Feeding Disorders

Basics

Description

  • Feeding disorder:
    • Inability to consume by mouth in quantity or quality the nutrition that is developmentally appropriate for that child
  • Dysphagia:
    • Disorder of swallowing characterized by difficulty in oral preparation for the swallow or in moving food or liquid from the mouth to the stomach
  • Aspiration:
    • Food or fluid enters the trachea and passes through the vocal cords to lungs.
  • Penetration:
    • 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

Risk Factors

  • 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
  • Prematurity
  • Prolonged tube feeders (>4 weeks)
  • Tachypnea (respiratory rate >40 breaths/minute)

General Prevention

  • 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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