Ann Rehabil Med.  2016 Aug;40(4):692-701. 10.5535/arm.2016.40.4.692.

Overall Profile of a Pediatric Multidisciplinary Feeding Clinic

• Jung JS
• Chang HJ
• Kwon JY

• KMID: 2356655
• DOI: http://doi.org/10.5535/arm.2016.40.4.692

Abstract

OBJECTIVE
To evaluate the overall profile of children with feeding disorders and their relationships to medical conditions in an outpatient feeding clinic of a tertiary hospital.
METHODS
The medical records of 143 children who had visited the feeding clinic between January 2010 and June 2014 were reviewed retrospectively. The presence of a feeding disorder (feeding behavior disorder, dysphagia, and/or failure to thrive [FTT]) and the children's medical conditions were examined by a physiatrist.
RESULTS
Half of the patients (n=74, 51.7%) were under 15 months of age, and 68 (47.6%) were born preterm. Ninety-three patients (65.0%) met the criteria for any combination of feeding behavior disorder, dysphagia, or FTT. Cardiorespiratory disease was the most common medical condition; children with this condition were more likely to show sensory food aversion and FTT. Feeding behavior disorders were significantly associated with gastrointestinal problems, and dysphagia was significantly related to almost all medical conditions.
CONCLUSION
A multidisciplinary approach to children with feeding difficulties is proposed for comprehensive evaluation and treatment because combinations of feeding problems are very common among children. This overall profile could provide clinicians with a clear understanding of the complexity of feeding disorders and their relationships with various medical conditions in children.

Keyword

Feeding behavior; Failure to thrive; Dysphagia; Comorbidity

MeSH Terms

Child
Comorbidity
Deglutition Disorders
Failure to Thrive
Feeding Behavior
Humans
Medical Records
Outpatients
Retrospective Studies
Tertiary Care Centers

Figure

• 

  Fig. 1 Proportions of patients who present with failure to thrive (FTT), dysphagia, and a feeding behavior disorder.

Reference

1. Manikam R, Perman JA. Pediatric feeding disorders. J Clin Gastroenterol. 2000; 30:34–46. PMID: 10636208.

2. Lefton-Greif MA, Arvedson JC. Pediatric feeding and swallowing disorders: state of health, population trends, and application of the international classification of functioning, disability, and health. Semin Speech Lang. 2007; 28:161–165. PMID: 17647128.

3. Burklow KA, McGrath AM, Valerius KS, Rudolph C. Relationship between feeding difficulties, medical complexity, and gestational age. Nutr Clin Pract. 2002; 17:373–378. PMID: 16215014.

4. Jarjour IT. Neurodevelopmental outcome after extreme prematurity: a review of the literature. Pediatr Neurol. 2015; 52:143–152. PMID: 25497122.

5. Berlin KS, Lobato DJ, Pinkos B, Cerezo CS, LeLeiko NS. Patterns of medical and developmental comorbidities among children presenting with feeding problems: a latent class analysis. J Dev Behav Pediatr. 2011; 32:41–47. PMID: 21099437.

6. Benoit D, Wang EE, Zlotkin SH. Discontinuation of enterostomy tube feeding by behavioral treatment in early childhood: a randomized controlled trial. J Pediatr. 2000; 137:498–503. PMID: 11035828.

7. Burklow KA, Phelps AN, Schultz JR, McConnell K, Rudolph C. Classifying complex pediatric feeding disorders. J Pediatr Gastroenterol Nutr. 1998; 27:143–147. PMID: 9702643.

8. Rommel N, De Meyer AM, Feenstra L, Veereman-Wauters G. The complexity of feeding problems in 700 infants and young children presenting to a tertiary care institution. J Pediatr Gastroenterol Nutr. 2003; 37:75–84. PMID: 12827010.

9. Cole SZ, Lanham JS. Failure to thrive: an update. Am Fam Physician. 2011; 83:829–834. PMID: 21524049.

10. Behrman RE, Kliegman R, Nelson WE. Nelson textbook of pediatrics. Philadelphia: W.B. Saunders;1996.

11. Chatoor I. Diagnosis and treatment of feeding disorders in infants, toddlers, and young children. Washington: Zero to Three;2009.

12. Carruth BR, Ziegler PJ, Gordon A, Barr SI. Prevalence of picky eaters among infants and toddlers and their caregivers' decisions about offering a new food. J Am Diet Assoc. 2004; 104(1 Suppl 1):s57–s64. PMID: 14702019.

13. Steinberg C. Feeding disorders of infants, toddlers, and preschoolers. B C Med J. 2007; 49:183–186.

14. Gisel EG. Effect of food texture on the development of chewing of children between six months and two years of age. Dev Med Child Neurol. 1991; 33:69–79. PMID: 1995410.

15. Coulthard H, Harris G, Emmett P. Delayed introduction of lumpy foods to children during the complementary feeding period affects child's food acceptance and feeding at 7 years of age. Matern Child Nutr. 2009; 5:75–85. PMID: 19161546.

16. Bernard-Bonnin AC. Feeding problems of infants and toddlers. Can Fam Physician. 2006; 52:1247–1251. PMID: 17279184.

17. Chatoor I, Ganiban J, Harrison J, Hirsch R. Observation of feeding in the diagnosis of posttraumatic feeding disorder of infancy. J Am Acad Child Adolesc Psychiatry. 2001; 40:595–602. PMID: 11349705.

18. Field D, Garland M, Williams K. Correlates of specific childhood feeding problems. J Paediatr Child Health. 2003; 39:299–304. PMID: 12755939.

19. Kogon BE, Ramaswamy V, Todd K, Plattner C, Kirshbom PM, Kanter KR, et al. Feeding difficulty in newborns following congenital heart surgery. Congenit Heart Dis. 2007; 2:332–337. PMID: 18377449.

20. Barker J, Martino R, Reichardt B, Hickey EJ, Ralph-Edwards A. Incidence and impact of dysphagia in patients receiving prolonged endotracheal intubation after cardiac surgery. Can J Surg. 2009; 52:119–124. PMID: 19399206.

21. DiBaise JK, Young RJ, Vanderhoof JA. Intestinal rehabilitation and the short bowel syndrome: part 2. Am J Gastroenterol. 2004; 99:1823–1832. PMID: 15330926.

22. Uhm KE, Yi SH, Chang HJ, Cheon HJ, Kwon JY. Videofluoroscopic swallowing study findings in full-term and preterm infants with dysphagia. Ann Rehabil Med. 2013; 37:175–182. PMID: 23705111.

23. Verhagen JV, Engelen L. The neurocognitive bases of human multimodal food perception: sensory integration. Neurosci Biobehav Rev. 2006; 30:613–650. PMID: 16457886.

24. Davis AM, Bruce AS, Khasawneh R, Schulz T, Fox C, Dunn W. Sensory processing issues in young children presenting to an outpatient feeding clinic. J Pediatr Gastroenterol Nutr. 2013; 56:156–160. PMID: 22986370.

25. Forchielli ML, McColl R, Walker WA, Lo C. Children with congenital heart disease: a nutrition challenge. Nutr Rev. 1994; 52:348–353. PMID: 7816352.

26. Kerzner B, Milano K, MacLean WC Jr, Berall G, Stuart S, Chatoor I. A practical approach to classifying and managing feeding difficulties. Pediatrics. 2015; 135:344–353. PMID: 25560449.

27. Davies WH, Satter E, Berlin KS, Sato AF, Silverman AH, Fischer EA, et al. Reconceptualizing feeding and feeding disorders in interpersonal context: the case for a relational disorder. J Fam Psychol. 2006; 20:409–417. PMID: 16937997.

28. Cardona Cano S, Tiemeier H, Van Hoeken D, Tharner A, Jaddoe VW, Hofman A, et al. Trajectories of picky eating during childhood: a general population study. Int J Eat Disord. 2015; 48:570–579. PMID: 25644130.

29. Yi SH, Joung YS, Choe YH, Kim EH, Kwon JY. Sensory processing difficulties in toddlers with nonorganic failure-to-thrive and feeding problems. J Pediatr Gastroenterol Nutr. 2015; 60:819–824. PMID: 25564810.

30. Broniatowski M, Sonies BC, Rubin JS, Bradshaw CR, Spiegel JR, Bastian RW, et al. Current evaluation and treatment of patients with swallowing disorders. Otolaryngol Head Neck Surg. 1999; 120:464–473. PMID: 10187935.

31. Breton A, Eyoum I, Fournie-Gardini E, Olives JP, Vergeau D, Vignes M. Treatment of children with feeding disorders. Rev Laryngol Otol Rhinol (Bord). 2008; 129:121–126. PMID: 18767331.