Meta- Analysis and Evidence-Based Research on Children Feeding Disorders The eating disorders are among pediatric clinical problems in the United States that can cause distress to clinicians and parents. Typically, eating disorders are affecting more than 40% of children of pre-school and school ages, and the associated psychology and health problems of the eating disorders include a mental retardation, behavioral problems, growth retardation, and poor academic records in schools. This study carries out the critical appraisal of a quantitative research article written by Williams et al. (2012) to demonstrate children eating disorders, and behavioral intervention in treating the problems. The study evaluates the credibility and reliability of the study by evaluating its research design, research findings, qualifications of the authors and its relevance to the clinical outcomes.

Background

The objective of this paper is to carry out the critical appraisal of evidence-based research of the article titled "Pediatric Feeding Disorders: A Quantitative Synthesis of Treatment Outcomes." (William, Jaques, Morton, et al. (2010 p 348). The critical appraisal refers to the process of systematically and carefully examining a research paper in order to judge its value, trustworthiness, and its relevance in solving the research problem. A critical appraisal allows the clinicians to identify and use research evidence efficiently and reliability. More importantly, a critical appraisal provides a reliable information to assist in making effective healthcare decisions. (Melnyk, 1999, Melnyk, 2002).

This paper chooses the article for the critical appraisal because the pediatric feeding disorders are the serious problems among children in the United States. Typically, more than 25% of children have been reported developing a feeding disorder, which can reach 80% among developmental delayed children. Consequently, the eating disorders can lead to growth failure, and chronic illness among children. A severe feeding disorder can provoke death of children.

Feeding disorders occur when children develop gastrointestinal disorders. In other words, feeding disorders arise where there is an interplay of psychological, biological and social factors, which require the intensive interventions in order to avoid long-term development and medical sequelae. A feeding disorder can also be caused by the combination of organic and psycho-social factors, and the interactions of genetic, social and psychological mechanisms can lead to behavioral problems. (Ramasamy, & Jay 2000). Additionally, multiple etiologies such as medical, behavioral, psychological, and environmental factors can be factors leading to feeding disorders. Since approximately 77% of the children with feeding disorders have had gastrointestinal-related disorders, William, Jaques, Morton, et al. (2010) believe that feeding disorders can lead to cerebral palsy, mental retardation, and behavioral modification among children. By consequence, children with feeding problems might develop behavioral problems even after the organic problem has been resolved. William, Jaques, Morton, et al. (2010) further reveal that approximately 40% of early school children and toddlers have some mealtime difficulties. Moreover, up to 10% of these children develop chronic feeding problems that result to negative development and medical outcomes, which include malnutrition, growth retardation, poor academic achievement, psychological and developmental deficits, and social difficulties.

The process of diagnosing and treating a severe feeding disorder can proved challenging for healthcare providers because healthcare professional provide different interpretations for the feeding disorders. For example, American Psychiatric Association believes that feeding disorder encompass children who are unable to eat a balance diet resulting into a chronic malnutrition. Thus, children who meet these criteria represent group of children suffering from feeding disorders.

The major reason that makes this study to carry out a critical appraisal on the William, et al. (2010) article is that research on the children feeding disorder is sparse despite that the feeding disorders among children are relative common. (Melnyk, Fineout-Overholt, Stone, et al.2000). Similar to the side effect of feeding disorder, the issues can also affect the parent's behavioral and psychological outcomes. Apart from the problems that parents encounter, however, feeding disorders can be challenging to diagnose, which can pose problems for the healthcare providers. Parents can face lots of emotional stress, which can affect the parent-child relationship. Moreover, children feeding disorder can also the caregiver emotional distress. Typically, stress in parents can affect the well-being of their children.

Statement of Purpose

Eating is very essential for the metabolism of human activity, which is necessary to ensure growth and sustain life. However, eating can become a common challenge to both caregivers and children. For example, feeding disorders can have both physiological repercussion and developmental issues on children, and the causal factors associated to the feeding disorders can disrupt family functioning. Potential feeding problem can lead to parental stress and inappropriate eating habits of children. Thus,...

This paper carries out the critical appraisal to enhance a greater understanding on the children clinical intervention strategies.
Research Question is clear in PICO format

The study uses the PICO format to develop the research question revealed as follows:

For young children (0-14 years) with suspected feeding disorders (P), should clinical and behavioral interventions (I) are able to improve the parents knowledge on the strategy to manage their children disorders (C) for the treatment of feeding disorders, and improve children health outcomes (O)?

Connections between the Research overall Clinical Problem Solutions

William, Jaques, Morton, et al. (2010) use the quantitative technique to investigate the treatment intervention for the children with eating disorders characterized with bottle/tube dependence, chronic food refusal, poor oral intake and food selectivity. Typically, the clinical and behavioral interventions are aimed to improve solid food intake among children. The authors analyze different treatment interventions for the children eating disorders, and the behavioral intervention approach that includes sensory therapy, family therapy, psychodynamic, and oral motor therapy have been identified as the effective intervention strategies for the feeding disorder among children. However, the authors partially agree that medication interventions are effective to address the problem of feeding disorders. Essentially, the behavioral intervention is an effective strategy to solve the problem of feeding disorder using the reinforcement strategy. However, the multi-component treatment strategy is also necessary involving the high degree of supervisions for a severe feeding problem. There is also a need for the intervention of behavioral psychologist, and the collaboration of other professionals such as dieticians, doctors, and occupation therapists. The goal of feeding intervention is to improve the children meal behavior, and improve the intake of calories. While the behavioral intervention is very critical to improve meal behaviors, typically, there is still a need to reduce a dependence of tube feedings, and improve the tongue control.

Ramasamy, et al. (2000) support the recommendation of behavioral intervention to change parents' behaviors towards children. Typically, parent training is very critical to ameliorate the feeding disorders because some children still face challenges in eating very well even after the feeding therapy is being carried out. Essentially, a systematic parent training involves role playing because parents who are able to participate in the role playing are able to address their children feeding disorders than parents who do not participate in a role playing. Moreover, nutrition education that involves concentration and volume of oral feeding, feeding routing and schedules are very important.

Credibility of the Study, Validity of Research design, Validity and Reliability of Research Measures

Overview of the research design carried out by William, et al. (2010) reveals that the authors use quantitative research design for the research method and analysis. The 96 children participants recruited presented both complex developmental and medical concerns. Moreover, all the children are undergoing different programs that involve the multidisciplinary feeding disorders programs coupled with clinical disciplines. The authors also listed the demographic characteristics of the participants that include their ages, and gender. Moreover, the authors identify the feeding concerns of the participants, which include children depending on feeding tube, children with poor oral intake, and liquid/bottle dependency. The authors also reveal the development issues associated to the participants feeding complications. For example, some children have been identified having mental retardation, developmental delay, and speech/language delay because of their feeding disorders. The authors also relate the medical issues associated to children with feeding disorders, and it is revealed that some children have issues such as gastrointestinal problems, genetic disorder, anatomical abnormalities, prematurity, cardiac impairment, pulmonary dysfunction / disorder, and CNS malformation/disorder because of their feeding disorders.

Despite the strategy that the authors use in enhancing the reliability and validity of the research, this paper still find some shortcomings in the method that Williams et al. (2012) employ in carrying out the research design. Although, the design of the intervention groups makes sense, nevertheless, the authors do not provide the control group in the research design. It is essential to realize that a valid and reliable research ought to have both intervention groups and control groups. Moreover, it is very important that the selection of both the intervention groups as well control groups to be similar in every respects. Thus, the study has been characterized with these shortcomings since Williams et al. 2012) do not provide the control group in their research design.

Moreover, William et al. (2012) do not discuss the ethical procedures to protect the participants' information. It is essential to realize that a…