Medical
Implications and Testing
Food Refusal in Children: an Overview of a Growing
Epidemic
Recent
statistics (source)
reveal that one in four children have some sort
of feeding disorder. Food refusal can take the form
of food selectivity, G-tube (gastrostomy tube) or NG-tube
(Nasogastric Feeding Tube) dependency, bottle dependency,
texture selectivity, or poor oral intake in general.
Nutritionists,
pediatricians, speech and language pathologists, occupational
therapists, and behavioral therapists all work in different
ways to solve this growing epidemic. Behavioral therapists
structure the environment and consequences during mealtime
to facilitate healthy eating habits.
Of
all the approaches, behavioral management strategies
have been proven to be the most effective. A significant
amount of progress can be made within a 4-6 week period.
Unfortunately, most behavioral clinics, such as the
Kennedy Krieger Institute (Baltimore), Marcus Institute
(Atlanta), Children’s Hospital of Philadelphia
(Pennsylvania), and St. Joseph's (New Jersey) are located
on the East Coast.
While
most feeding disorders are simple to treat, there may
be medical complications which interfere with treatment
possibilities. Before starting treatment, a child with
a feeding disorder should be carefully evaluated by
a physician to determine whether he or she is physically
safe to eat. These evaluations are done both to ensure
the safety of the child and also to optimize the treatment
effects.
The
most common medical conditions, which interfere with
treatment of feeding disorders, are reflux,
allergies,
aspiration, and motility problems (explained below).
These conditions are typically solved with medications,
surgery, or special treatments.
In
the case of reflux,
medications are usually prescribed. In the most severe
cases a surgery is performed called a Nissen Fundoplication.
This involves a repositioning of the stomach which results
in a smaller opening into the organ. This allows for
a greater probability of food going in without reflux
or vomiting.
Allergy
testing is essential because if a child ingests a food
to which he or she is allergic, lesions or irritations
can form in the GI
track, which can make eating a very painful
ordeal. There are several ways to test for allergies.
Talk to your pediatrician for advice on the best test
to administer to your child.
Aspiration
occurs when liquids enter the lungs. This occurs when
a ligament over the passage to the lungs, which usually
closes during oral intake, remains open. This can be
dangerous because the liquid in the lungs can cause
pneumonia. A speech pathologist or an occupational therapist
can help determine if aspiration is occurring and what
consistency of food is likely to lower the probability
of aspiration occurring.
Lastly,
with motility issues, food does not pass through the
GI track
at a normal rate. This can cause food to stay in the
stomach too long, overfilling it, and causing vomiting,
pain, and constipation. This can be treated with medications
such as Reglan and Erythromycin.
Common
tests to do before seeking treatment to increase your
child’s food/drink intake orally:
1.
Allergy
testing
2. Upper GI
3. Swallow study
4. Gastric emptying study
5. Endoscopy
|
