(PS7-30) Efficacy of Telehealth Interventions in Pediatric Feeding Disorders

Background: Pediatric feeding disorders present significant medical risks and exert substantial emotional and financial burden on families. Telehealth interventions offer a promising solution by providing remote access to specialized care, especially for families in underserved areas. These interventions often involve teaching parents behavioral shaping techniques to address feeding difficulties effectively. However, despite their potential benefits, the efficacy and specific factors contributing to the success of telehealth-based interventions in treating pediatric feeding disorders are not fully understood. Therefore, this systematic review aims to assess the efficacy of telehealth interventions in this context. By synthesizing evidence on their effectiveness, this review seeks to identify more effective and sustainable approaches to improving outcomes in pediatric feeding disorders.

Methods: We searched PubMed, PsycINFO, and Google Scholar for studies published up to December 2023. Eligibility criteria included: behavioral feeding disorder intervention studies for pediatric (under 18-years-old) feeding disorders taking place in the United States with a telehealth component, a quantitative measure of efficacy, and written in English. A total of 1126 studies were imported into Covidence software for screening. After the removal of duplicate studies, 1079 studies remained for title/abstract screening. 1005 studies were deemed irrelevant based on title/abstract screening, leaving 74 studies for full-test eligibility assessment. After full-text review, 13 studies were included, and citation matching identified 1 additional study.

Results: Our search identified 14 studies that met inclusion criteria. Overall, studies showed improvements in food acceptance (M = 212.4% of increases in oral acceptance) with 36.36% of children across all studies demonstrating increases in novel foods. Studies also reported decreases in undesirable mealtime behaviors, compliance with feeding demand, and increases in mastication. Studies comparing telehealth to hybrid programs (telehealth + in-person) showed small differences in effect sizes (Tau-U = 0.76 for telehealth-only and d = 0.95 for hybrid) and in a hybrid program, telehealth sessions had 99-87% oral acceptance as compared to 100-90% in clinic sessions. One study found escape extinction alone was less effective in increasing self-feeding over telehealth than in clinic. Telehealth follow-up was reported in nine studies, which demonstrated high levels of maintenance and generalization both across hybrid and telehealth alone.

Conclusions: Results suggest that behavioral interventions administered via telehealth are efficacious across a wide range of child ages and medical comorbidities. The findings underscore the need for further high-quality research to establish best practices, optimize intervention strategies, and evaluate the long-term efficacy and cost-effectiveness of telehealth services in this field. Moreover, the adoption of telehealth services can significantly enhance the accessibility of specialized care for diverse populations, potentially diminishing healthcare disparities by reaching underserved or remote communities.