Picky Eating or Feeding Disorders Caused By Hypersensitivities Gastrointestinal

Picky eating include many problem feeding is not a normal part of child development. Children who are problem feeders often have inadequate caloric intake, poor weight gain and growth, as well as vitamin and mineral deficiencies. If left untreated, children who are problem feeders can suffer from malnutrition, dehydration, and impaired intellectual, emotional and academic development

SYMPTOMS FEEDING DIFFICULTIES 

  • Eat less than 20 foods
  • Eat fewer and fewer foods over time until they are limited to about 5-10 foods they will eat
  • Refuse foods of certain textures altogether
  • Will eat one food over and over, but unlike picky eaters they will eventually burn out and not go back to eating that food again
  • Will not accept new foods on their plate and will not tolerate even touching or tasting a new food
  • Cry, scream and tantrum when new foods are placed on their plate
  • Are unwilling to try a new food even after 10 exposures
  • Have a rigidity and need for routine/sameness during meals
  • Are inflexible about certain foods

FACTORS AFFECTING OF THE EATING DIFFICULTIES IN CHILDREN

POOR APPETITE

  • Loss of appetite, medically referred to as anorexia, can be caused by a variety of conditions and diseases.
  • Appetite disorders display a mild form of bottle-fed often rest, drink the milk declined (previously 20 minutes to 10 minutes), eat only a little or take out, spray food or keep food in the mouth for too long.
  • Strong Clossing Mouth while eating
  • This disturbance is more severe visible child shut her mouth, brushed off the bribes parents or do not want to eat and drink at all.

SWALLOWING DISTURBANCE AND SENSORY FOOD AVERSION  Signs or symptoms of feeding and swallowing disorders in children

  • difficulty chewing
  • difficulty breast feeding
  • coughing or gagging during meals
  • arching or stiffening of the body during feeding
  • irritability or lack of alertness during feeding
  • refusing food or liquid
  • failure to accept different textures of food (e.g., only    pureed foods or crunchy cereals)
  • long feeding times (e.g., more than 30 minutes)
  • excessive drooling or food/liquid coming out of the mouth    or nose
  • difficulty coordinating breathing with eating and  drinking
  • increased stuffiness during meals
  • gurgly, hoarse, or breathy voice quality
  • frequent spitting up or vomiting
  • recurring pneumonia or respiratory infections
  • less than normal weight gain or growth

CAUSE

  • MOST OFTEN:  Gastrointrestinal Hypersensitivities suc as FOOD ALLERGIES, FOOD intolerance, COELIAC and Food Hypersensitivities.
  • Acute infections (flu, cough, cold, accut diarrhea)
  • VERY RARELY chronic disorders such as tuberculosis, urinary tract infections, malignancies, congenital heart defects, endocrine and metabolic disorders, and neurological disorders, Psychological Disorders

SIGNS AND SYMPTOMS OF GASTROINTESTINAL FOOD HYPERSENSITIVITIES  AS MAIN CAUSES OF FEEDING DIFFICULTIES IN CHILDREN

SIGNS AND SYMPTOMS OF GASTROINTESTINALHYPERSENSITIVITIES  IN INFANT

Stomach –   gastrointestinal
  • Gastrooesephageal   Refluks: vomiting
  • Frequent spitting up or   vomiting, frequent wet/sour burps, wet hiccups. Silent reflux: food coming part   way up more than an hour after eating, spitting up-after six months of age.   Rare: projectile vomiting, forceful vomiting through the nose and mouth.
  • Feses: Black, dark, dark   green , smelly, like pebbles, liquid or watery
  • Irritability, constant   or sudden crying, “colic”, back arching, abdominal pain, chest pain,   heartburn, burning sensation in the esophagus, doesn’t tolerate pressure on   the stomach.
  • Rare: pain migrating to   the shoulder/shoulder blade.
  • Constipation or   obstipation
  • Gas (flatulence)
  • Diarrhea or constipation   — sometimes even alternating bouts of constipation and diarrhea
  • Chronic diarrhea   (stooling above 2 times a day)
  • Bloody Diarrhoe
  • Smelly Stool
  • Mucus in the stool
  • Bowel movements may   occur either more often (diarrhea) or less often (constipation) than usual,   such as having more than 3 bowel movements a day or less than 3 a week.
  • Bowel movements may   differ in size or consistency (may be hard and small, pencil-thin, or loose   and watery).
  • The way stools pass   changes. You may strain, feel an urgent need to have a bowel movement, or   feel that you haven’t completely passed a stool.
  • You may have bloating or   a feeling of gas in the intestines.
  • may have lower abdominal   pain with constipation that is sometimes followed by diarrhea. Other people   have pain and mild constipation but no diarrhea
  • Gastroparisis-also   called Delayed Gastric Emptying or Slow Motility
  • Cyclic Vomiting Syndrome
  • Hernia umbilical, scrotal and inguinal
Mouth – Tooth   hypersensitive
  • White or dirty tongue
  • bad breath or halitosis
  • Likes oral candidiasis
  • excessive salivation or   drooling.
  • Cracked lips: dark lips,   dry lips, peeling or chapped. Breaks may appear on the surface, and the lips   may become painful and bleed.

SIGNS AND SYMPTOMS OF GASTROINTESTINAL HYPERSENSITIVITIES IN CHILDREN, TEENS AND ADULT

Stomach –   gastrointestinal Hypersensitive
  • colic”, back arching,   abdominal pain, chest pain, heartburn, burning sensation in the esophagus,   doesn’t tolerate pressure on the stomach.
  • Gastrooesephageal   Refluks Diseases (GERD)
  • Rare: pain migrating to   the shoulder/shoulder blade.
  • Frequent spitting up or   vomiting, frequent wet/sour burps, wet hiccups,
  • Silent reflux: food   coming part way up more than an hour after eating, spitting up-after six   months of age. Rare: projectile vomiting, forceful vomiting through the nose   and mouth.
  • Abdominal pain or   cramping
  • A bloated feeling
  • Gas (flatulence)
  • Diarrhea or constipation   — sometimes even alternating bouts of constipation and diarrhea. You may have   bloating or a feeling of gas in the intestines.
  • Some people may have   lower abdominal pain with constipation that is sometimes followed by   diarrhea. Other people have pain and mild constipation but no diarrhea.
  • Mucus in the stool
  • Bowel movements may   occur either more often (diarrhea) or less often (constipation) than usual,   such as having more than 3 bowel movements a day or less than 3 a week.
  • Bowel movements may   differ in size or consistency (may be hard and small, pencil-thin, or loose   and watery).
  • The way stools pass   changes. You may strain, feel an urgent need to have a bowel movement, or   feel that you haven’t completely passed a stool.
  • Unpleasant taste in the   mouth.
  • Gastroparisis-also   called Delayed Gastric Emptying or Slow Motility
  • Symptoms that are   sometimes present include intestinal gas and passage of mucus in stools.
  • Inflammatory bowel   disease
  • Vocal cord nodules,   laryngospasm, Barrett’s Esophagus, ulcers, esophagitis, Sandifer Syndrome,   fainting
Mouth – Tooth   hypersensitive (especially GERD or Frequent Vomiting)
  • Geographic tongue
  • Tooth enamel erosion
  • bad breath or halitosis
  • excessive salivation or   drooling.
  • Discoloration of Teeth:   yellow
  • Poor dental hygiene
  • teeth grinding or   bruxism
  • Dental Caries
  • strong reaction to too   much warmth or too much cold.
  • Pain Teeth: short, sharp   pain caused by exposure of the dentine
  • Plaque build-up.
  • Cracked teeth
  • Gum disease (gingivitis)
  • Tooth decay near the gum   line
  • Stomatitis, Canker Sores   (Aphthous Stomatitis Or Recurrent Mouth Ulcers)
  • Cracked lips: dry lips,   peeling or chapped. Breaks may appear on the surface, and the lips may become   painful and bleed.
  • tooth loss, cavities

 

OTHER SYMPTOMS FOOD ALLERGIES AND FOOD HYPERSENSITIVITIES in children with feeding disorders

Skin Hypersensitivites
  • Redness
  • Swelling
  • Itching
  • Skin lesions
  • Contact dermatitis, a   rash that results from either repeated contact with irritants or contact with   allergy-producing substances, such as poison ivy
  • Neurodermatitis, a   chronic itchy skin condition localized to certain areas of the skin
  • Seborrheic dermatitis, a   common scalp and facial condition that often causes dandruff
  • Stasis dermatitis, a   skin condition that’s caused by a buildup of fluid under the skin of the legs
  • Atopic dermatitis, more   commonly known as just eczema or atopic eczema, a chronic itchy rash that   tends to come and go
  • Perioral dermatitis, a   bumpy rash around the mouth
  • Ptyriasis Alba
  • Psoriasis
  • Urticaria
  • acne
  • xerosis
Respiratory Hypersensitivities
  • Asthma
  • Coughing, especially at   night
  • Wheezing
  • Noisy Breathing in   Infant (Hipersecretion Bronchus)
  • Shortness of breath
  • Deep Breathing
  • Chest tightness, pain,   or pressure
Ear- Nose-Throath Hypersensitivites
  • A stuffy nose, possibly   with sniffing. This is the most common symptom in children and may be their   only complaint.
  • Sneezing repeatedly,   especially after you wake up in the morning. Sneezing can occur as soon as 1   to 2 minutes after you breathe in an allergen.
  • Bleeding Nose
  • A runny nose   (rhinorrhea)
  • Watery, itchy eyes. This   may be allergic pinkeye.
  • Itchy ears, nose, and   throat.
  • Symptoms that may take longer   to develop include:
  • Eyes that are sensitive   to light.
  • Feeling grumpy or moody.
  • Loss of energy.
  • Poor sleep.
  • Breathing through your   mouth because your nose is blocked.
  • An altered sense of   smell.
  • A long-lasting (chronic)   cough.
  • Problems with sinuses and   the tubes that run between the inside of the ears and the back of the throat   (eustachian tubes).
  • A sense of pressure in   an ear or difficulty hearing.
  • Discomfort or pain in   the face.
  • Dark circles or patches   under the eyes (allergic shiners).
  • Rubbing the nose, which   may cause a crease on the bridge of the nose (allergic crease)
  • Rubbing the nose upward   with the palm of the hand to reduce itching and open the nasal passages   (allergic salute). This is often seen in children
  • Sinusitis
  • Polip
  • Ear infections
Eyes Hypersensitivites
  • Watery eyes. Eyes can   water either because tear ducts are blocked, or because something is   irritating them, such as an allergy.
  • Itchiness and burning.   Histamine and other chemicals released during an allergic cascade produce   these symptoms.
  • Redness.
  • Black circles around the   eyes. Sometimes known as allergic shiners, they are the result of constant   rubbing and scratching of the skin, which causes a darkening effect. This can   be seen in children with allergic rhinitis (hay fever), as well as with other   conditions.
  • Sensation that something   is in the eye.
  • Cobblestone pattern of   lesions on the conjunctiva under the eyelids.
  • Light sensitivity   (photophobia).
  • Discharge. The   characteristics of the discharge will vary based on the type of condition.
  • Swelling of the eyelid.
  • Symptoms of   allergy-related eye conditions may occur alone or can appear in combination   with nasal (e.g., sneezing, sniffling, stuffy nose)
  • Abnormal alignment of   the eyes, or unusual eye movement after 6 months of age
  • Red-rimmed, crusted or   swollen eyelids
  • Watery or red eyes
  • Rubs eyes often
  • Closes or covers one eye
  • Tilts head, or thrusts   head forward
  • Struggles with reading   or other work that involves close-up vision
  • Blinks more often than   normal
  • Mentions that things are   blurry or hard to see
  • Squints or frowns a lot   while trying to see things
  • Has difficulty following   (tracking) objects visually
Hormone Imbalance
  • Hormone Imbalance in Infant: comedo, vaginal discharge (bleeding or mentrual)
  •   PMS (Pre Menstrual Syndrome)
  •   Hair Loss
  •   Weight Problems
  •   Loss of Short Term Memory
  •   Fatigue
  •   Skin Problems
  •   Mood Swings
  •   Diminished Sex Drive
  •   Anxiety and Panic Attacks
  •  Premenstrual  Asthma
  •  Menstrual Migraine
  •  Fibromyalgia
  •  Interstitial Cystitis
  •  Arthritis
  •  Chronic  Fatigue Syndrome
  • amenorrhoea
  • Polycystic ovary syndrome (PCOS)
  • Endometriosis
  • lanugo
Others Hypersensitivites
  • Anxiety
  • Bed-wetting
  • Depression
  • Diabetes
  • Fatigue
  • Hay fever
  • Muscle aches
  • Obesity
  • Panic attacks

OTHER DISTURBANCES in children with feeding disorders

Sleep Problems
  • Sleep Apnea
  • Resistance to going to   bed
  • Difficulty falling   asleep
  • Restless / erratic sleep
  • Nightmares, bad dreams
  • Poor sleep
  • Frequent walking
  • Snoring
  • Breathing pauses during sleep
  • Problems with sleeping through the night
  • Difficulty staying awake during the day
  • Unexplained decrease in daytime performance
  • Unusual events during sleep
  • Resists lying down
  • Ccries when placed on   back or flat surface
  • Only sleeps when upright   on shoulder, car seat, wedge.
Gross Motoric Delayed(especially in patient   with GER and frequent vomiting)
  • Delayed motor milestones   due to restricted positioning and frequent pain. Gross motor delay can   include delay in: Walking, Crawling, Transitions, Rolling, Sitting, Jumping,   Stair climbing, Running, Riding a bike andOther large motor skills
  • Difficulty with   playground activities
Oral motor Disturbance (especially in patient   with GER and frequent vomiting)
  • Developmental apraxia of   speech (DAS or dyspraxia of speech). Children with apraxia have   trouble moving and coordinating the different parts of their mouths in order   to form words.
  • Articulation disorders: These include lisping,   leaving out consonants when speaking, and substituting one sound for another.
  • Swallowing disturbances
  • Speech Delayed
  • have a droopy, or “long”   face (her mouth frequently hangs open)
  • refuse to eat food that   needs to be chewed
  • gag frequently when   eating (and not just when she’s asked to swallow her peas)
  • weigh less and be   shorter than other tots her age
  • have trouble sticking   out her tongue or moving it from side to side
  • be hard to understand
  • drool past the age of 18   months
  • lisp excessively
  • take extra time to form   words while speaking
  • use mostly vowel sounds   after 18 months (“aah-aah” instead of “mama”)
  • leave out some   consonants in words at age three ( “at” instead of “cat”)
  • add extra sounds to   words (“animinal” instead of “animal”)
  • substitute certain   sounds when speaking (“wittle” instead of “little”); note that this is common   in young toddlers, so if a tot who does this improves as she nears age two,   she’s likely fine
  • have trouble stringing   together syllables in the right order (“minacin” instead of “cinnamon”)
Neurology Problems and  Behaviour Problems
  • Neuro-Muscular   Involvement : Accident prone, Poor muscle coordination, Difficulty writing,   drawing , Dyslexia/reading problems, Speech difficulties/delays, Difficulty   with playground activities, sports, Eye muscle disorder (nystagmus,   strabismus), Tics (unusual or uncontrollable movements)
  • Cognitive and Perceptual   Disturbances :Auditory memory deficits (difficulty remembering what is   heard)
    Visual memory deficits (difficulty remembering what is seen), Difficulty in   comprehension and short term memory, Disturbance in spatial orientation   (up-down, right-left), Difficulties in reasoning (simple math problems,   meaning in words
  • Motor Skills Disorder: clumsy child syndrome,   minimal brain dysfunction, poorly coordinated children, movement-skill   problems, physical awkwardness. Dyspraxia (which suggests underlying   difficulties in motor planning), perceptual motor difficulties (which   suggests problems in perceptual motor integration), minor neurologic   dysfunction (MND), and sensory integrative dysfunction.
  • Sensory Integration   Dysfunction
  • Seizures (some types,   especially if combined with migraine or hyperactivity)
  • Seizures Attacks Non Epelepticus (Nonsiezure episode, Nonepilepticseizure, Nonepileptic paraxysmal disorders or nonepileptic attack disorders) with Normaly Electro Encephalography (EEG). Including : BREATH HOLDING SPELL, BENIGN PAROXYSMAL VERTIGO, RECURRENT ABDOMINAL, MIGREN, TRANSIENT GLOBAL AMNESIA, HIPERVENTILATION, SINCOPE CARDIOGENICM SINCOPE NONCARDIOGENIC AND  ”MOTOR SPELL DISORDERS”,   HEADBANGING,  JITTERINESS, BENIGN INFANTILE MYOKLONUS, TIC, SINDROMA TOURETTES AND CHOREIFORM MOVEMENT
  • Attention Deficit   Hyperactivity Disorder (ADHD)
  • Autism Spectrum disease
  • Short Attention Span :  Impatience, Distraction, Failure to complete projects, Inability to listen to   whole story, Inability to follow directions
  • Learning Problems
  • Bedwetting (enuresis)

How to know Feeding Difficulties caused By Food Allergy or Food Hypersensitivity ?

  • If you find sign and symptoms of gastrointestinal, mouth and teeth hypersensitivites, Feeding Difficulties or problems feeding of you or you children may be caused by Food Allergy or Food Hypersensitivities
  • Food allergy or food hypersensitivities, eating or swallowing even a tiny amount of a particular food can cause symptoms such as skin rash, nausea, vomiting, cramping, and diarrhea. Food allergies or food Hypersensitivities may cause symptoms in your skin, stomach, airways, eyes, brain, heart or entire body. Food allergy is an abnormal response to a food triggered by your body’s immune system. Sometimes a reaction to food is not an allergy. It is often a reaction called “food intolerance”. Your immune system does not cause the symptoms of food intolerance. However, these symptoms can look and feel like those of a food allergy. Because the body is reacting to something that is otherwise harmless, this type of allergic reaction is often called a hypersensitivity reaction
  • To diagnose food allergy or food hypersensitivity, a doctor first must determine if the  patient is having an adverse reaction to specific foods. The doctor  makes this assessment with the help of a detailed history from the  patient, the patient’s dietary diary, or an elimination diet. The elimination diet and food challenge test are tools used to identify food allergies or food hypersensitivities not by test allergy or test laboratory. The elimination diet involves removing specific foods or ingredients from diet
  • After elimination and chalenges tes feeding difficulties and feeding prblems much better and many other symptoms better. So, exactly Feeding Difficulties caused By Food Allergy or Food Hypersensitivity ?

Pediatric Articles Dr Widodo Judarwanto (pediatrician)

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