Feeding Problems, Pediatric

Basics

Description

Problems may present in 1 or several of the components of “feeding”:
- Getting food into oral cavity: Appetite, food-seeking behavior, ingestion
- Swallowing food: Oral and pharyngeal phases
- Ingestion and absorption: Esophageal swallowing, GI phase
Poor feeding is common in acute pediatric disorders:
- Infectious, inflammatory, obstructive
Chronic feeding problems may result from underlying structural, neuromuscular, cardiovascular, respiratory, GI, behavioral, or environmental issues:
- Congenital anomalies, cerebral palsy, prematurity, congenital heart disease (CHD), GERD avoidant/restrictive food intake disorder, neglect
Minor feeding difficulties are reported in 25–50% of normally developing children:
- Mainly colic, vomiting, slow feeding, and picky eating
- Transient. Causes no serious outcomes
- Often present during feeding transitions (breast to bottle, introduction to solids)
More severe problems observed in 40–80% of infants born prematurely and children with chronic medical conditions and/or developmental disabilities

Etiology

Several distinct areas of pathology – but overlap is common
Structural abnormalities:
- Naso-oropharynx:
  - Cleft lip/palate, submucosal cleft
  - Choanal atresia
  - Micrognathia and/or Pierre Robin sequence
  - Macroglossia (Down syndrome, Beckwith–Wiedemann syndrome)
  - Tongue/sublingual masses
  - Tonsillar/adenoidal hypertrophy
- Larynx and trachea:
  - Laryngo- or tracheomalacia
  - Tracheoesophageal fistula
  - Laryngeal cleft or cyst
- Esophagus:
  - Esophageal strictures, stenosis, or web
  - Tracheoesophageal compression from vascular ring/sling
  - Esophageal mass or tumor
  - Foreign body
Neurologic/neuromuscular conditions:
- Cerebral palsy
- Hypoxic injury
- Traumatic brain injury
- Cerebrovascular disease
- Posterior fossa tumors
- Muscular dystrophies
- Mitochondrial disorders
- Myasthenia gravis
- Infant botulism
- Polymyositis/dermatomyositis
Prematurity (especially those requiring prolonged enteral or parenteral feedings)
Chronic aspiration
CHD:
- Precorrection: Fatigue, respiratory compromise, increased metabolic needs
- Postcorrection: Any or all of the above as well as recurrent laryngeal nerve injury
Immune disorders:
- Allergy
- Eosinophilic esophagitis
- Celiac disease
GI problems:
- Gastroesophageal reflux disease (GERD)
- Constipation
- Obstruction
Metabolic disorders:
- Hypothyroidism
- Inborn errors of metabolism
Acute illness or event:
- Sepsis
- Pharyngitis, tonsillitis, peritonsillar abscess, retropharyngeal abscess, epiglottitis, CNS infection
- Oropharyngeal/esophageal lesions:
  - Gingivostomatitis (HSV), herpangina (coxsackievirus), candida, Stevens–Johnson syndrome, esophagitis, caustic ingestion
- Intussusception, malrotation
- Trauma: Abusive head trauma, oropharyngeal trauma/burn, abdominal trauma
- Foreign body ingestion or aspiration
Developmental problems:
- Pervasive developmental disorders (includes autism spectrum disorders)
- Developmental delays
Behavioral problems:
- Avoidant/restrictive food disorder (DSM-5):
  - Eating too little
  - Eating restrictive number of foods
  - Fear of eating, phobia
- Rumination (food is regurgitated then reswallowed)
- Conditioned emotional reactions
- Depression
Environmental/parental issues:
- Poor environmental stimulation
- Dysfunctional feeder–child interaction
- Poverty (inadequate food available)

There's more to see -- the rest of this topic is available only to subscribers.