Wilkins JW, Piazza CC, Groff RA, Volkert VM, Kozisek JM, Milnes SM.Utensil manipulation during initial treatment of pediatric feeding problems. J Appl Behav Anal. 2014 Oct 24. doi: 10.1002/jaba.169. PMID: 25345577
In this study, the authors implemented nonremoval and re-presentation of bites either on a spoon or on a Nuk for 12 children with feeding problems. The nonremoval and re-presentation treatment improved feeding behavior for 8 of 12 children. The study describes the subsequent clinical course of treatment and present follow-up data for 7 of the 8 children who responded to the nonremoval and re-presentation treatment with the spoon or Nuk. The data are discussed in terms of potential reasons why the utensil manipulation improved feeding behavior for some children.
Romano C, Hartman C, Privitera C, Cardile S, Shamir R.Current topics in the diagnosis and management of the pediatric non organic feeding disorders (NOFEDs). Clin Nutr. 2014 Sep 15. pii: S0261-5614(14)00219-2. doi: 10.1016/j.clnu.2014.08.013. PMID: 25240803
Non-Organic Feeding Disorders (NOFEDs) are characterized by feeding aversion, failure to advance to age-appropriate foods, food selectivity and negative mealtime behaviors. Parents of children with feeding disorders often use abnormal feeding behaviors, such as intrusive feeding. Persistent inadequate caloric intake leads to non-organic failure to thrive in up to 40-50% of cases. Management by a multidisciplinary team should address both nutritional support and feeding behavior modification. Even in the absence of failure to thrive, children with behavioral feeding problems are at risk of negative health, social and emotional outcomes, including nutrient deficiencies, social and family disruption or conflict. The aims of the current review are to present an update of the definition, classification, etiology, epidemiology of NOFED, as well as clinical presentation, evaluation and management of this condition and non-organic failure to thrive, often associated with NOFED.
Marshall J, Raatz M, Ward EC, Dodrill P. Use of parent report to screen for feeding difficulties in young children. J Paediatr Child Health. 2014 Sep 5. doi: 10.1111/jpc.12729. [Epub ahead of print] PMID: 25195498
This study confirmed that the Behavioral Pediatric Feeding Assessment Scale is a valid tool for identifying Australian children with feeding difficulties. Given that it is simple to administer and has a high reliability and specificity, it is suggested as a useful screening tool for physicians working with young children. Data collected using this tool found that typically developing children display few undesirable feeding behaviours, and few behaviors are perceived as problems by parents. Therefore, any child presenting with a large number of feeding problems on this parent-reported measure should be referred for further multidisciplinary evaluation and treatment as required.
Chun RH, Wittkopf M, Sulman C, Arvedson J.Transient swallowing dysfunction in typically developing children following supraglottoplasty for laryngomalacia. Int J Pediatr Otorhinolaryngol. 2014 Nov;78(11):1883-5. doi: 10.1016/j.ijporl.2014.08.017. Epub 2014 Aug 21. PMID: 25194725
Supraglottoplasty in otherwise typically developing children carries a risk of transient swallowing dysfunction with a low risk of persistent dysfunction. Most patients can be assessed post-operatively via clinical swallow evaluation without requiring an instrumental swallow study. Of 37 children identified as having undergone supraglottoplasty for severe laryngomalacia, 24 were identified as otherwise typically developing with no indications/signs of swallowing problems pre-operatively and eligible for inclusion in this study. Seventeen children were seen post-operatively for a clinical swallow evaluation. Six children were found to have swallowing dysfunction. Four of the six children showed variable symptoms, signs, or findings concerning for aspiration with oral feeding. Three of six underwent video fluoroscopic swallow study (VFSS). All 6 children responded to dietary modifications, positioning alterations, and anti-reflux medications. All showed improvement by their 4-week post-operative follow-up visit. There was no association between post-operative swallowing dysfunction and the surgical technique employed.
Beer S, Hartlieb T, Müller A, Granel M, Staudt M.Aspiration in children and adolescents with neurogenic Dysphagia: comparison of clinical judgment and fiberoptic endoscopic evaluation of swallowing. Neuropediatrics. 2014 Dec;45(6):402-5. doi: 10.1055/s-0034-1387814. Epub 2014 Oct 24.
A total of 30 children and adolescents with dysphagia due to various chronic neurological disorders were assessed for their risk of aspiration. This assessment was performed clinically by experienced speech and swallowing therapists, and verified thereafter by fiberoptic endoscopy. We found the clinical judgment to be correct in only 70% (for aspiration of saliva), 55% (of puree), and 67% (of thin liquids). We conclude that, because of this unacceptably high error rate of clinical assessment, a fiberoptic evaluation of swallowing is a necessary diagnostic step both for the planning of therapy and for the development of feeding strategies in children and adolescents with neurogenic dysphagia.
Singendonk MM, Rommel N, Omari TI, Benninga MA, van Wijk MP. Upper gastrointestinal motility: prenatal development and problems in infancy. Nat Rev Gastroenterol Hepatol. 2014 Sep;11(9):545-55. doi: 10.1038/nrgastro.2014.75. Epub 2014 Jun 3. Review. PMID: 24890279
Deglutition, or swallowing, refers to the process of propulsion of a food bolus from the mouth into the stomach and involves the highly coordinated interplay of swallowing and breathing. At 34 weeks gestational age most neonates are capable of successful oral feeding if born at this time; however, the maturation of respiration is still in progress at this stage. Infants can experience congenital and developmental pharyngeal and/or gastrointestinal motility disorders, which might manifest clinically as gastro-oesophageal reflux (GER) symptoms, feeding difficulties and/or refusal, choking episodes and airway changes secondary to micro or overt aspiration. This Review highlights the prenatal development of upper gastrointestinal motility and describes the most common motility disorders that occur in early infancy.
Indrio F, Di Mauro A, Riezzo G, Civardi E, Intini C, Corvaglia L, Ballardini E, Bisceglia M, Cinquetti M, Brazzoduro E, Del Vecchio A, Tafuri S, Francavilla R. Prophylactic use of a probiotic in the prevention of colic, regurgitation, and functional constipation: a randomized clinical trial. JAMA Pediatr. 2014 Mar;168(3):228-33. doi: 10.1001/jamapediatrics. 2013.4367. PMID: 24424513
Infantile colic, gastroesophageal reflux, and constipation are the most common functional gastrointestinal disorders that lead to referral to a pediatrician during the first 6 months of life and are often responsible for hospitalization, feeding changes, use of drugs, parental anxiety, and loss of parental working days with relevant social consequences. In total, 589 infants were randomly allocated to receive L reuteri DSM 17938 or placebo daily for 90 days. Results indicated at 3 months of age, the mean duration of crying time, the mean number of regurgitations per day, and the mean number of evacuations per day for the L reuteri DSM 17938 and placebo groups, respectively, were significantly different. The use of L reuteri DSM 17938 resulted in an estimated mean savings per patient of €88 (US $118.71) for the family and an additional €104 (US $140.30) for the community. Prophylactic use of L reuteri DSM 17938 during the first 3 months of life reduced the onset of functional gastrointestinal disorders and reduced private and public costs for the management of this condition.
Harding C, Frank L, Van Someren V, Hilari K, Botting N. How does non-nutritive sucking support infant feeding? Infant Behav Dev. 2014 Jun 27;37(4):457-464. doi: 10.1016/j.infbeh.2014.05.002. [Epub ahead of print] PMID: 24974134
Fifty nine premature infants aged 26-35 weeks gestation participated in a randomized controlled study to determine the effectiveness of non-nutritive sucking (NNS). At 6 months, there were no significant differences with number of days to full oral feeding between the groups receiving NNS and the Control group. A significant difference in number of days in hospital between the Control group and the other two groups was found. Significant changes were noted with the development of more normal sucking patterns in Groups 1-3. At 6 months there were no significant differences in receptive or expressive language skills between all groups. NNS had no significant impact on the transition to full oral feeding or later language development.
Sant’Anna AM, Hammes PS, Porporino M, Martel C, Zygmuntowicz C, Ramsay M. Use of cyproheptadine in young children with feeding difficulties and poor growth in a pediatric feeding program. J Pediatr Gastroenterol Nutr. 2014 Nov;59(5):674-8. doi: 10.1097/MPG.0000000000000467.
The aim of this study was to assess the efficacy and safety of cyproheptadine use in infants and young children with poor growth and to describe changes in their weight and feeding behaviors. Of the 127 patients with poor weight, 82 took the medication regularly as prescribed in combination with our interventional program. For these patients, the majority of the parents (96%) reported a positive change in mealtime and feeding behaviors. A significant improvement was observed after starting CY when compared with before treatment. This effect was independent of patients’ age and/or presence of an underline medical problem. The authors conclude that the use of cyproheptadine in combination with a specialized multidisciplinary interventional program is a safe and effective therapy in infants and young children with low appetite and poor growth.
Li L, Zhao Y, Ma X, Zhang D, Wu Z, Chen S. 2014 Clinical manifestations in pediatric laryngopharyngeal reflux. Aug;28(15):1145-8. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2014 Aug;28(15):1145-8. Chinese. PMID: 25322604 2014
The aim of this study was to explore the clinical manifestations in pediatric laryngopharyngeal reflux and to provide more information on diagnosis and treatment. Sixty-two cases with recurrent respiratory infections, hoarseness and chronic cough were examined with reflux symptom index (RSI), reflux finding score (RFS), and 24-hour pH monitoring. Those who had at least two positive test for reflux were given PPI for diagnostic therapy. Authors concludes that there are no clinical presentations specific to pediatric laryngopharyngeal reflux. Patients often present with a wide range of atypical symptoms and signs. RSI questionnaire and RFS may provide diagnostic datas. Primary treatment includes lifestyle and medical therapy.
Wolthuis-Stigter MI, Luinge MR, da Costa SP, Krijnen WP, van der Schans CP, Bos AF. The Association between Sucking Behavior in Preterm Infants and Neurodevelopmental Outcomes at 2 Years of Age. J Pediatr. 2014 Oct 10. pii: S0022-3476(14)00821-X. doi: 10.1016/j.jpeds.2014.09.007. PMID: 25311711
Fifty-two preterm infants participated in this study. The infants’ sucking patterns were assessed at 37-50 weeks PMA using the Neonatal Oral-Motor Assessment Scale. At age 2 years, assessment was based on a neurologic examination and the Bayley Scales of Infant and Toddler Development, Second Edition. The inability to sustain sucking at 46 weeks PMA and the absence of a mature sucking pattern at 44 weeks PMA significantly increased the odds of abnormal neurodevelopmental outcomes at age 2 years. Specific elements of sucking at 4-6 weeks post term are associated with abnormal neurodevelopmental outcomes in preterm infants at age 2 years. This period might be a sensitive time of infant development in which sucking behavior is an early marker of abnormal developmental outcomes. This finding may offer opportunities for early intervention.
Sidrak S, Yoong T, Woolfenden S.Iron deficiency in children with global developmental delay and autism spectrum disorder. J Paediatr Child Health. 2014 May;50(5):356-61. doi: 10.1111/jpc.12483. Epub 2013 Dec 23. PMID: 24372984
Iron deficiency and iron deficiency anaemia were more common in this clinical sample of children with global developmental delay and/or ASD than in the general population.
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