Diagnosis and Treatment of Feeding Disorders in Children With Developmental Disabilities

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.

  ABSTRACT

 Abstract

Objectives.  To determine the results of diagnostic evaluation and the effects of nutritional intervention on energy consumption, weightgain, growth, and clinical status of children with neurodevelopmentaldisabilities 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) whowere referred for diagnosis and treatment of feeding or nutritionalproblems. Initial assessments included a 3-day calorie intakerecord, videofluoroscopic swallowing study (VFSS), 24-hour intraesophagealpH monitoring, milk scintigraphy, and esophagogastroduodenoscopy.

Results.  These studies demonstrated gastroesophageal reflux (GER) with or without aspiration in 44 of 79 patients (56%), oropharyngealdysphagia in 21 (27%), and aversive feeding behaviors in 14 (18%).Diagnosis-specific approaches included medical GER therapy in20 patients (25%), fundoplication plus gastrostomy tube (GT) in18 (23%), oral supplements in 17 (22%), feeding therapy only in14 (18%), and GT only in 10 (13%). After 24.6 ± 3.0 months, relativecalorie intake, expressed as intake (kcal/d)/recommended dailyallowance (RDA, kcal/d), improved significantly (initial:final= 0.78 ± 0.36:1.23 ± 0.27). The z scores increased significantlyfor both weight (initial:final =  2.80 ± 1.33: 0.81 ± 0.69) andheight ( 3.14 ± 0.98: 2.00 ± 0.67). Improved subcutaneous tissuestores were demonstrated by increased thickness of both subscapularskinfolds (change = 71% ± 26%) and triceps skinfolds (38% ± 17%).After nutritional intervention, the acute care hospitalizationrate, compared with the 2-year period before intervention, decreasedfrom 0.4 ± 0.18 to 0.15 ± 0.06 admissions per patient-year andincluded only 3 admissions (0.02 per patient-year) related tofeeding problems.

Conclusions.  In children with developmental disabilities, diagnosis-specific treatment of feeding disorders results in significantly improvedenergy consumption and nutritional status. These data also indicatethat decreased morbidity (reflected by a lower acute care hospitalizationrate) may be related, at least in part, to successful managementof feeding problems. Our results emphasize the importance of astructured approach to these problems, and we propose a diagnosticand treatment algorithm for children with developmental disabilitiesand 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 gastroesophagealreflux (GER), oral motor dysfunction, pharyngoesophageal dyskinesia,and aversive feeding behavior.Proteinenergy intake and nutritional status often are compromised asa consequence of feeding impairment, particularly among the mostseverely disabled patients. If not adequatelytreated, feeding disorders may result in additional complicationsincluding esophagitis, reactive airway disease, aspiration pneumonia,and bedsores. Previous reports indicate thatenteral feeding regimens for nutrition support in developmentallydisabled children improve overall nutritional status.To date, however, few investigations have evaluated the effectsof diagnosis-specific nutritional therapies on clinical outcomeswith respect to the frequency of feeding disorder-related complicationsand rates of acute care hospitalization. Accordingly, the objectivesof the present study were to assess feeding problems in a largegroup of children with developmental disabilities and to determinethe effects of nutritional management on growth, weight gain,and feeding-associated morbidity.

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