High-resolution Esophageal Manometry Patterns in Children and Adolescents With Rumination Syndrome.

BACKGROUND: Rumination is defined by effortless regurgitation within seconds or minutes of ingested food. The aim of this study was to determine the high-resolution esophageal manometry (HREM) pattern in children with rumination syndrome. METHODS: HREM was evaluated in 15 pediatric patients with rumination syndrome according to the Rome criteria and compared with 15 controls. Primary rumination was defined as a clinical rumination episode associated with a rise of gastric pressure above 30 mmHg. Secondary rumination was defined as a clinical rumination episode associated with a rise of gastric pressure above 30 mmHg during a transient lower esophageal sphincter relaxation (TLESR). RESULTS: Ninety-two episodes of rumination were demonstrated during HREM study in 12 of the 15 patients (80%; 1-29 episodes per patient; median intragastric pressure 49.6 mmHg). Primary rumination occurred in 3 patients and secondary rumination in 5 patients. One patient had primary and secondary rumination episodes. In 3 patients, classification of rumination episodes was not possible due to repetitive swallowing leading to lower esophageal sphincter relaxation. In the control group, no episodes of rumination occurred. The sensitivity and the specificity of the HREM study (association of a clinical rumination episode with a rise in gastric pressure >30 mmHg) to confirm the diagnosis of rumination were 80% and 100%, respectively. CONCLUSIONS: HREM allows confirming diagnosis of rumination syndrome and to differentiate between primary and secondary rumination in the presence of objective rumination episodes. Further research is needed to study whether HREM results may influence treatment and outcome of children with rumination syndrome.

Rumination in bipolar disorder: a systematic review

Objective:To conduct a systematic review of the literature about the symptom of rumination in bipolar disorder (BD).Methods:We searched the MEDLINE (PubMed), ISI Web of Knowledge, PsycINFO, and SciELO databases using the descriptors “rumination” and “bipolar disorder” and no time limits. This strategy yielded 105 references, of which 74 were selected. Inclusion criteria were studies involving patients with BD and the use of at least one validated scale for the assessment of rumination. Review articles were excluded. Seventeen articles were ultimately analyzed and included in the review.Results:Rumination is present in all BD phases, is a stable interepisodic symptom, is associated with symptoms of depression, anxiety, and hypomania, and may occur in response to both positive and negative affect. There is no research on rumination and neurobiological findings in patients with BD.Conclusions:Rumination seems to be independent of mood state, but shows close relationship with it. It is possible that rumination has a negative impact on cognitive and executive functions, particularly inhibitory control. Finally, rumination is an important symptom in both phases of BD, and, therefore, may be a useful target for further exploration as a dimensional domain and a transdiagnostic phenomenon in Research Domain Criteria (RDoC) projects.

Associations between parental feeding practices, problem food behaviours and dietary intake in New Zealand overweight children aged 4-8 years.

OBJECTIVE: Parents report that children's eating behaviours are a major barrier to providing them with a healthy diet. Links between problem eating behaviours and parental feeding practices are not well established and have not previously been examined in overweight children. The aim of the present study was to assess associations between problem food behaviours, dietary intake and parental feeding practices of overweight children aged 4-8 years. DESIGN: Participants were recruited for a lifestyle intervention (n 203). At baseline, children's BMI was measured and parents completed comprehensive questionnaires about the feeding practices they used, the problem food behaviours their children exhibited and the foods their child consumed. A fussy eating scale was developed and associations were determined using correlations and regression analysis, including interactions. SETTING: Dunedin, New Zealand. SUBJECTS: Overweight children aged 4-8 years. RESULTS: Healthy eating guidance and monitoring by parents were related to the consumption of fewer unhealthy foods (B=-0·4, P=0·001 and B=-0·4, P<0·001). Conversely, a lack of parental control (child control) was related to a higher intake of unhealthy foods (B = 0·5, P<0·001). Parents of children who were fussy eaters monitored their child's food intake less (P<0·001) and allowed the child more freedom over what he/she ate (P<0·001). These children consumed fewer fruit and vegetables than those who were not fussy eaters (P<0·001). However, fussy eaters with food-restrictive parents ate more fruit and vegetables (B=2·9, P<0·001). CONCLUSIONS: These results suggest that a more structured food environment might be beneficial for the diet and food behaviours of young overweight children.

Measuring oral sensitivity in clinical practice: a quick and reliable behavioural method.

This article aims to offer a behavioural assessment strategy for oral sensitivity that can be readily applied in the clinical setting. Four children, ranging in age and with a variety of developmental and medical problems, were used as test cases for a task analysis of tolerance to touch probes in and around the mouth. In all cases, the assessment was sensitive to weekly measures of an intervention for oral sensitivity over a 3-week period. Employing an inexpensive, direct, specific to the individual, replicable, reliable, and effective measure for a specific sensory problem would fit better with the edicts of evidence-based practice. The current method offered the initial evidence towards this goal.

Use of behavioral interventions and parent education to address feeding difficulties in young children with spastic diplegic cerebral palsy.

The purpose of this study was to assess the effectiveness of an intensive day patient pediatric feeding program using oral motor exercises, behavioral interventions, and parental education to increase the oral feeding of children with spastic diplegic cerebral palsy. Eight children between the ages of 18 months to 4.7 years participated in the feeding program for an average of 5.8 weeks. The program consisted of structured oral motor exercises, rewards for reinforcement of appropriate feeding behaviors such as accepting food, chewing, and swallowing, as well as extinction for inappropriate feeding responses. Results show improvement in mealtime skills and behaviors necessary for increasing oral intake. There was improvement in ability to open the mouth for the presentation of the food as well as improved timeliness of swallowing without gagging, expelling or holding food in the mouth. The children were able to tolerate longer meal sessions and consume a greater quantity of food resulting in greater caloric consumption. The children who were tube fed at admission were able to decrease the amount of tube supplementation due to their improved oral intake. Caregivers improved in their ability to feed their children by providing appropriate instructions, prompts and consequences (IPC) during meals.

Outcome of intensive oral motor and behavioural interventions for feeding difficulties in three children with Goldenhar Syndrome.

OBJECTIVE: The facial anomalies and surgeries associated with Goldenhar Syndrome often lead to feeding problems. The purpose of this study was to demonstrate the outcome of Goldenhar Syndrome children admitted to the day patient paediatric feeding programme. SUBJECTS: Three children with Goldenhar Syndrome and feeding difficulties participated, mean age 3 years. Average length of stay was 8 weeks. Upon admission all were dependent on tube feedings. METHODS: The children received four therapeutic sessions daily. The sessions included oral motor interventions, behavioural techniques and a structured meal. Data regarding children's feeding were collected at admission and discharge. RESULTS: The patients had 52% acceptance of food/drink at admission and 88.7% at discharge. Expels were 30% at admission and 14% at discharge. Mouth clean was 9.3% at admission and 97% at discharge. Total inappropriate feeding behaviours averaged 83% at admission and 27.3% at discharge. Children averaged 3.4 g per meal at admission and 105.4 g at discharge. Two children were completely weaned from tube feedings by discharge. CONCLUSIONS: Results support the hypothesis that combining oral motor and behavioural interventions offer effective treatment for children with Goldenhar Syndrome. Many children with Goldenhar Syndrome are reliant on tube feedings and this regimen allows them to eat orally, thereby improving their nutrition and quality of life.