Key Principles of Practice
A child’s eating, feeding and swallowing abilities are influenced by a range of individual, physiological, social and environmental factors. Intervention and health service provision should be tailored according to the specific needs of the child, their family, and environment. The following key principles should underpin the practice of clinicians throughout the screening, assessment and management of children with PFD.
A child’s safety, welfare and protection are important factors to consider when working with families. Healthcare providers are uniquely placed to support families and work collaboratively to promote the development of a safe and healthy environment for all children, their parents and caregivers.
Refer to: How Child Intervention Works
“Family-centred service is made up of a set of values, attitudes, and approaches to services for children with special needs and their families. Family-centred service recognizes that each family is unique; that the family is the constant in the child's life; and that they are the experts on the child's abilities and needs. The family works with service providers to make informed decisions about the services and supports the child and family receive. In family-centred service, the strengths and needs of all family members are considered.” (Rush & Shelden, 2011).
Refer to: Patient & Family-Centred Care
“At the core of the provision of family-centred care lies the premise that practitioners believe that all families are capable and competent.” (Rush & Shelden, 2011).
The AHS Patient First Strategy provides the foundation for supporting children and their families. Clinicians focus on promoting respect, open communication, a team-based approach to care and supported transitions. Child and family perspectives, context, cultural considerations and strategies to involve families in co-designing services are essential to collaborative practice. For practice guidance, refer to Voice & Choice: Team and Self Reflection in Person & Family Centred Care.
Refer to: Patient First Strategy
For the purposes of this guide, the term ‘parent’ will be used to refer to any individual who takes on the role of caring for a child in the context of the family unit. The term ‘caregiver’ will be used in the context of educational and child care settings.
Relational and responsive approaches to feeding serve as the foundation to guide assessment and management. In a relational approach, behaviour is interpreted through the lens of safety, challenge, or threat; safety, security and trust in the relationship is promoted over reward and punishment (Rowell & McGlothlin, 2015); (Lillas & Turnbull, 2009).
Responsive feeding is embedded in a theoretical framework of responsive parenting (Black & Aboud, 2011). It emphasizes parental responsivity to the infant, and honours the partnership and relationship between the child or youth, and parent or caregiver. An important element of responsive parenting is serve and return interactions, which support healthy brain development and have a lifelong impact on development, and physical and mental health (Harvard University, 2016). The traditional example is a parent responding to a child’s attempt to communicate by communicating back with words, or with eye contact or a playful interaction. Within the feeding relationship, serve and return is being responsive to a child’s hunger cues and satiety cues.
Early feeding problems may affect parent-infant interactions which can impact later feeding relationships (Browne & Sundseth Ross, 2011). In some cases, early feeding problems may be experienced as trauma.
A responsive feeding environment promotes both recognition and prompt response to the child’s signs of hunger and satiety in emotionally supportive, and developmentally appropriate ways (Black & Aboud, 2011).
Responsive Feeding Therapy (RFT) is feeding guidance that depends on the caregiver’s ability to read the child’s cues in order to make the eating or feeding opportunity manageable, enjoyable, and successful, while retaining developmentally appropriate structure and expectations (Rowell & McGlothlin, 2015).
As a philosophical and clinical framework, RFT describes an overarching interprofessional approach to feeding and eating interventions that is applicable across the life span
- Relationship: a dynamic and responsive exchange between the child and parent
- Autonomy: enabling the child to be in control of their actions
- Internal motivation: action that is self-driven
- Individualized care: personalized holistic care
- Competence: the parent and child feel they have the skills to manage
(Rowell, Wong, Cormack, & Moreland, 2020)
Parents and caregivers need to be cognizant of their own triggers (emotional, sensory, physical, and environmental), so they can self-regulate and provide co-regulation for the child at mealtimes and other daily routines (Lillas & Turnbull, 2009).
Interdisciplinary practice is defined as a “dynamic process involving two or more healthcare providers with complementary backgrounds and skills, sharing common health goals and exercising concerted physical and mental effort in assessing, planning, or evaluating patient care. This is accomplished through interdependent collaboration, open communication and shared decision-making. This in turn generates value-added patient, organizational and staff outcomes” (Xyrichs & Ream, 2008). An interdisciplinary approach analyzes, synthesizes and harmonizes links between disciplines into a coordinated and coherent whole (Choi & Pak, 2008).
Team members from multiple disciplines play a critical role in the provision of care in the area of PFD. Interprofessional collaboration is the process of developing and maintaining effective interprofessional working relationships with learners, practitioners, patients, clients or families, and communities to enable optimal health outcomes. Foundational elements of collaboration include respect, trust, shared decision making, and partnerships (National Interprofessional Competency Framework: Canadian Interprofessional Health Collaborative, 2010).
A comprehensive, interdisciplinary team approach may not be feasible in all settings, due to geographical, financial, and organizational circumstances. However, it is recommended that where possible, all disciplines involved with the child work together in a collaborative family-centred model to meet the needs and goals of the child and their family. Clinicians who are not established as part of a site-based team should seek support and work with other disciplines to facilitate the provision of as holistic a service as possible. This support may come from within their own department, geographical area, specialist services from a or tertiary facility offering specialized care for eating, feeding, and swallowing.
When appropriate, children with PFD should be under the management of a community physician, to oversee the child’s care and act as a central point of coordination.
Refer to: PEAS Collaborative Practice
Alberta Quality Matrix for Health – Continuum of Health & Dimensions of Quality
The Quality Matrix enables the public, patients, providers, and organizations to see how levels of quality and areas of need might intersect. It has been used in numerous ways, including policy development, strategic and service planning, and as a way to educate the public about quality in healthcare. This Matrix has been used to guide the development of evaluation tools for the PEAS Project.
Refer to: Alberta Quality Matrix for Health
Our Values - AHS Cares
The five AHS values – compassion, accountability, respect, excellence and safety – are at the heart of everything that we do. They inspire, empower and guide how we work together with patients, clients, families and each other.
Refer to: AHS Vision, Mission, Values & Strategies
Professional Practice and Rehabilitation Conceptual Frameworks
Professional Practice in Action outlines how AHS supports excellence in professional practice. It illustrates the expectation of how professionals work at AHS so they can provide patient and family-centred, quality care to Albertans. Professional Practice in Action is part of Our People Strategy and supports the Patient First Strategy. The Rehabilitation Conceptual Framework is a practical example of professional practice in action. This guide can be used to conceptualize, design and deliver rehabilitation services. The PEAS Collaborative Practice toolkit/handbook, is a set of practical tools specific to PFD to be used by managers and healthcare professionals including scope of practice, collaborative practice guidance, and communication tools to use with families.