Most often, children with problems related to eating may not have a clear diagnostic reason. Up to 25 percent of parents report that their children have some problems with eating. These are often toddlers and young children, who are active or otherwise busy and just not interested in eating. They grow and often maintain their growth along the lower percentiles on the growth chart. Some of these children have food texture issues and choose to only eat certain foods. This is often a problem in children with autism, who have heightened oral sensitivities. Children with chronic medical conditions, especially those requiring prolonged hospitalization, often develop some degree of feeding issues. Examples of this include children with heart or kidney problems or other disorders that require prolonged inpatient hospital admission. Decreased interest in eating and poor eating are also seen in premature babies.
Children with neuromuscular disorders who do not have a coordinated swallowing mechanism also struggle to eat. This is seen in children with cerebral palsy, a disease that predominantly affect muscles. Children with anatomical problems affecting the lips and back of their throat (palate) and upper airway may also find it difficult to eat. Cleft lip and palate are examples of this, but these children improve with surgery and support. Children with genetic disorders, for example Down syndrome, are poor feeders in the beginning and will require special help and support in the early years.
What kind of evaluations would a child with a feeding problem require?
If you think that your child is a poor eater and you’re concerned, it’s prudent to seek help from his or her pediatrician. Red flags that warrant further evaluation are as follows:
— Weight and growth trends dropping off from the norms
— Child becoming more fatigued or lacks energy
— Feeding becomes increasingly prolonged or distressing to the child and family
— There are concerning findings on an exam that suggest breathing problems, heart problems or other structural problems or disorders that affect feeding
After reviewing your child’s history and conducting a physical, the pediatrician may choose to follow your child more carefully or refer your child to a specialist, such as a pediatric gastroenterologist, pediatric dietitian, genetics specialist, pediatric ear nose and throat specialist or developmental pediatrician (especially if developmental miles stones are lagging or if there are concerns of autism), and may also seek input from a pediatric speech therapist. Based on these assessments, the doctor may order a blood test to look for anemia and nutritional deficiencies and check blood electrolyte status. The doctor may also order special barium X-ray tests (upper GI) to evaluate the anatomy of the upper gastrointestinal tract, plus a swallow study to assess the swallowing mechanism.
What can be done to help children with feeding problems?
Most children with feeding problems improve over time and with some help and support. Often, dietetic interventions with some increase in caloric intake is all that is required. This approach helps those children who also have poor growth associated with poor oral intake. In children, only 5 to 10 percent of caloric intake is required for growth and therefore only requires a small increase in caloric intake. The help of a pediatric dietitian may be sought, and the food choices may be rotated and repeated to make it more appealing for the child to eat different foods. It’s not uncommon for children to stick with a limited choice of foods in this situation, but they usually improve with time.
Those children who are at risk for persistent feeding problems, especially premature babies, children with autism and kids with neurological or anatomical problems, as well as genetic disorders, require a more comprehensive approach. The help of occupational and speech therapists may also be enlisted. These children often improve at their own pace, and pushing them to improve intake can become counterproductive. Occasionally, children with coexistent gastroesophageal reflux may do better after optimal management of reflux. Some children may show improvement after taking medications like cyproheptadine that help boost appetite.
There are some children and toddlers who have significant oral aversions and require further interventions and support. Placement of a feeding tube through the nostril into the stomach, or directly into the stomach, will help ease pressure off the child and the parents, plus help provide extra calories to maintain growth and development. The intention of the tube is not to provide the entire caloric need but to serve as a conduit to provide supplementary nutrition. Children should still be encouraged to take food by mouth, despite the tube.
Occasionally, enrolling children with significant oral aversions and feeding problems in an established feeding program may be required to help a child work on his or her oral feeding skills. The program often involves a child psychologist, a pediatric dietitian and occupational and speech therapists. The needs of the patient is evaluated extensively in such programs and an individual program is charted for the patient. Therapy involves working with the parents to help advance their child’s oral intake skills. These therapies take time to work, and the programs often work in close coordination with other specialists.
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