Nutrition Publication

Feeding Disorders in Infants and Children

Editor(s): Carlos Lifschitz, Buenos Aires. 73 / 2

There is a wide spectrum of feeding disorders that vary in origin from organic to functional or a mix of both. In C. Lau’s paper suction and swallowing mechanism is explained as well as how they are relevant to term and pre-term infants as well as the problems associated with suction and swallowing processes. A. Rybak discusses the different possible causes of poor weight gain related to feeding issues. Evaluation and symptoms of swallowing defects in children is explained in Dodrill and Gosa’s paper. And to conclude, A. Silverman outlines different ways parents and doctors can help encourage children to eat

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Behavioral Management of Feeding Disorders of Childhood

Author(s): Alan H. Silverman

Feeding disorders, characterized by suboptimal intake and/or lack of age-appropriate eating habits, are common andmay be seen in up to 45% of children. Feeding disorders area significant concern to both the affected families and to theproviders who treat them. Fortunately, there are well-establishedbehavioral treatments which have been shown to behighly efficacious. This article provides an overview of behavioralassessment and treatment of pediatric feeding disorders, provides guidance in treatment planning, and providesinformation which may be useful in considering if additionalpsychological consultation may be beneficial.

Development of Suck and Swallow Mechanisms in Infants

Author(s): Chantal Lau

Preterm infants’ hospital discharge is often delayed due totheir inability to feed by mouth safely and competently. Noevidence-based supported guidelines are currently availablefor health-care professionals caring for these infants.Available interventions advocating benefits are not readilyacknowledged for lack of rigorous documentation inasmuchas any improvements may ensue from infants’ normal maturation. Through research, a growing understanding of thedevelopment of nutritive sucking skills has emerged, sheddinglight on how and why infants may encounter oral feedingdifficulties due to the immaturity of specific physiologicfunctions. Unfortunately, this knowledge has yet to be translatedto the clinical practice to improve the diagnoses of oralfeeding problems through the development of relevant assessmenttools and to enhance infants’ oral feeding skillsthrough the development of efficacious preventive andtherapeutic interventions. This review focuses on the maturationof the various physiologic functions implicated in thetransport of a bolus from the oral cavity to the stomach. Althoughinfants’ readiness for oral feeding is deemed attainedwhen suck, swallow, and respiration are coordinated,we do not have a clear definition of what coordination implies.We have learned that each of these functions encompassesa number of elements that mature at different timesand rates. Consequently, it would appear that the properfunctioning of sucking, the swallow processing, and respirationneed to occur at two levels: first, the elements withineach function must reach an appropriate functional maturationthat can work in synchrony with each other to generatean appropriate suck, swallow process, and respiration; andsecond, the elements of all these distinct functions, in turn,must be able to do the same at an integrative level to ensurethe safe and efficient transport of a bolus from the mouth tothe stomach. 

Organic and Nonorganic Feeding Disorders

Author(s): Anna Rybak

 Feeding is one of the most important interactions betweencaregiver and child in the first few years of life and even lateron in handicapped children. Feeding disorders can present as food refusal or low quantity of food intake due to behavioralissues or underlying organic conditions. This situationconcerns mostly infants and children below 6 years of age;however, feeding problems can appear also later on in life.Feeding disorders are a concern for over 10–25% of parentsof otherwise healthy children below 3 years of age, but only1–5% of infants and toddlers suffer from severe feedingproblems resulting in failure to thrive. In case of prematureinfants or neurologically disabled children, this rate is muchhigher. Feeding disorders may appear as an isolated problem,mainly due to negative behaviors during feeding, or asa concomitant disorder with an underlying organic diseaseor structural anomaly. The newest classification also includesthe feeding style presented by the caregiver (responsive,controlling, indulgent or neglectful) as a separate cause offeeding disorders.  

Pediatric Dysphagia: Physiology, Assessment, and Management

Infancy and childhood represent a time of unparalleledphysical growth and cognitive development. In order for infantsand children to reach their linear and neurologicalgrowth potential, they must be able to reliably and safelyconsume sufficient energy and nutrients. Swallowing difficulties (dysphagia) in pediatric populations can have a detrimentaleffect on dietary intake and, thus, growth and development.As a result, it is imperative to accurately identify andappropriately manage dysphagia in pediatric populations.This article provides an overview of dysphagia in children, aswell as common causes of childhood swallowing difficulties,populations at risk for pediatric dysphagia, techniques usedto assess swallowing in pediatric patients, and the currenttreatment options available for infants and children withdysphagia.