Pediatric Practice: PLAY as a Therapeutic Practice for Undernutrition, Feeding, and Development

Faculty: Alexandra Gonzalez, OTD, OTR/L


Project Objectives
  • To gain insight into issues of food security, food preferences, food habits, and nutritional deficits as determinants of health and early child development in Guatemala
  • To understand the relationship between nutrition and early childhood developmental trajectories and occupational capacity
  • To gain an introduction to nutritional assessment approaches and feeding techniques used to facilitate early child development
  • To research the use of nutritional supplementation for undernourished children in a clinical setting and in the wider population
  • To explore the relationship between occupational capacity and social and occupational justice
Project Activities

Approximately 45% of all children in Guatemala experience chronic undernutrition, which is one of the highest rates in the Western Hemisphere. Undernutrition has a profound impact on early childhood developmental trajectories. Through direct hands-on experience on an in-patient infant nutrition unit, the Pediatric Practice group will focus on the social, political, and economic determinants of child development in Guatemala and the impacts of chronic undernutrition on childhood occupational capacities. The group will specifically consider the clinical outcomes and social implications of local infant and child feeding practices and norms of development, including expectations for play.  

The Pediatric Nutrition group will gain hands-on experience on an infant nutrition unit at Obras Sociales Hermano Pedro, a Catholic charity hospital located in Antigua, Guatemala, serving low-income families throughout the country. The infant nutrition unit is a restricted-entry in-patient medical unit with 25-30 beds, served by a specialized team of nurses, nutritionists, and volunteers. The unit is populated by infants with cleft palate awaiting surgical reconstruction; severely malnourished infants presenting with failure to thrive; and infants and children with neurodevelopmental disabilities requiring special feeding.

Students will be introduced to occupational therapy pediatric practice using developmentally-based and sensory-motor approaches in order to understand the developmental trajectories of children experiencing severe undernutrition.  Observational methods and chart reviews will be used for assessing nutritional and occupational status, and students will experience a variety of feeding techniques and therapeutic approaches based on play and sensory motor intervention strategies. Students will be guided in how to observe and understand the cultural dimensions of early childhood development and explore them in light of the social determinants of health.  The group will develop case study analyses of developmental trajectories of children on the clinical unit, describing in detail the feeding and handling techniques implemented by clinical staff and students.  These techniques will be further analyzed in comparison to the infant feeding and play practices and beliefs found within the local community, which will be elicited through informal engagement with the community and qualitative research methods.

Key competencies gained will include:  in-depth understanding of the physiological outcomes of poor infant and child nutrition and impacts on occupation and neurodevelopment; knowledge of feeding and swallowing techniques, sensory-motor and play strategies; ability to use growth parameters/measurements to understand the impact of nutrition on physical development and to compare nutritional status across populations; and qualitative research methods and analysis, including case study methodology.