70. PubMed
  • Remington A, Anez E, Croker H, Wardle J, Cooke L. Increasing food acceptance in the home setting: a randomized controlled trial of parent-administered taste exposure with incentives. Am J Clin Nutr. 2012 Jan;95(1):72-7. PubMed
  • Seiverling L, Williams K, Sturmey P, Hart S. Effects of behavioral skills training on parental treatment of children’s food selectivity. J Appl Behav Anal. 2012 Spring;45(1):197-203. PubMed
  • Sharp WG, Harker S, Jaquess DL. Comparison of bite-presentation methods in the treatment of food refusal. J Appl Behav Anal. 2010 Winter;43(4):739-43. PubMed
  • Sharp WG, Jaquess DL, Morton JF, Miles AG. A retrospective chart review of dietary diversity and feeding behavior of children with autism spectrum disorder before and after admission to a day-treatment program. Focus Autism Dev Disabil. 2011 Mar;26(1):37-48. [39 references]
  • Sharp WG, Jaquess DL. Bite size and texture assessments to prescribe treatment for severe food selectivity in autism. Behav Interv. 2009;24(3):157-70.
  • Sharp WG, Odom A, Jaquess DL. Comparison of upright and flipped spoon presentations to guide treatment of food refusal. J Appl Behav Anal. 2012 Spring;45(1):83-96. PubMed
  • Shore BA, Babbitt RL, Williams KE, Coe DA, Snyder A. Use of texture fading in the treatment of food selectivity. J Appl Behav Anal. 1998 Winter;31(4):621-33. PubMed
  • Snider L, Majnemer A, Darsaklis V. Feeding interventions for children with cerebral palsy: a review of the evidence. Phys Occup Ther Pediatr. 2011 Feb;31(1):58-77. PubMed
  • Sullivan SA, Birch LL. Infant dietary experience and acceptance of solid foods. Pediatrics. 1994 Feb;93(2):271-7. PubMed
  • Sullivan SA, Birch LL. Pass the sugar, pass the salt: experience dictates preference. Dev Psychol. 1990;26(4):546.
  • Tarbell MC, Allaire JH. Children with feeding tube dependency: treating the whole child. Infants Young Child. 2002;15(1):29-41.
  • Valdimarsdottir H, Halldorsdottir LY, Sigurthardottir ZG. Increasing the variety of foods consumed by a picky eater: generalization of effects across caregivers and settings. J Appl Behav Anal. 2010 Mar;43(1):101-5. PubMed
  • VanDalen KH, Penrod B. A comparison of simultaneous versus sequential presentation of novel foods in the treatment of food selectivity. Behav Interv. 2010;25(3):191-206.
  • Volkert VM, Vaz PC, Piazza CC, Frese J, Barnett L. Using a flipped spoon to decrease packing in children with feeding disorders. J Appl Behav Anal. 2011 Fall;44(3):617-21. PubMed
  • Wardle J, Cooke LJ, Gibson EL, Sapochnik M, Sheiham A, Lawson M. Increasing children’s acceptance of vegetables; a randomized trial of parent-led exposure. Appetite. 2003 Apr;40(2):155-62. PubMed
  • Wardle J, Herrera ML, Cooke L, Gibson EL. Modifying children’s food preferences: the effects of exposure and reward on acceptance of an unfamiliar vegetable. Eur J Clin Nutr. 2003 Feb;57(2):341-8. PubMed
  • Williams KE, Field DG, Seiverling L. Food refusal in children: a review of the literature. Res Dev Disabil. 2010 May-Jun;31(3):625-33. [57 references] PubMed
  • Williams KE, Paul C, Pizzo B, Riegel K. Practice does make perfect. A longitudinal look at repeated taste exposure. Appetite. 2008 Nov;51(3):739-42. PubMed

Type of Evidence Supporting the Recommendations

The type of supporting evidence is identified and graded for each recommendation (see the “Major Recommendations” field).

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits

Improved outcomes in children with feeding problems through effective behavioral and oral motor interventions to increase food intake

Potential Harms

Not stated

Qualifying Statements

Qualifying Statements

This Best Evidence Statement addresses only key points of care for the target population; it is not intended to be a comprehensive practice guideline. These recommendations result from review of literature and practices current at the time of their formulation. This Best Evidence Statement does not preclude using care modalities proven efficacious in studies published subsequent to the current revision of this document. This document is not intended to impose standards of care preventing selective variances from the recommendations to meet the specific and unique requirements of individual patients. Adherence to this Statement is voluntary. The clinician in light of the individual circumstances presented by the patient must make the ultimate judgment regarding the priority of any specific procedure.

Implementation of the Guideline

Description of Implementation Strategy

Applicability Issues

Further development of interdisciplinary collaboration between occupational therapy, behavioral psychology and other medical professionals is needed. Program development, structure, processes and staffing would be required to implement recommendations regarding intensity. A potential barrier may be the cost of training occupational therapists to implement these recommendations. Clinical judgment is necessary to apply the evidence to each patient, due to the variability of the body of evidence. While studies mentioned the importance of treating medical conditions comorbid with food refusal, the role of medical management in the treatment of food refusal was not clear. Further research is needed in this area.

Implementation Tools

  • Audit Criteria/Indicators

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need

  • Getting Better

IOM Domain

  • Effectiveness
  • Patient-centeredness

Identifying Information and Availability

Bibliographic Source(s)

  • Cincinnati Children’s Hospital Medical Center. Best evidence statement (BESt). Behavioral and oral motor interventions for feeding problems in children. Cincinnati (OH): Cincinnati Children’s Hospital Medical Center; 2013 Jul 15. 10 p. [54 references]

Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released

2013 Jul 15

Guideline Developer(s)

  • Cincinnati Children’s Hospital Medical Center - Hospital/Medical Center

Source(s) of Funding

Cincinnati Children’s Hospital Medical Center

No external funding was received for development of this Best Evidence Statement (BESt).

Guideline Committee

Not stated

Composition of Group That Authored the Guideline

Team Leader : Michelle Koziel, OTR/L, Division of Occupational Therapy and Physical Therapy

Team Members : Angela Bates, OTD, OTR/L, Division of Occupational Therapy and Physical Therapy; Julie Gerdes, MHS, OTR/L, Division of Occupational Therapy and Physical Therapy; Elizabeth Manford, MOT, OTR/L, Division of Occupational Therapy and Physical Therapy; Rebecca D. Reder, OTD, OTR/L, Senior Clinical Director, Division of Occupational Therapy and Physical Therapy

Financial Disclosures/Conflicts of Interest

Conflict of interest declaration forms are filed with the Cincinnati Children’s Hospital Medical Center (CCHMC) Evidence-Based Decision Making (EBDM) group. No financial conflicts of interest were found.

Guideline Status

This is the current release of the guideline.

Guideline Availability

Available from the Cincinnati Children’s Hospital Medical Web site.

Availability of Companion Documents

The following are available:

  • Judging the strength of a recommendation. Cincinnati (OH): Cincinnati Children’s Hospital Medical Center; 2008 Jan. 1 p. Available from the Cincinnati Children’s Hospital Medical Center.
  • Grading a body of evidence to answer a clinical question. Cincinnati (OH): Cincinnati Children’s Hospital Medical Center; 1 p.
  • Table of evidence levels. Cincinnati (OH): Cincinnati Children’s Hospital Medical Center; 2008 Feb 29. 1 p. Available from the Cincinnati Children’s Hospital Medical Center.

In addition, suggested process or outcome measures are available in the original guideline document.

Patient Resources

None available

NGC Status

This NGC summary was completed by ECRI Institute on December 2, 2013.

This NGC summary is based on the original full-text guideline, which is subject to the following copyright restrictions:

Copies of this Cincinnati Children’s Hospital Medical Center (CCHMC) Best Evidence Statement (BESt) are available online and may be distributed by any organization for the global purpose of improving child health outcomes. Examples of approved uses of the BESt include the following:

  • Copies may be provided to anyone involved in the organization’s process for developing and implementing evidence based care.
  • Hyperlinks to the CCHMC website may be placed on the organization’s website.
  • The BESt may be adopted or adapted for use within the organization, provided that CCHMC receives appropriate attribution on all written or electronic documents.
  • Copies may be provided to patients and the clinicians who manage their care.

Notification of CCHMC at EBDMInfo@cchmc.org for any BESt adopted, adapted, implemented or hyperlinked by the organization is appreciated.

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