The following questions should guide assessment of a child’s eating ability.
- What are the child’s eating and drinking mechanics? If an infant, can he or she suckle? If older, can he or she eat with a spoon? Can the child close his or her lips properly? When drinking from a cup, can he or she form a proper seal? A formal evaluation should involve not only the physician but also health care professionals with varied backgrounds and training, including speech therapists, occupational therapists and physiotherapists, who take a special Interest in eating problems.,
- How long does it take the child to eat? From video recordings of children eating, investigators have developed norms for eating efficiency. Most children with a severe disability and an eating problem have efficiencies of less than 10%. Caregivers may spend half or more of the waking day trying to feed these children, who still remain emaciated. Parents and caregivers have repeatedly remarked that the use of supplemental feeding through a gastrostomy tube has taken the pressure off feeding and provided more time for play, stimulation and education.
- Has the child ever required admission to hospital for pneumonia? Is there any evidence of food aspiration? If so, careful investigation is required. Aspiration during feeding can usually be detected by radiologic techniques, but food aspiration caused by gastroesophageal reflux is harder to determine. In some cases a milk technetium study is helpful.5,3,910 On occasion, food aspiration can be determined only by stopping regular feeding completely and providing the child with total parenteral nutrition; a child who is suffering respiratory distress caused by food aspiration will then show progressive improvement.
- How much of a problem are gastroesophageal reflux and vomiting? Although none of the investigations for reflux is foolproof, esophageal pH measurements, endoscopy and biopsy are the most valuable methods. In addition to the risk of food aspiration, reflux and vomiting cause concern because of the resulting esophagitis and the loss of ingested nutrients. Esophagitis, reflux and vomiting can usually be managed medically. However, the clinical concern is whether the child retains enough food to thrive.
- Ottenbacher K, Scoggins A. Wayland J: The effectiveness of a program of oral sensory-motor therapy with the severely and profoundly developmentally disabled. Occup Ther J Res 1981; 1: 147-160
- Gisel EG: Chewing cycles in 2- to 8-year-old normal children: a developmental profile. Am J Occup Ther 1988; 42: 40-46
- Fried MD, Khoshoo V, Secker DJ et al: Decreases of gastric emptying time and episodes of regurgitation in children with spastic quadriplegia fed a whey-based formula. J Pediatr 1992; 120: 569-572
- Wesley JR, Coran AG, Sarahan TM et al: The need for evaluation of gastroesophageal reflux in brain-damaged children referred for feeding gastrostomy. J Pediatr Surg 1981; 16: 866-871
- Palmer S, Horn S: Feeding problems in children. In Palmer S, Ekvall S (eds): Pediatric Nutrition in Developmental Disorders, Charles C. Thomas, Springfield. Ill, 1978: 107-129
- Gisel EG, Patrick J: Identification of children with cerebral palsy unable to maintain a normal nutritional state. Lancet 1988; 1: 283-286
- Sochaniwskyji AE, Koheil RM, Bablich K et al: Oral motor functioning, frequency of swallowing and drooling in normal children and in children with cerebral palsy. Arch Phys Med Rehabil 1986, 67: 866-874
- Patrick J, Gisel E: Nutrition for the feeding impaired child. J Neurol Rehabil 1990; 4: 115-119
- Nielson DW, Heldt GP, Tooley WH: Stridor and gastroesophageal reflux in infants. Pediatrics 1990; 85: 1034-1039
- Fung KP, Seagram G, Pasieka J et at: Investigation and outcome of 121 infants and children requiring Nissen fundoplication for the management of gastroesophageal reflux. Clin Invest Med 1990; 13: 237-246
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