Medical
Implications and Testing
What is a Pediatric Feeding Disorder?
A pediatric feeding disorder is a condition in which a child will not consume adequate nutritional, hydrational or caloric intake orally in amounts needed in order to thrive. Behavior deficits or excesses that inhibit such intake may result in a child, toddler or infant to be characterized as failure to thrive (FTT). Failure to thrive is characterized by being under the third percentile for weight.
Other pediatric feeding disorders can be characterized by the consumption of a limited number of foods (i.e. only eats goldfish crackers, only eats foods that are yellow, only eats particular food groups such as starches or only eats certain textures, such as purees). Additional pediatric feeding problems include failure to self-feed, vomiting, packing or pooling solids and liquids, eating non-edible items, or general food refusal.
Food Refusal in Children: an Overview of a Growing
Epidemic
Recent
statistics (source)
reveal that one in four children have some sort
of feeding disorder. Food refusal can take the form
of food selectivity, G-tube (gastrostomy tube) or NG-tube
(Nasogastric Feeding Tube) dependency, bottle dependency,
texture selectivity, or poor oral intake in general.
Nutritionists, dieticians,
pediatricians, pediatric gastroenterologists, speech and language pathologists (SLP), occupational
therapists (OT), and behavioral therapists all work in different
ways to solve this growing epidemic. Behavioral feeding therapists
structure the environment and consequences during mealtime
to facilitate healthy eating habits.
Behavioral Approach to Feeding
Of
all the approaches, behavioral management strategies
have been proven to be the most effective and efficient. A significant
amount of progress can be made within a 4-6 week period.
Unfortunately, most behavioral clinics, such as the Kennedy
Krieger Institute (Baltimore), Marcus Institute or Marcus Autism Center (Atlanta),
Children’s Hospital of Philadelphia (Pennsylvania),
and St. Joseph's (New Jersey), Penn State Hershey Feeding Program (Pennsylvania) are located on the East
Coast.
Medical Implications
While
most pediatric feeding disorders are simple to treat, there may
be medical complications which interfere with treatment
possibilities. Before starting treatment, a child with a feeding disorder should
be carefully evaluated by a physician to determine whether
he or she is physically safe to eat. These evaluations are
done both to ensure the safety of the child and also
to optimize the treatment effects.
The
most common medical conditions, which interfere with
treatment of pediatric feeding disorders, are reflux,
allergies, aspiration,
and motility problems (explained below). These conditions
are typically solved with medications, surgery, or special
treatments.
In
the case of reflux,
medications are usually prescribed. In the most severe
cases a surgery is performed called a Nissen Fundoplication.
This involves a repositioning of the stomach which results
in a smaller opening into the organ. This allows for
a greater probability of food going in without reflux
or vomiting.
Allergy
testing is essential because if a child ingests a food
to which he or she is allergic, lesions or irritations
can form in the GI
tract, which can make eating a very painful
ordeal. There are several ways to test for allergies.
Talk to your pediatrician for advice on the best test
to administer to your child.
Aspiration
occurs when liquids enter the lungs. This occurs when
a ligament over the passage to the lungs, which usually
closes during oral intake, remains open. This can be
dangerous because the liquid in the lungs can cause
pneumonia. A speech pathologist or an occupational therapist
can help determine if aspiration is occurring and what
consistency of food is likely to lower the probability of aspiration
occurring.
Lastly,
with motility issues, food does not pass through the
GI tract
at a normal rate. This can cause food to stay in the
stomach too long, overfilling it, and causing vomiting,
pain, and constipation. This can be treated with medications
such as Reglan and Erythromycin.
Common
tests to do before seeking treatment to increase your
child’s food/drink intake orally:
1.
Allergy
testing
2. Upper GI
3. Swallow study
4. Gastric emptying study
5. Endoscopy
Los Altos Feeding Clinic
2235 Grant Rd. Ste 2
Los Altos, California 94024 |
