The role of the speech language pathologist in the diagnosis and multidisciplinary treatment of children with feeding difficulties: a new vision
O papel do fonoaudiólogo no diagnóstico e tratamento multiprofissional da criança com dificuldade alimentar: uma nova visão
Patrícia Junqueira; Priscila Maximino; Cláudia de Cassia Ramos; Rachel Helena Vieira Machado; Izaura Assumpção; Mauro Fisberg
Abstract
The article reports the case study of a two year and six months 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 sensorial development, followed by chewing development and associated to family guidance. Patient started having meals with the family and taking part in social mealtime routines. Duration of meals diminished and food refusal eliminated. Motor-oral system patterns improved significantly. Reassessment in 3 months showed reduction in gastroesophagealreflux symptoms and medication was removed. The nutritionist introduced dairy products with good acceptance. The Mealtime Partners Program, proved to be effective in the diagnostics 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.
Keywords
Resumo
O presente artigo relata o caso clínico de paciente de dois anos e seis meses atendida por equipe multidisciplinar. A paciente apresentou dificuldades alimentares caracterizadas por recusa alimentar, tempo prolongado das refeições, defesa sensório-oral, reflexo de vômito anteriorizado e dificuldade mastigatória. Não se alimentava sozinha, nem participava das refeições em família. Apresentava refluxo gastroesofágico, alergia a proteína do leite de vaca e tosse seguida por vômito. Não apresentou comprometimento pondero-estatural. Foi utilizado o Programa de Refeição Compartilhada. Após acompanhamento médico, a conduta de trabalho foi definida e iniciada pelo trabalho sensório-oral, seguido do trabalho com a mastigação, associados ao trabalho de orientação familiar. A paciente passou a realizar as refeições com a família e participar das rotinas sociais de alimentação. O tempo de refeição foi reduzido e a recusa alimentar eliminada. Os aspectos sensório-motores-orais melhoraram significantemente. Após a alta e reavaliação em três meses, apresentou melhora no refluxo gastro-esofágico e a medicação foi suprimida. A nutricionista iniciou a introdução de derivados do leite, com boa aceitação por parte da paciente. O programa utilizado mostrou-se eficaz para o diagnóstico e tratamento da dificuldade alimentar apresentada pela paciente. A equipe multidisciplinar foi capaz de ter uma visão ampliada da dificuldade alimentar apresentada pela paciente, compreendendo as questões motoras, orais, orgânicas e nutricionais da alimentação da criança inseridas no seu contexto familiar.
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Referências
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Submetido em:
03/07/2014
Aceito em:
08/12/2014
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