RESUMEN
BACKGROUND & AIMS: Feeding dysfunction is common in children. Efficient processes to identify and treat feeding dysfunction are not commonly known or used among healthcare practitioners. The aim of this study was to develop and validate a survey tool to assess current practice procedures used by Registered Dietitian Nutritionists (RDN) in identifying, diagnosing, and treating feeding dysfunction in children 0-18 years of age. METHODS: A survey was developed and distributed to gather information on RDN practice procedures, prevalence of pediatric feeding dysfunction, identification of pediatric feeding dysfunction, and method of treatment used to address pediatric feeding dysfunction. Emails were sent to 4449 RDNs in United States. All participants were classified by the Commission on Dietetic Registration (CDR) as clinical dietitians. Distribution and frequency of survey responses were assessed, and in the case of qualitative questions, were categorized according to themes identified. RESULTS: Responses of RDNs from 41 states completed 341 total surveys, 179 surveys were included in data analysis. Eighty percent of participants do not use a specific screening tool to identify feeding dysfunction. Results concerning feeding therapy strategies and terms used by RDNs to describe feeding dysfunction were highly varied or lacking. Increased inclusion of RDNs on interdisciplinary teams was indicated by 80% of participants. The majority of participants indicated they refer patients with feeding dysfunction to other practitioners instead of providing feeding therapy themselves. CONCLUSIONS: Standardized screening, diagnostic, and treatment protocols regarding feeding dysfunction are needed to provide consistent and comprehensive care for the pediatric population. Use of these protocols among RDNs would enable them to improve feeding abilities in more patients earlier in individual child development.
Asunto(s)
Trastornos de Ingestión y Alimentación en la Niñez/diagnóstico , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Nutricionistas , Niño , Preescolar , Atención a la Salud , Irritabilidad Alimentaria , Humanos , Lactante , Encuestas y Cuestionarios , Estados UnidosRESUMEN
Recent studies suggest that speech, solid feeding, and sleep difficulties may be linked to restricted tongue function. Children with tongue restrictions and speech, feeding, and sleep issues underwent lingual frenectomies with a CO2 laser, paired with myofunctional exercises. Questionnaires were completed before, 1 week after, and 1 month following treatment. Thirty-seven patients participated in the study (mean age 4.2 years [range 13 months to 12 years]). Overall, speech improved in 89%, solid feeding improved in 83%, and sleep improved in 83% of patients as reported by parents. Fifty percent (8/16) of speech-delayed children said new words after the procedure (P = .008), 76% (16/21) of slow eaters ate more rapidly (P < .001), and 72% (23/32) of restless sleepers slept less restlessly (P < .001). After tongue-tie releases paired with exercises, most children experience functional improvements in speech, feeding, and sleep. Providers should screen for oral restrictions in children and refer for treatment when functions are impaired.
Asunto(s)
Anquiloglosia/cirugía , Trastornos de Ingestión y Alimentación en la Niñez/etiología , Frenillo Lingual/cirugía , Trastornos del Sueño-Vigilia/etiología , Trastornos del Habla/etiología , Anquiloglosia/complicaciones , Anquiloglosia/rehabilitación , Niño , Preescolar , Terapia Combinada , Trastornos de Ingestión y Alimentación en la Niñez/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Terapia Miofuncional , Estudios Prospectivos , Trastornos del Sueño-Vigilia/diagnóstico , Trastornos del Habla/diagnóstico , Resultado del TratamientoRESUMEN
BACKGROUND: Rumination syndrome is a functional gastrointestinal disorder characterized by effortless and repetitive regurgitation of recently ingested food from the stomach to the oral cavity followed by either re-swallowing or spitting. Rumination is thought to occur due to a reversal of the esophagogastric pressure gradient. This is achieved by a coordinated abdominothoracic maneuver consisting of a thoracic suction, crural diaphragm relaxation and an increase in intragastric pressure. Careful history is important in the diagnosis of rumination syndrome; patients often report "vomiting" or "reflux" and the diagnosis can therefore be missed. Objective testing is available with high resolution manometry or gastroduodenal manometry. Increase in intra-gastric pressure followed by regurgitation is the most important characteristic to distinguish rumination from other disorders such as gastroesophageal reflux. The mainstay of the treatment of rumination syndrome is behavioral therapy via diaphragmatic breathing in addition to patient education and reassurance. PURPOSE: The purpose of this review was to critically appraise recent key developments in the pathophysiology, diagnosis and therapy for rumination syndrome. A literature search using OVID (Wolters Kluwer Health, New York, NY, USA) to examine the MEDLINE database its inception until May 2016 was performed using the search terms "rumination syndrome," "biofeedback therapy," and "regurgitation." References lists and personal libraries of the authors were used to identify supplemental information. Articles published in English were reviewed in full text. English abstracts were reviewed for all other languages. Priority was given to evidence obtained from randomized controlled trials when possible.
Asunto(s)
Terapia Conductista/métodos , Ejercicios Respiratorios/métodos , Trastornos de Ingestión y Alimentación en la Niñez/diagnóstico , Trastornos de Ingestión y Alimentación en la Niñez/fisiopatología , Biorretroalimentación Psicológica/métodos , Niño , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/fisiopatología , Reflujo Gastroesofágico/terapia , Humanos , Manometría/métodos , Síndrome , Resultado del Tratamiento , Vómitos/diagnóstico , Vómitos/fisiopatología , Vómitos/terapiaRESUMEN
In cystic fibrosis (CF), approximately 5-8% of the patients develop multilobular cirrhosis during the first decade of life. Annual screening (clinical examination, liver biochemistry, ultrasonography) is recommended in order to identify early signs of liver involvement, initiate ursodeoxycholic acid therapy and detect complications (portal hypertension and liver failure). Management should focus on nutrition and prevention of variceal bleeding. The gut may also be involved in children with CF. Gastroesophageal reflux is frequent, although often neglected and should be investigated by pH monitoring and impedancemetry, if available. Acute pancreatitis occurs in patients with persistent exocrine pancreatic activity. Intussusception, appendicular mucocele, distal intestinal occlusion syndrome, small bowel bacterial overgrowth and Clostridium difficile colitis should be considered in case of abdominal pain. Preventive nutritional support should be started as soon as possible after diagnosis of CF. Attainment of normal growth is one of the main goals and can be achieved with hypercaloric and salt supplemented food. Pancreatic enzyme replacement therapy should be started as soon as exocrine pancreatic insufficiency is confirmed and ingested immediately prior to meals with intake of fat-soluble vitamins. Curative nutritional interventions are more likely to be effective in the early stages of pulmonary disease. Feeding disorders, related to the physiopathology and the psychologic aspects of the disease are frequent. Repeated corporeal aggressions, associated with inappropriate medical and parental pressure, may increase the child's refusal of food. The multidisciplinary team should guide parents in order to avoid all intrusive feeding practices and promote pleasant mealtimes.
Asunto(s)
Fibrosis Quística/complicaciones , Fibrosis Quística/terapia , Enfermedades del Sistema Digestivo/etiología , Enfermedades del Sistema Digestivo/terapia , Trastornos de Ingestión y Alimentación en la Niñez/etiología , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Cirrosis Hepática/etiología , Cirrosis Hepática/terapia , Niño , Preescolar , Terapia Combinada , Fibrosis Quística/diagnóstico , Enfermedades del Sistema Digestivo/diagnóstico , Diagnóstico Precoz , Intervención Médica Temprana , Trastornos de Ingestión y Alimentación en la Niñez/diagnóstico , Humanos , Lactante , Comunicación Interdisciplinaria , Colaboración Intersectorial , Cirrosis Hepática/diagnóstico , Relaciones Padres-HijoRESUMEN
Children with feeding disorders frequently present to primary care practitioners. The causes of these feeding disorders are often a mix of medical, developmental, and behavioral factors. Evaluation and treatment of feeding problems typically require the expertise of physicians, speech and language pathologists, registered dietitians, and psychologists. This article advocates an interdisciplinary, biobehavioral approach for the assessment and treatment of feeding disorders. First, prevalence and causes of feeding problems are discussed. Second, interdisciplinary assessment and treatment strategies are considered, including the specific roles of the interdisciplinary team members. Third, behavioral treatment strategies are described. Fourth, various treatment options are described.
Asunto(s)
Terapia Cognitivo-Conductual , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Trastornos de Alimentación y de la Ingestión de Alimentos/terapia , Terapia Nutricional , Niño , Fenómenos Fisiológicos Nutricionales Infantiles , Trastornos de Alimentación y de la Ingestión de Alimentos/diagnóstico , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Trastornos de Ingestión y Alimentación en la Niñez/diagnóstico , Trastornos de Ingestión y Alimentación en la Niñez/psicología , Humanos , Evaluación Nutricional , Relaciones Padres-HijoRESUMEN
Clinicians and researchers have long recognized the existence of eating disorders in very young children, including infants whose mothers have eating disorders. This paper combines reviews of the literature relevant to the study of eating disorders from the perspectives of both research and psychoanalytic theory in order to explore the psychodynamics of the intergenerational transmission of eating-disordered pathology from mother to child. A developmental pathway as well as several mechanisms that illuminate the pathogenesis of the intergenerational transmission of eating disorders are proposed and described. Clinical-observational data from a therapeutic play nursery for mothers with eating disorders and their children are presented, and this material is examined in relation to the proposed psychodynamic pathways of transmission.
Asunto(s)
Trastornos de Ingestión y Alimentación en la Niñez/psicología , Relaciones Madre-Hijo , Terapia Psicoanalítica , Psicoterapia de Grupo , Adulto , Agresión , Anorexia Nerviosa/diagnóstico , Anorexia Nerviosa/psicología , Anorexia Nerviosa/terapia , Bulimia/diagnóstico , Bulimia/psicología , Bulimia/terapia , Preescolar , Conducta Cooperativa , Insuficiencia de Crecimiento/diagnóstico , Insuficiencia de Crecimiento/psicología , Insuficiencia de Crecimiento/terapia , Terapia Familiar , Trastornos de Ingestión y Alimentación en la Niñez/diagnóstico , Trastornos de Ingestión y Alimentación en la Niñez/terapia , Femenino , Humanos , Identificación Psicológica , Conducta Imitativa , Lactante , Comunicación Interdisciplinaria , Grupo de Atención al Paciente , Ludoterapia , Autoimagen , SimbolismoRESUMEN
Assessment of infants and children with dysphagia (swallowing problems) and feeding disorders involves significantly more considerations than a clinical observation of a feeding. In addition to the status of feeding in the child, considerations include health status, broad environment, parent-child interactions, and parental concerns. Interdisciplinary team approaches allow for coordinated global assessment and management decisions. Underlying etiologies or diagnoses must be delineated to every extent possible because treatment will vary according to history and current status in light of all factors that are often interrelated in complex ways. A holistic approach to evaluation is stressed with a primary goal for every child to receive adequate nutrition and hydration without health complications and with no stress to child or to caregiver. Instrumental swallow examinations that aid in defining physiological swallowing status are needed for some children. Successful oral feeding must be measured in quality of meal time experiences with best possible oral sensorimotor skills and safe swallowing while not jeopardizing a child's functional health status or the parent-child relationship.
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Trastornos de Deglución/diagnóstico , Trastornos de Deglución/epidemiología , Trastornos de Ingestión y Alimentación en la Niñez/diagnóstico , Trastornos de Ingestión y Alimentación en la Niñez/epidemiología , Niño , Preescolar , Trastornos de Deglución/fisiopatología , Ambiente , Fluoroscopía , Estado de Salud , Humanos , Incidencia , Lactante , Relaciones Padres-Hijo , Grupo de Atención al Paciente , Prevalencia , Índice de Severidad de la Enfermedad , Organización Mundial de la SaludAsunto(s)
Trastornos de Ingestión y Alimentación en la Niñez/diagnóstico , Derivación y Consulta , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/genética , Trastornos de Ansiedad/psicología , Trastornos de Ansiedad/rehabilitación , Ejercicios Respiratorios , Niño , Terapia Combinada , Condicionamiento Psicológico , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/genética , Trastorno Depresivo/psicología , Trastornos de Ingestión y Alimentación en la Niñez/genética , Trastornos de Ingestión y Alimentación en la Niñez/psicología , Trastornos de Ingestión y Alimentación en la Niñez/rehabilitación , Humanos , Lorazepam/administración & dosificación , Masculino , Mianserina/administración & dosificación , Mianserina/análogos & derivados , Persona de Mediana Edad , Mirtazapina , Terapia Ocupacional , Terapia por RelajaciónRESUMEN
The association of weight loss and pediatric brain tumors that affect the diencephalon or brain stem with weight loss is a recognized, but not fully understood phenomenon. Tumors located in the hypothalamic region may induce the diencephalic syndrome (DS), which is characterized by profound emaciation with almost complete loss of subcutaneous fatty tissue. Tumors that compress or infiltrate the brain stem rarely cause both psychological disturbance and emaciation. The clinical presentation may be different, depending on the location of the lesion and age of the patient. In this report we present an unusual case of severe emaciation in a 4(9)/(12)-year-old girl with a juvenile pilocytic astrocytoma of the hypothalamic region and brain stem with neuroaxis dissemination. This case illustrates the importance of considering intracranial mass-lesions in the differential diagnosis of weight loss, psychological disturbance and atypical eating disorder. We discuss the importance of tumor multifocality and the role of patient age in the clinical presentation with reference to the literature.
Asunto(s)
Astrocitoma/patología , Neoplasias Encefálicas/patología , Emaciación/etiología , Trastornos de Alimentación y de la Ingestión de Alimentos/etiología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Astrocitoma/complicaciones , Astrocitoma/tratamiento farmacológico , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/tratamiento farmacológico , Tronco Encefálico/patología , Preescolar , Diagnóstico Diferencial , Emaciación/patología , Emaciación/cirugía , Trastornos de Alimentación y de la Ingestión de Alimentos/patología , Trastornos de Alimentación y de la Ingestión de Alimentos/cirugía , Trastornos de Ingestión y Alimentación en la Niñez/diagnóstico , Femenino , Humanos , Hipotálamo/patología , Neoplasias de la Médula Espinal/complicaciones , Neoplasias de la Médula Espinal/secundario , Resultado del TratamientoRESUMEN
The reciprocal influence of body postures on the oral structures, but also of the oral structures on body postures, has been proposed by clinicians and is taken into consideration when treating children with poor postural control and moderate to severe eating impairments. However, this relationship has not been rigorously investigated. The purpose of this study was to document the possible relationships among oral-motor, postural, and ambulatory control. Ambulatory skills [exclusive use of wheelchair (w/c) vs w/c and ambulation], postural control when sitting, "pathologic" reflexes, and lip and tongue posture were recorded before and after one year of therapy with an intraoral appliance (ISMAR) in 20 children with cerebral palsy and moderate eating impairment. Significant improvement occurred in sitting (head-trunk-foot control) following one year of ISMAR therapy. Ambulatory status also significantly improved above the level of maturation. Half of the children showed marked improvement in oral posture, i.e., their resting mouth posture was closed rather than open. These results support an hypothesis of interaction between oral structures and postural control of the "whole body." Further studies are needed to determine the controls of such a relationship.