Gastrointestinal Motility and Sensory Abnormalities May Contribute to Food Refusal in Medically Fragile Toddlers

Zangen, Tsili; Ciarla, Carla; Zangen, Samuel; Lorenzo, Carlo Di; Flores, Alex F. C.; Cocjin, Jose; Reddy, S. N.; Rowhani, Anita; Schwankovsky, Lenore; Hyman, Paul E.

doi:10.1097/00005176-200309000-00016

Cited by 100 publications

(66 citation statements)

References 30 publications

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“…Pain from esophagitis is a common sequela of gastroesophageal reflux due to recurrent contact between acid gastric contents and the esophageal mucosa [18]. Zangen et al [32] have speculated that a history of gastritis and esophagitis, combined with past medical treatment, may contribute to the creation of pathological pain pathways in infants with central nervous system (CNS) disorders. This might explain the heightened food aversion or refusal in the subgroup of children in this study who experienced gastroesophageal reflux.…”

Section: Discussionmentioning

confidence: 99%

Early Oral Sensory Experiences and Feeding Development in Children with CHARGE Syndrome: A Report of Five Cases

Dobbelsteyn

Marche²,

Blake

et al. 2005

Dysphagia

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Children with CHARGE syndrome commonly experience feeding and swallowing problems. Difficulties may be associated with congenital structural anomalies, motor impairment, and/or oral sensory impairment. For many children with CHARGE syndrome, the introduction of functional oral feeding is delayed and there are often long-term feeding complications. Oral aversion or defensiveness is a frequent serious issue; however, it is uncertain whether this is a primary sensory disorder or secondary to delayed and/or negative oral sensory and feeding experiences. This article examines in detail the early oral sensory and feeding experiences of five children with CHARGE syndrome, through a review of medical records and caregiver questionnaires. Findings indicate variable early oral sensory experiences in this group of children, with all of the children having some difficulty or delay in the development of oral feeding and swallowing. The nature of these difficulties and the potential contributory factors are discussed.

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Section: Discussionmentioning

confidence: 99%

Early Oral Sensory Experiences and Feeding Development in Children with CHARGE Syndrome: A Report of Five Cases

Dobbelsteyn

Marche²,

Blake

et al. 2005

Dysphagia

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“…73 Recently, medications to suppress visceral hyperalgesia have helped establish normal feeding in tube-fed children. 74 …”

Section: Management Of Fear Of Feedingmentioning

confidence: 99%

A Practical Approach to Classifying and Managing Feeding Difficulties

Kerzner¹,

et al. 2015

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Many young children are thought by their parents to eat poorly. Although the majority of these children are mildly affected, a small percentage have a serious feeding disorder. Nevertheless, even mildly affected children whose anxious parents adopt inappropriate feeding practices may experience consequences. Therefore, pediatricians must take all parental concerns seriously and offer appropriate guidance. This requires a workable classification of feeding problems and a systematic approach. The classification and approach we describe incorporate more recent considerations by specialists, both medical and psychological. In our model, children are categorized under the 3 principal eating behaviors that concern parents: limited appetite, selective intake, and fear of feeding. Each category includes a range from normal (misperceived) to severe (behavioral and organic). The feeding styles of caregivers (responsive, controlling, indulgent, and neglectful) are also incorporated. The objective is to allow the physician to efficiently sort out the wide variety of conditions, categorize them for therapy, and where necessary refer to specialists in the field.Parents of young children worldwide are concerned about feeding difficulties. When asked, more than 50% of mothers claim that at least 1 of their children eats poorly; this implicates ∼20% to 30% of children.

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“…The mechanisms of DGE in NI patients, similar to GERD, might be considered as the cause of aggravated gastric emptying via affected gastric motility, such as abnormal modulation of extrinsic innervations due to a damaged central nervous system or hypoxicischemic damage to the enteric nerves. 27 Moreover, a combination of several factors, such as scoliosis, horizontal position and long- (12) SDGE (14) DGE (14) SDGE (12) DGE (18) SDGE (8) DGE (20) SDGE (6) pHI ( term anticonvulsant use potentially delays GE. Gatti et al 22 also…”

Section: Discussionmentioning

confidence: 99%

Severe Delayed Gastric Emptying Induces Non-acid Reflux up to Proximal Esophagus in Neurologically Impaired Patients

Ishii

Fukahori

Asagiri

et al. 2017

J Neurogastroenterol Motil

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Background/AimsThe aim of this study is to investigate the degree of delayed gastric emptying (DGE) and evaluate how the severity of DGE affects gastroesophageal reflux disease (GERD) in neurologically impaired (NI) patients utilizing 24-hour multichannel intraluminal impedance pH measurements (pH/MII) and 13 C-acetate breath test ( 13 C-ABT) analyses. Methods 13C-ABT and pH/MII were conducted in 26 NI patients who were referred to our institution due to suspected GERD. At first, correlation analyses were performed to investigate the correlation between the 13 C-ABT parameters and the clinical or pH/MII parameters. Thereafter, all patients were divided into 2 groups (DGE and severe DGE [SDGE] group) according to each cut off half emptying time (t 1/2 , 90-170 minutes). Each pH/MII parameter was compared between the 2 groups in each set-up cutoff t 1/2 . ResultsThe mean t 1/2 of all patients was 215.5 ± 237.2 minutes and the t 1/2 of 24 (92.3%) patients were > 100 minutes. Significant moderate positive correlations were observed between both t 1/2 and lag phase time and the non-acid reflux related parameters. Furthermore, the patients in the SDGE group demonstrated higher non-acid reflux related parameters than those of the DGE groups when the cutoff was t 1/2 ≥ 140 minutes. ConclusionThe present study demonstrated that GE with t 1/2 ≥ 140 minutes was related to an increase of non-acid exposure reaching up to the proximal esophagus in NI patients, and indicating that NI patients with SDGE might have a high risk of non-acid GERD.

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Gastrointestinal Motility and Sensory Abnormalities May Contribute to Food Refusal in Medically Fragile Toddlers

Abstract: Upper gastrointestinal motor and/or sensory disorders contributed to reduced quality of life for a majority of children and families with persistent feeding problems. A multidisciplinary approach improved symptoms and problems in these children

Cited by 100 publications

References 30 publications

Early Oral Sensory Experiences and Feeding Development in Children with CHARGE Syndrome: A Report of Five Cases

Early Oral Sensory Experiences and Feeding Development in Children with CHARGE Syndrome: A Report of Five Cases

A Practical Approach to Classifying and Managing Feeding Difficulties

Severe Delayed Gastric Emptying Induces Non-acid Reflux up to Proximal Esophagus in Neurologically Impaired Patients

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