++
Pediatric feeding disorders may
be defined as problems with the developmentally appropriate intake
of food. This broad category includes difficulties that objectively
result in nutritional or medical risk (e.g., refusal of dietary
protein leading to protein energy malnutrition), as well as those
perceived as problematic by the child’s family that result
in stressful mealtimes without objective medical consequence. These
do not include eating disorders (i.e., anorexia and bulimia) or
obesity. Pediatric feeding disorders may be associated with medical
disease (often gastrointestinal), malnutrition or failure to gain
weight, developmental delays affecting skill acquisition, and interpersonal
disorders. Feeding problems have been characterized simply along
axes of ability and desire,1 by biophysical etiology,2 or
by criteria that focus on interpersonal relationships.3 Children
with feeding disorders are best assessed and managed by interdisciplinary
teams that address all sides of the problem, given that distinct
facets of the disorder require individual expert assessment and
intervention.
++
Feeding disorders occur in children with an incidence as high
as 25% in normal children,4 with a higher incidence
in those with neurologic disability.5–7 While
children with feeding disorders require evaluation by a gastroenterologist
due to the high coincidence with gastrointestinal disorders,1,8 skill
acquisition and behavioral components are often present and require
behavioral evaluation and management beyond what a gastroenterologist
may provide.9
++
An individual patient’s feeding disorder is unique.
Environmental and family social-dynamic issues are different for
each individual with the same underlying pathology (e.g. hypoplastic
left heart syndrome). Furthermore, feeding, the airway, and the
upper gastrointestinal tract exist in a reciprocal relationship
system where problems with one of these components may produce problems
in the others (Figure 3–1); such may be seen in an infant
with pulmonary disease, where cough and tachypnea may aggravate
reflux and feeding problems, respectively. Additionally, the central
nervous system, with respect both to basic motor and sensory function
and to its higher order processes such as personality development,
exists in the background of this relationship and can both contribute
to, and be affected by, problems of the airway, upper GI tract,
and feeding ability (Figure 3–1).
++
++
Achievement of normal feeding is a function of skill acquisition
as permitted by the child’s internal and external environments.
The progression of feeding that occurs over infancy is governed by
neuromuscular and anatomic maturation that limit the manner of feeding
at any specific age.10 A newborn is limited by neurologic
immaturity and unique anatomy that helps isolate the oral cavity
from the airway. ...