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Feeding Problems, Pediatric

Feeding Problems, Pediatric is a topic covered in the 5-Minute Emergency Consult.

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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
  • Acute feeding problems may be a component of acute systemic disease:
    • Infection, bowel obstruction
  • Chronic feeding problems may result from underlying neuromuscular, cardiovascular, or behavioral issues:
    • Cerebral palsy, prematurity, congenital heart disease, chronic neglect
  • Minor feeding difficulties reported in 25–50% of normal children:
    • Mainly colic, vomiting, slow feeding, and refusal to eat
  • More severe problems observed in 40–70% of infants born prematurely or children with chronic medical conditions.

Etiology

  • Several distinct areas of pathology—but overlap is common
  • Structural abnormalities:
    • Naso-oropharynx:
      • Cleft lip/palate
      • Choanal atresia
      • Micrognathia and/or Pierre Robin sequence
      • Macroglossia
      • Tonsillar hypertrophy
      • Retropharyngeal mass or abscess
    • Larynx and trachea:
      • Laryngeal cleft or cyst
      • Subglottic stenosis
      • Laryngo- or tracheomalacia
      • Tracheoesophageal fistula
    • Esophagus:
      • Esophageal strictures, stenosis, or web
      • Tracheoesophageal compression from vascular ring/sling
      • Esophageal mass or tumor
      • Foreign body
  • Neurologic conditions:
    • Cerebral palsy
    • Muscular dystrophies
    • Mitochondrial disorders
    • Arnold–Chiari malformation
    • Myasthenia gravis
    • Brainstem injury
    • Pervasive developmental disorder (autism spectrum disorders)
    • Infant botulism
    • Brainstem glioma
    • Polymyositis/dermatomyositis
  • Prematurity
  • Immune disorders:
    • Allergy
    • Eosinophilic esophagitis
    • Celiac disease
  • Congenital heart disease:
    • Precorrection: Fatigue, respiratory compromise, increased metabolic needs
    • Postcorrection: Any/all of the above, recurrent laryngeal nerve injury
  • Chronic aspiration
  • Conditioned dysphagia:
    • Gastroesophageal reflux (GER)
    • Prolonged tube or parenteral feeding early in life
  • Metabolic disorders:
    • Hypothyroidism
    • Inborn errors of metabolism
  • Acute illness or event:
    • Sepsis
    • Pharyngitis
    • Intussusception
    • Malrotation
    • Shaken baby syndrome
  • Behavioral issues:
    • Poor environmental stimulation
    • Dysfunctional feeder–child interaction
    • Selective food refusal
    • Rumination
    • Phobias
    • Conditioned emotional reactions
    • Depression
    • Poverty (inadequate food available)

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Citation

Rosen, Peter, et al., editors. "Feeding Problems, Pediatric." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307252/all/Feeding_Problems__Pediatric.
Feeding Problems, Pediatric. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307252/all/Feeding_Problems__Pediatric. Accessed April 25, 2019.
Feeding Problems, Pediatric. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307252/all/Feeding_Problems__Pediatric
Feeding Problems, Pediatric [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307252/all/Feeding_Problems__Pediatric.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Feeding Problems, Pediatric ID - 307252 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307252/all/Feeding_Problems__Pediatric PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -