Feeding Problems, Pediatric
Basics
Description
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
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
- Naso-oropharynx:
- 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
- Avoidant/restrictive food disorder (DSM-5):
- Environmental/parental issues:
- Poor environmental stimulation
- Dysfunctional feeder–child interaction
- Poverty (inadequate food available)
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Citation
Schaider, Jeffrey J., et al., editors. "Feeding Problems, Pediatric." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307252/0.1/Feeding_Problems_Pediatric.
Feeding Problems, Pediatric. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307252/0.1/Feeding_Problems_Pediatric. Accessed November 14, 2024.
Feeding Problems, Pediatric. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307252/0.1/Feeding_Problems_Pediatric
Feeding Problems, Pediatric [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 November 14]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307252/0.1/Feeding_Problems_Pediatric.
* Article titles in AMA citation format should be in sentence-case
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T1 - Feeding Problems, Pediatric
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ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307252/0.1/Feeding_Problems_Pediatric
PB - Lippincott Williams & Wilkins
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