Inadequate weight gain or failure to thrive is a primary concern in infants, closely monitored by health care professionals. Less attention is paid to children whose weight gain is acceptable but who exhibit early atypical feeding patterns.
Unfortunately, these irregular feeding habits often become ingrained and may result in picky eaters or more serious sensory disorders.
Creating early proper feeding habits and developing positive neuropathways is certainly preferable to trying to correct inappropriate feeding habits in headstrong toddlers and young children.
Diagnosing and treating childhood feeding dysfunction (pediatric dysphagia) is a coordinated effort between pediatric radiologists and speech pathologists. Prior to initiation of feeding interventional therapy, radiographic evaluation is commonly performed to evaluate for anatomic abnormalities and the swallowing mechanism.
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Significant, symptomatic gastroesophageal reflux is common in infants in which food/gastric acids flow back into the esophagus, a condition that can be painful and irritating. These children may exhibit arching of the back (from pain), persistent vomiting or chronic cough. Fortunately, this is usually a temporary condition, effectively treated with medications. However, anatomic issues such as hiatal hernia can complicate GER.
Other esophageal problems also can occur such as a vascular ring (blood vessel around the esophagus and airway/trachea) and trachea-esophageal fistula (a connection between the esophagus and trachea which allows food to enter the lungs), often resulting in repeated pneumonias.
Infants who have had multiple episodes of pneumonia can be evaluated for aspiration pneumonia in which swallowed food can enter the lungs. Persistent aspiration is commonly seen in children who are neurologically compromised.
Early signs of sensory integration disorders can also present as pediatric dysphagia with infantile oral aversion including refusal to eat certain textures/solid foods. With proper early referral this can be effectively treated and may potentially result in earlier diagnosis of significant sensory disorders such as autism.
Children with congenital facial disorders (including cleft lip/palate) particularly benefit from early feeding therapy. Children with chronic conditions, such as complex congenital heart disease or chronic lung disease from prematurity, often manifest early feeding disturbances that can be diagnosed and corrected at an earlier age, often as infants, preventing the development of future abnormal feeding habits.
Pediatric dysphagia has many presentations, but early diagnosis and treatment is beneficial to prevent long term, ingrained aberrant feeding behavior in young children.
Dr. Vesna Martich Kriss, a pediatric radiologist, practices in the Baptist Health Pediatric Feeding and Swallowing Clinic at Brannon Crossing in Nicholasville.