PEDIATRICS Vol. 108 No. 3 September 2001, pp. 671-676
Diagnosis and Treatment of Feeding Disorders in Children With Developmental Disabilities
Steven M. Schwarz, MD*, , Julissa Corredor, MD*, Julie Fisher-Medina, MS , Jennifer Cohen, MD*, and Simon Rabinowitz, MD, PhD*
From the * Department of Pediatrics and the Stanley S. Lamm Institute for Developmental Medicine and Child Neurology, Long Island College Hospital, State University of New York Downstate Medical Center, Brooklyn, New York.
Objectives. To determine the results of diagnostic evaluation and the effects of nutritional intervention on energy consumption, weight gain, growth, and clinical status of children with neurodevelopmental disabilities and suspected feeding disorders.
Methods. We studied 79 children with moderate to severe motor or cognitive dysfunction (male:female, 38:41; age, 5.8 ± 3.7 years) who were referred for diagnosis and treatment of feeding or nutritional problems. Initial assessments included a 3-day calorie intake record, videofluoroscopic swallowing study (VFSS), 24-hour intraesophageal pH monitoring, milk scintigraphy, and esophagogastroduodenoscopy.
Results. These studies demonstrated gastroesophageal reflux (GER) with or without aspiration in 44 of 79 patients (56%), oropharyngeal dysphagia in 21 (27%), and aversive feeding behaviors in 14 (18%). Diagnosis-specific approaches included medical GER therapy in 20 patients (25%), fundoplication plus gastrostomy tube (GT) in 18 (23%), oral supplements in 17 (22%), feeding therapy only in 14 (18%), and GT only in 10 (13%). After 24.6 ± 3.0 months, relative calorie intake, expressed as intake (kcal/d)/recommended daily allowance (RDA, kcal/d), improved significantly (initial:final = 0.78 ± 0.36:1.23 ± 0.27). The z scores increased significantly for both weight (initial:final = 2.80 ± 1.33: 0.81 ± 0.69) and height ( 3.14 ± 0.98: 2.00 ± 0.67). Improved subcutaneous tissue stores were demonstrated by increased thickness of both subscapular skinfolds (change = 71% ± 26%) and triceps skinfolds (38% ± 17%). After nutritional intervention, the acute care hospitalization rate, compared with the 2-year period before intervention, decreased from 0.4 ± 0.18 to 0.15 ± 0.06 admissions per patient-year and included only 3 admissions (0.02 per patient-year) related to feeding problems.
Conclusions. In children with developmental disabilities, diagnosis-specific treatment of feeding disorders results in significantly improved energy consumption and nutritional status. These data also indicate that decreased morbidity (reflected by a lower acute care hospitalization rate) may be related, at least in part, to successful management of feeding problems. Our results emphasize the importance of a structured approach to these problems, and we propose a diagnostic and treatment algorithm for children with developmental disabilities and suspected feeding disorders.children, developmental disabilities, fundoplication, gastroesophageal reflux, gastrostomy, hospitalization, nutrition.
Children with developmental disabilities are at increased risk for developing feeding-related difficulties, including gastroesophageal reflux (GER), oral motor dysfunction, pharyngoesophageal dyskinesia, and aversive feeding behavior.1-3 Protein energy intake and nutritional status often are compromised as a consequence of feeding impairment, particularly among the most severely disabled patients. If not adequately treated, feeding disorders may result in additional complications including esophagitis, reactive airway disease, aspiration pneumonia, and bedsores. Previous reports indicate that enteral feeding regimens for nutrition support in developmentally disabled children improve overall nutritional status.To date, however, few investigations have evaluated the effects of diagnosis-specific nutritional therapies on clinical outcomes with respect to the frequency of feeding disorder-related complications and rates of acute care hospitalization. Accordingly, the objectives of the present study were to assess feeding problems in a large group of children with developmental disabilities and to determine the effects of nutritional management on growth, weight gain, and feeding-associated morbidity.
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