Feeding disorders in ex-prematures do exist and may constitute a major challenge to their families' well being. A cases series of 86 ex-prematures with severe feeding disorders was analysed regarding co-morbidity, response to therapy and the long-term outcome after treatment. These children with a gestational age of <37 weeks had been referred for hospital rehabilitation because of severe feeding disorders, defined as tube feeding or average feeding times of more than 30 minutes. Behavioural therapy was the key element of the treatment. Ex-prematures accounted for 86/266 patients admitted for treatment of feeding disorders between 1995 and 2004. Whereas only 40.8% of these had cerebral palsy, 51.1% had a diagnosis of mental retardation and 87% had interaction problems. Response to treatment up to discharge was achieved in 61.6%. Univariat analyses showed that tube feeding at admission and swallowing difficulties were the best predictors of failure to respond to the intervention. Long-term follow-up data that were collected for 53 of the 86 children with similar initial response to therapy (64.2%) compared to children with no follow-up data (57.6%). Success of therapy after discharge was maintained in 94.1%; however, 25% of the children with normal BMI's at discharge and sustained success of therapy fell below the 3rd BMI percentile. Cerebral palsy, mental retardation and interaction problems appear to be important risk factors for severe feeding disorders in ex-prematures. A therapeutic intervention based on behavioural therapy achieved sustained success in almost two thirds of the children.
Feeding disorders and failure-to-thrive (prevalence 2% to 4%) rarely have an isolated cause, but most often a number of inappropriate conditions are leading up to the development and, especially, the maintenance of the disorder. These can include organic causes like chronic diseases, peculiarities of the person, strange behavior of the child or the care person or of the interaction-problems. An obligatory classification of feeding disorders does not exist. Feeding disorders and failure-to-thrive can ask for a long-term additional or full tube-feeding or the child rejects age-appropriate food texture, has a very selective eating behavior or there are massive interaction problems during feeding. Feeding disorders and failure-to-thrive can not only have direct physical effects but also long-term unfavourable influences on behavioral aspects as well as on mental abilities. The diagnosis of feeding disorders and failure-to-thrive comprises next to the clarification of a basic organic disease, the clarification of swallowing and oral-motor capabilities as well as the exclusion of a gastroesophageal reflux. A differentiated feeding protocol must include the oral feeding as well as the tube feeding. A behavior observation comprises the feeding situation and, if necessary, further situations of interaction. Besides the treatment of the basic disease, a direct guidance in the feeding situation for the care person is necessary. Furthermore, a therapy of the oral motorics as well as one of the care person and guidelines for interaction during different situations can be important.
Schwere Nahrungsverweigerungen mit Mangelernährung sind bei geistig behinderten Kindern erheblich häufiger als bei intelligenten Kindern. Verlauf und Therapie einer jahrelangen totalen oralen Nahrungsverweigerung bei einem schwer mental behinderten 10;6 Jahre alten Kind mit Down–Syndrom werden berichtet. Nach schwieriger Schwangerschaft, Mangelgeburt, Trinkschwäche und Teilsondierung konnte vorübergehend eine voUständige orale Ernährung erreicht werden. Häufige Infekte der oberen Luftwege und eine Enzephalitis erforderten ab dem 2. Lebensjahr eine voUständige Sondierung. Auf der Basis einer «organischen» Eβstörung führten zusätzliche organische, operante und soziale Faktoren zu einer Aufrechterhaltung der Nahrungsverweigerung. In kleinsten Schritten konnten bei dem schwerstbehinderten Kind zuerst die Gewöhnung an die Fütterumstände, dann das Schlucken kleinster Flüssigkeitsmengen und schlieβlich eine voUständige, ausreichende orale Nahrungsaufnahme erreicht werden.
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