Parent-Reported Feeding Difficulties among Children Born with Esophageal Atresia: Prevalence and Early Risk Factors

Abstract

Introduction We aimed to describe the prevalence of observable feeding difficulties during mealtimes among children with repaired esophageal atresia (EA) and to determine their early predictors. Materials and Methods A survey, based on parents' reports and concerning difficulties in EA children's nutritional intake, was performed with the help of 114 families of 2 to 17-year-old EA patients. Neonatal and clinical/surgical data were collected from medical records. Comparisons were made of the prevalence n (%) of feeding difficulties between children in three age groups (2 to 7 years, 8 to 12 years, or 13 to 17 years of age) using the Mantel-Haenszel chi-square test. Logistic regression identified outcome predictors (odds ratio: 95% confidence interval). Predictors with p ≤ 0.1 in the univariable analysis were included in multiple regression analysis (p < 0.05). Results Seventy-five percent of the young children aged 2 to 7, (median number of feeding difficulties: 2), 61% of school-aged children aged 8 to 12 (median number of feeding difficulties: 1), and 60% patients in the teenage group, aged 13 to 17, (median number of feeding difficulties: 1), reported feeding difficulties. Surgical complications after EA repair independently predicted children having a gastrostomy (p ≤ 0.01), using a food infusion pump (p ≤ 0.01), taking small portions to facilitate eating (p = 0.01), and needing >30 minutes to finish a main meal (p = 0.02). Congenital independent predictors were VACTERL, low birth weight, and preterm birth. Conclusion Parentally observed feeding difficulties were commonly reported during early childhood, although prevalence decreases in older age groups. Several congenital and surgical factors were identified as independent predictors of complicated nutritional intake patterns.

Postoperative morbidity and health-related quality of life in children with delayed reconstruction of esophageal atresia: a nationwide Swedish study

“…Interestingly, when comparing the presence of respiratory or digestive symptoms in children with DREA and PA, there were very few significant differences. In children aged 2–7, these symptoms and medical treatments were common in both groups [ 23 , 29 , 52 ], which may explain these findings. Though, chest tightness was more frequent in children with DREA.…”

Factors of family impact in a Swedish–German cohort of children born with esophageal atresia

“…After repair of EA, children commonly present with dysphagia (43–71%) [ 4 ], anastomotic strictures with a need for esophageal dilation (58%), and gastrointestinal reflux disease (44–65%) with management by antireflux medication and/or antireflux surgery [ 4 – 6 ]. Feeding difficulties are present in 63% of the children and can include choking episodes and taking a long time to finish a meal [ 7 ]. Symptoms from the respiratory tract are also frequent (52–69%), including, e.g., wheeze, chronic cough, dyspnea, and recurrent airway infections [ 8 , 9 ].…”

Parents’ experiences of feeding children born with oesophageal atresia/tracheo-oesophageal fistula

“…Following surgical repair, long-term eating and drinking difficulties are one of the most significant problems affecting those born with oesophageal atresia (OA) and tracheo-oesophageal fistula (TOF) [1] , [2] , [3] , placing a considerable burden on patients, parents and health services [4] . Besides delayed introduction of oral feeding, establishing eating and drinking in children with OA/TOF is complicated by other factors including: oesophageal dysmotility, oesophageal stricture, upper airway abnormality, and tracheomalacia, which can result in bolus obstruction, gastro-oesophageal reflux, aspiration and negative mealtime experiences [5] , [6] , [7] , [8] .…”