Mousa H1, Hassan M2.. Gastroesophageal Reflux Disease. Pediatr Clin North Am. 2017 Jun;64(3):487-505. doi: 10.1016/j.pcl.2017.01.003.
Gastroesophageal reflux (GER) is a normal physiologic process. It is important to distinguish GER from GER disease (GERD) since GER does not require treatment. Although a diagnosis of GERD can largely be based on history and physical alone, endoscopy and pH impedance studies can help make the diagnosis when there in atypical presentation. In children and adolescents, lifestyle changes and acid suppression are first-line treatments for GERD. In infants, acid suppression is not effective, but a trial of hydrolyzed formula can be considered, as milk protein sensitivity can be difficult to differentiate from GER symptoms.
Wauters L1, Nightingale S2,3, Talley NJ4, Sulaiman B5, Walker MM5,6. Functional dyspepsia is associated with duodenal eosinophilia in an Australian paediatric cohort. Aliment Pharmacol Ther. 2017 May;45(10):1358-1364. doi: 10.1111/apt.14045. Epub 2017 Mar 21.
In this retrospective cohort study, children with normal upper endoscopy and routine histology at a single tertiary paediatric centre between 2010 and 2014 were included. Functional dyspepsia (FD) was defined as epigastric pain or discomfort >2 months without response to acid suppression. Controls presented with nonerosive reflux disease, dysphagia or rumination syndrome. Intramucosal eosinophil counts were compared between the groups using uni- and multivariate regression analyses. Functional dyspepsia in children is strongly associated with duodenal eosinophilia, in the absence of endoscopic or routine histological findings. Frequent atopic and psychological comorbidity illustrate likely multifactorial mechanisms.
The purpose of this study was to identify the relationship between dietary habits and childhood gastroesophageal reflux disease (GERD) in preschool children. Dietary habits such as picky and irregular eating, snack preference, a preference of liquid foods, late night eating, and a shorter dinner-to-bedtime interval had a significant correlation with GERD. Further large-scale studies are necessary to confirm our results.
Unlike adult populations, who primarily depend on liquids for hydration alone, infants rely on liquids to provide them with hydration and nutrition. This study was designed to determine (1) the relationship between consistencies in modified barium swallow studies and thickened infant formulas and (2) the effects of time and temperature on the resulting thickness of infant formula. Prepackaged barium consistencies and 1 standard infant formula that was thickened with rice cereal and with 2 commercially available thickening agents were studied. Thickness was determined via a line spread test after various time and temperature conditions were met. Results indicated significant differences between the thickened formula and barium test consistencies. Formula thickened with rice cereal separated over time into thin liquid and solid residue. Formula thickened with a starch-based thickening agent was thicker than the desired consistency immediately after mixing, and it continued to thicken over time. The data from this project suggest that nectar-thick and honey-thick infant formulas undergo significant changes in flow rates within 30 minutes of preparation or if refrigerated and then reheated after 3 hours. Additional empirical evidence is warranted to determine the most reliable methods and safest products for thickening infant formula when necessary for effective dysphagia management.
Simons JP1, Greenberg LL1, Mehta DK1, Fabio A2, Maguire RC1, Mandell DL3.Laryngomalacia and swallowing function in children. Laryngoscope. 2016 Feb;126(2):478-84. doi: 10.1002/lary.25440. Epub 2015 Jul 7.
To determine the prevalence of dysphagia in children with laryngomalacia, To ascertain whether severity of laryngomalacia influences the presence of swallowing dysfunction, and to examine whether patients with medical comorbidities and laryngomalacia have a higher prevalence of swallowing. Swallowing function was assessed by symptoms, clinical swallowing evaluations (CSE) performed by speech pathologists, modified barium swallow (MBS) studies, and fiberoptic endoscopic evaluations of swallowing (FEES). There was no significant relationship between severity of laryngomalacia and presence of abnormal swallowing function based on symptoms, CSE, MBS, or FEES. However, patients with greater severity were more likely to have failure to thrive. There was not a significant association between the presence of swallowing dysfunction or disease severity and medical comorbidities such as Down syndrome, neurological impairment, or congenital heart disease. However, GERD was more likely to be present in patients with moderate and severe laryngomalacia than in patients with mild disease. Swallowing dysfunction is common in children with laryngomalacia regardless of disease severity or other medical comorbidities. Swallowing studies are frequently abnormal in laryngomalacia patients presenting both with and without subjective symptoms of dysphagia. Dysphagia assessment should be considered as part of the evaluation of infants with laryngomalacia.
Han TH1, Lee J1, Kim YJ1.Hair Zinc Level Analysis and Correlative Micronutrients in Children Presenting with Malnutrition and Poor Growth. Pediatr Gastroenterol Hepatol Nutr. 2016 Dec;19(4):259-268. doi: 10.5223/pghn.2016.19.4.259. Epub 2016 Dec 28.
Zinc deficiency can induce serious clinical problems in the gastrointestinal (GI) system and immune system and can affect growth and development. It is more severe in younger patients. Chronic zinc deficiency is reflected more precisely in hair than in serum. We studied hair zinc levels and other hair and serum micronutrients in chronic malnourished children to identify which micronutrients are affected or correlated with the other ones. Hair mineral analyses were performed in 56 children (age, 1-15 years) presenting with malnutrition, poor growth, poor appetite, anorexia, with/without other GI symptoms (diarrhea, abdominal pain, constipation) from August 2012 to March 2015. Biochemical studies for macronutrients and major micronutrients were also conducted. Hair zinc and mineral analyses are useful as a therapeutic guide in the clinical investigation of children with malnutrition and poor growth.
Franken J1, Mauritz FA2,3, Stellato RK4, Van der Zee DC2, Van Herwaarden-Lindeboom MYA2. The Effect of Gastrostomy Placement on Gastric Function in Children: a Prospective Cohort Study. J Gastrointest Surg. 2017 Apr 19. doi: 10.1007/s11605-017-3376-3.
A gastrostomy placement is frequently performed in pediatric patients who require long-term enteral tube feeding. Unfortunately, postoperative complications such as leakage, feeding intolerance, and gastroesophageal reflux frequently occur. These complications may be due to postoperative gastric dysmotility. Our aim was to evaluate the effect of gastrostomy placement on gastric emptying in children. Gastrostomy placement in children causes a significant delay in gastric emptying. Postoperative DGE was associated with gastroesophageal reflux and was found in most patients with postoperative leakage and feeding intolerance. These negative physiologic effects should be taken into account when considering gastrostomy placement in children.
Gastroesophageal reflux disease is an important cause of morbidity in childhood. Although various diagnostic methods are available, short course of empiric treatment with a proton pump inhibitor is widely used in adults as a diagnostic test. Data about empiric treatment is scarce in children. The aim of this study is to evaluate the effectiveness of empiric treatment of reflux-like symptoms in children. Empiric treatment was found to be effective in 78% of patients. Treatment response tended to be better in children older than 5 years of age. Of the 22 non-responders 9 underwent endoscopy and pathological findings were discovered in 7 of them. Treatment of children with gastroesophageal reflux symptoms with a proton pump inhibitor might significantly decrease the need for extensive evaluations. However it is important to investigate non-responders to empiric therapy, as it seems there might be high probability of pathological findings.
Jadcherla S1.Dysphagia in the high-risk infant: potential factors and mechanisms. Am J Clin Nutr. 2016 Feb;103(2):622S-8S. doi: 10.3945/ajcn.115.110106. Epub 2016 Jan 20.
Neonatal dysphagia, or abnormalities of swallowing, represent a major global problem, and consequences of dysfunctional feeding patterns carry over into infancy and toddler age groups. Growth, development, and independent feeding skills are all delayed among high-risk infants. Such a group comprises premature birth, low-birth-weight, congenital anomalies, perinatal asphyxia, post surgical, and sepsis categories. The conflict between pathophysiologic and pragmatic feeding strategies remains a major conundrum and is largely due to a lack of validated diagnostic approaches amid heterogeneity of the patient phenotype. Thus, well-tested feeding management strategies that can be generalizable are lacking. Furthermore, the aerodigestive symptoms and signs, potential risk factors, and contributory etiologies remain nonspecific. This article presents mechanistic evidence related to the pathophysiologic basis of neonatal dysphagia as well as potential opportunities to improve feeding abilities and long-term development.
Coad J1, Toft A1, Lapwood S2, Manning J3, Hunter M4, Jenkins H5, Sadlier C5, Hammonds J6, Kennedy A7, Murch S8, Widdas D9. Blended foods for tube-fed children: a safe and realistic option? A rapid review of the evidence. Arch Dis Child. 2017 Mar;102(3):274-278. doi: 10.1136/archdischild-2016-311030. Epub 2016 Oct 18.
With the growing number of children and young people with complex care needs or life-limiting conditions, alternative routes for nutrition have been established (such as gastrostomy feeding). The conditions of children and young people who require such feeding are diverse but could relate to problems with swallowing (dysphagia), digestive disorders or neurological/muscular disorders. However, the use of a blended diet as an alternative to prescribed formula feeds for children fed via a gastrostomy is a contentious issue for clinicians and researchers. From a rapid review of the literature, we identify that current evidence falls into three categories: (1) those who feel that the use of a blended diet is unsafe and substandard; (2) those who see benefits of such a diet as an alternative in particular circumstances (eg, to reduce constipation) and (3) those who see merit in the blended diet but are cautious to proclaim potential benefits due to the lack of clinical research. There may be some benefits to using blended diets, although concerns around safety, nutrition and practical issues remain.
Castro K1, Faccioli LS2, Baronio D3, Gottfried C3, Perry IS4, Riesgo R5. Feeding behavior and dietary intake of male children and adolescents with autism spectrum disorder: A case-control study. Int J Dev Neurosci. 2016 Oct;53:68-74. doi: 10.1016/j.ijdevneu.2016.07.003. Epub 2016 Jul 16.
This study aims to evaluate dietary intake and identify feeding behavioral problems in male children and adolescents with ASD when compared to matched controls, as well as parents or caregivers’ feelings about strategies for dealing with eating problems. ASD patients consumed in average more calories than controls (though with a high patient’s frequency above and below calorie range references), had a limited food repertoire, high prevalence of children with inadequate calcium, sodium, iron vitamin B5, folate, and vitamin C intake. BPFA scores were also higher in the ASD group when compared to controls for all frequencies (child behavior, parents and total). These findings lead us to endorse the importance of evaluating feeding problems in the clinical routine, considering also the singular features of the patients.
Background Guidance during Meals is a two-week inpatient intervention undertaken at the Folke Bernadotte Regional Habilitation Centre, Sweden, to help parents deal with children’s eating problems. Parents are given advice about medical and/or behavioural reasons for food selectivity and possible treatment strategies. Most parents thought that the intervention had helped them and their child, by teaching them how to guide their child during mealtimes, what made it easier for their child to eat, and how to communicate with their child in an encouraging way. Most children retained their increased interest in eating once back at home. These results were not dependent on time of onset of eating problems, number of intervention periods, length of time since the intervention, or gastrostomy. Conclusion The Guidance during Meals intervention helps parents develop knowledge about factors that hinder or facilitate eating in their child and tools that can help their child finish meals, and gives them a sense of hope that positive change can occur.
Fletcher S1, Wright C1, Jones A2, Parkinson K2, Adamson A2. Tracking of toddler fruit and vegetable preferences to intake and adiposity later in childhood. Matern Child Nutr. 2017 Apr;13(2). doi: 10.1111/mcn.12290. Epub 2016 Apr 4.
This study examined whether toddlers’ liking for fruit and vegetables (FV) predicts intake of FV later in childhood, how both relate to childhood adiposity and how these were moderated by factors in infancy. Feeding data collected in the first year were linked to data from a parental questionnaire completed and to anthropometry, skinfolds and bioelectrical impedance and 4-day food diary data. Aged 30 months, 50% of children were reported to like eight different vegetables and three fruits, but at 7 years, children ate a median of only 1.3 (range 0-7) portions of vegetables and 1.0 portion of fruit (0-4). Early appetite, feeding problems and food neophobia showed significant univariate associations with liking for FV aged 30 m, but the number of vegetables toddlers liked was the only independent predictor of vegetable consumption at age 7 years. Liking for fruit aged 30 m also independently predicted fruit intake, but these were also related to deprivation, maternal education ,and female gender. Children eating more FV at age 7 years had slightly lower body mass index and skinfolds. An early liking for FV predicted increased later intake, so increasing early exposure to FV could have long term beneficial consequences.