Recognition and Management of Feeding Dysfunction in the Pediatric Patient with Eosinophilic Esophagitis.

Feeding is a complex skill requiring coordination of multiple body systems. Multiple factors are considered in feeding dysfunction in pediatric patients with eosinophilic gastrointestinal disorders, including overall development, nutritional status, mealtime behaviors, and medical comorbidities. Symptoms of feeding dysfunction vary by age, with maladaptive learned feeding behaviors spanning all age ranges. Knowledge of the normal acquisition of feeding skills is critical to interpret the impact of the disease and plan appropriate intervention. Assessment and treatment from a feeding and swallowing disorders specialist can dramatically impact successful outcomes in nutrition, growth, mealtime dynamics and ultimatly quality of life for children and their caregivers in home and social settings.

Nutritional State and Feeding Behaviors of Children With Eosinophilic Esophagitis and Gastroesophageal Reflux Disease.

OBJECTIVE: As both gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE) are associated with malnutrition and feeding dysfunction, this study compares growth, nutrition, and feeding behaviors in children with GERD and EoE. METHODS: Subjects ages 1 to 7 years with GERD or EoE were enrolled in a prospective study. Assessments included length/height, weight, 3-day food diary, serum biomarkers of nutrition, and the Behavioral Pediatric Feeding Assessment Scale. RESULTS: Mean weight-for-length z scores in GERD and EoE children were -0.93 and -1.14 (p = NS) and mean body mass index z scores were 0.29 and -0.13 (P = NS). Vitamin D intake was below the daily recommended intake in GERD subjects. EoE subjects' intake was below daily recommended intake of Vitamin D and calcium. GERD and EoE groups both had normal intake of calories, carbohydrates, proteins, fats, and iron, and normal serum ferritin (25 vs 34 ng/mL), prealbumin (21 vs 20 mg/dL), parathyroid hormone (42 vs 37 pg/mL), and Vitamin D (both 30 ng/mL). Behavioral Pediatric Feeding Assessment Scale problem and frequency scores were similar in GERD and EoE subjects but were higher than those of a historical cohort of healthy controls (Hedges' g of 0.95 and 1.1, respectively). EoE subjects on food allergen restriction diets had significantly less feeding dysfunction than those on regular diets. CONCLUSIONS: As a selected group of children with uncomplicated GERD or EoE were without nutritional deficiencies but had maladaptive feeding, providing anticipatory guidance to minimize mealtime challenges, monitoring for improvement, or referring to a feeding therapist, may be beneficial. A trial of food allergen restriction may provide additional benefit for those with EoE.

Significance of feeding dysfunction in eosinophilic esophagitis.

Feeding dysfunction is a frequent presenting symptom of eosinophilic esophagitis (EoE). Here we present 3 children of various ages whose manifestations of EoE associated feeding dysfunction led to significant and life altering impact on their growth and development. Early identification of presenting symptoms of EoE will allow for prompt diagnosis and initiation of appropriate treatments. Recognition of salient features of dysfunction and treatment by feeding therapists and nutritionists led to symptom resolution and growth.

Feeding disorders in food allergic children.

Feeding disorders are increasingly being recognized in children with food allergy. For some children, symptoms of feeding dysfunction may persist after allergens are removed from the diet secondary to learned associations with food and discomfort and reinforcement of maladaptive feeding behaviors. Many food allergic children require care from a multidisciplinary team of specialists, which includes allergists, gastroenterologists, mental health professionals, and feeding specialists. Early referral for feeding assessment by a pediatric feeding specialist can be a critical component of the food allergic child's care. This article reviews and discusses the recent literature regarding feeding disorders in food allergic children. A literature review was conducted using the PubMed database for English language articles published between January 1980 and February 2010. Additional information was obtained via review of recent textbooks and review of the general information web page of several established pediatric feeding programs.

Clinical presentation of feeding dysfunction in children with eosinophilic gastrointestinal disease.

Feeding issues may affect many aspects of a child's health, development, growth, nutrition and overall well-being. There is a developmental continuum for the acquisition of feeding skills, which includes motor skills, sensory systems, behavioral/emotional components and communication. Food refusal, dysphagia, reduced volume and reduced variety of intake are common complaints associated with eosinophilic gastrointestinal diseases in children. As the understanding of this disease process evolves, clinicians are recognizing that feeding difficulties are a prevalent characteristic of children with eosinophilic gastrointestinal disease and the difficulties can disrupt a child's progress along the typical developmental feeding continuum. Despite effective medical treatment, the residual effects on feeding can persist and need to be addressed. Collaboration regarding the medical, nutritional, and developmental plan of care optimizes outcomes for the well-being of children and families affected by this disease.