is a topic covered in the 5-Minute Pediatric Consult
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- Feeding disorder:
- Inability to consume by mouth in quantity or quality the nutrition that is developmentally appropriate for that child
- Disorder of swallowing characterized by difficulty in oral preparation for the swallow or in moving food or liquid from the mouth to the stomach
- Food or fluid enters the trachea and passes through the vocal cords to lungs.
- Food or fluid enters the trachea but remains above vocal cord
- However, food or fluid can be cleared by patient through coughing to prevent aspiration.
- Oral motor disorder:
- Inability to manipulate an age-appropriate diet
- Often related to incoordination of facial muscles and/or tongue
- Pharyngeal dysphagia:
- Inability to protect airway during swallow
- May be due to anatomic abnormality or neurologic dysfunction
- Avoidant restrictive food intake disorder (ARFID):
- As defined by the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5): a voluntary food or fluid refusal associated with maladaptive interactions at mealtimes; associated with learned fear when foods or textures are advanced before a child is developmentally or medically ready to swallow without dysfunction
- Anatomic deformities (i.e., Pierre Robin sequence, laryngomalacia, tracheotomy, cleft palate)
- Autism spectrum disorder
- Congenital heart disease
- Cystic fibrosis
- Developmental delay/cerebral palsy
- GI disorders: gastroesophageal reflux disease (GERD), eosinophilic esophagitis, celiac disease
- Metabolic disorders
- Neuromotor dysfunction
- Prolonged tube feeders (>4 weeks)
- Tachypnea (respiratory rate >40 breaths/minute)
- Monitor weight, height, head circumference, weight for height, and BMI percentiles at regular interval office visits to identify changes in nutritional status early, especially in high-risk populations.
- Selective eater: Educate parents on age-appropriate portion sizes and foods.
- Provide vitamin and mineral supplementation or refer to nutritionist for complete assessment if patient is at risk for deficiencies.
- Developmental delay: Evaluate diet and feeding skills to manipulate nutrition provided.
- Ensure that foods offered are matched to developmental readiness rather than to chronologic age.
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