P2.132: Feeding Challenges in Substance-Exposed Infants and Young Children: Insights from the Baby Steps Clinic

Background: Prenatal substance exposure (PSE) is a growing concern in the United States with a national rate of 28.4 per 1000 Medicaid births in 2020 (West et al., 2023). Prenatal substance exposure can have known detrimental effects on development and behavior in infancy and childhood (Eiden, et al., 2023). Oral feeding is one of the most complex tasks of infancy, and evidence suggests prenatally opioid exposed infants have greater feeding problems than non-opioid-exposed infants (McGlothen-Bell, et al., 2020).

Project Description: The ETSU Health Baby Steps Clinic is a multidisciplinary, interprofessional clinic that serves infants and children from birth through five years of age. The clinic is part of a 2-generational, trauma-informed, patient- and family-centered perinatal care coordination program for children affected by prenatal substance exposure. The clinic provides an arena style, collaborative evaluation of concerns, assessment of development, and targeted education for caregivers. Since the inception of Baby Steps in 2020, the clinic has encountered high rates of feeding difficulties in the patient population.
The purpose of this project is to describe the most common feeding problems identified in prenatally substance exposed infants and young children (ages birth through five). The project will describe the role of the multidisciplinary team, including Pediatrician, Occupational Therapist, Speech-Language Pathologist, and Dietitian, in the assessment of feeding and specific interventions to improve feeding. Recommendations for appropriate referrals for feeding intervention will also be shared.

Discussion: Data collected from a retrospective chart review of the electronic health record of prenatally substance exposed infants and children (birth through five) in the Baby Steps Clinic between 2020-2023 revealed 60 of 98 (61.2%) patients had feeding problems. Common feeding problems among infants included 12.4% with poor latch / weak suck and 16.8% with difficulty of the suck / swallow / breathe coordination. In older infants and young children, 30.1% had picky eating and 18.6% had sensitivity to food textures. Specific feeding interventions included education on developmental milestones in 37.2%, sensory and food type modifications in 31.9%, and recommendations on routine and feeding schedule in 25.7%. Frequency analysis of referrals for specific feeding problems revealed 24.8% were referred to speech and language pathology, 11.5% to occupational therapy, and 6.2% to dietitian/nutrition.

Conclusion: This project details the common feeding problems identified in a multidisciplinary clinic caring for substance exposed infants and children as well as the family-centered and trauma-informed education provided by the team. Given the high rates of feeding difficulties in infants and children with PSE, it is recommended that pediatricians illicit concerns about feeding, observe feeding when possible, provide targeted recommendations on feeding, and refer for specific feeding evaluations and interventions when concerns are identified.