ABSTRACT

Background

Swallowing difficulties are common and complex in children with physical, behavioural, and cognitive needs. This study (i) describes mealtime management and (ii) identifies barriers and facilitators to implementation of a guideline for school-aged children with feeding difficulties in one specialist school.

Method

Three data sets were collected: (i) 51 school records, (ii) 48 meal observations, and (iii) seven staff interviews. The model of behaviour COM-B (Capacity Opportunity Motivation and Behaviour) was used to identify barriers and facilitators.

Results

28 school records stated diet modifications and five children were enterally tube fed. Seventy percent of children had mealtime assistance. Only 25% of children had written plans and these did not contain all strategies observed. When feeding plans were vague or disagreements occurred, policy did not support decision-making.

Conclusions

A coordinated approach is needed. Target areas for change include staff and family education; defined processes for cross-agency documentation and more detailed plans for all children.

中文翻译：

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实施针对有喂养困难的学龄儿童指南的障碍和促进因素

摘要

背景

吞咽困难在有身体、行为和认知需求的儿童中很常见，也很复杂。本研究 (i) 描述了进餐时间管理，并 (ii) 确定了在一所专科学校为有喂养困难的学龄儿童实施指南的障碍和促进因素。

方法

收集了三个数据集：(i) 51 份学校记录，(ii) 48 份膳食观察，以及 (iii) 7 名员工访谈。行为模型 COM-B（能力机会动机和行为）用于识别障碍和促进因素。

结果

28 份学校记录表明饮食调整，5 名儿童接受肠内管饲。70% 的儿童有进餐帮助。只有 25% 的儿童有书面计划，而且这些计划并未包含所有观察到的策略。当喂养计划含糊不清或出现分歧时，政策不支持决策。

结论

需要一种协调的方法。变革的目标领域包括员工和家庭教育；为所有儿童定义跨机构文件和更详细计划的流程。