ABSTRACT
Resistance to oral feedings occurring during the course of chronic gastroesophageal reflux (GER) in infants has received little attention in the literature. Accordingly, we reviewed the clinical courses of 600 infants of < 24 months of age with GER seen over an 8-year period to determine the prevalence and course of this problem. After excluding infants with severe neurologic disease, craniofacial disorders, or a history of esophageal surgery, 25 infants were found to have resistance to oral feedings that was severe enough to warrant tube feedings for nutritional support. Sixteen of these 25 infants had a history of resistance to oral feeding antedating a diagnosis of GER, whereas nine developed resistance to feeding during the course of therapy. Gestational age, age at onset of GER symptoms, severity of GER, presence/severity of esophagitis, type of medical therapy, need for fundoplication, or postfundoplication complications were similar in these two groups. When the clinical records of these 25 infants were compared to an age- and sex-matched infant population with GER but without feeding resistance, no differences were noted in severity of GER or the presence/severity of esophagitis. However, failure to thrive and the need for fundoplication were significantly more common in the feeding resistance group (p < 0.001). Among those infants with neurodevelopmental evaluation, mild delay was seen more commonly in the infants with feeding resistance but fell short of statistical significance (p = 0.08). Our observations suggest that resistance to oral feedings is an uncommon but severe problem associated with GER in infancy.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Feeding and Eating Disorders/etiology , Gastroesophageal Reflux/physiopathology , Enteral Nutrition , Esophagitis/diagnosis , Esophagitis/physiopathology , Feeding and Eating Disorders/therapy , Female , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/therapy , Humans , Infant , MaleSubject(s)
Colic/physiopathology , Colon/physiopathology , Hydrogen/analysis , Breath Tests , Crying , Female , Humans , Infant , MaleABSTRACT
A review of colic research supports the theory that colic may be caused by pain, particularly pain generated by gastrointestinal causes. At the same time, it also supports the view that disturbing crying in the first 3 months of life may be secondary to behavioral-interactive problems or simple parental misinterpretation of cry. In fact, a closer look at the methodology of colic studies along with our preliminary results suggest there may be at least two different patterns of disturbing infant crying. It is possible that one is associated with true pain and the other not. Dependence on retrospective parental reports alone to substantiate the presence of pain is only as reliable as parent interpretation of crying. Although specific cry patterns may represent specific infant conditions, parents may not be accurate interpreters of those patterns. In trying to determine the presence of gastrointestinal pain in colicky crying, close attention therefore should be given to the nature of the cry. Specific attention to qualitative and quantitative aspects of crying in colicky infants is identified as important by our pilot work. In the future this may help to explain the apparent discrepancies in the colic literature and to determine to what extent infant colic is a true pain syndrome.
Subject(s)
Colic/etiology , Gastrointestinal Diseases/etiology , Child Behavior , Colic/diagnosis , Colic/drug therapy , Colic/psychology , Crying , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/drug therapy , Gastrointestinal Diseases/psychology , Humans , Infant , Maternal Behavior , Pilot Projects , Prospective Studies , Research Design , Syndrome , TemperamentABSTRACT
Infants requiring prolonged hyperalimentation for a variety of conditions may experience difficulty in establishing oral feedings. Indeed, active resistance to oral feeding is often observed. We describe an infant who was deprived of normal oral feedings for the first ten months of life. Because subsequent feeding resistance was apparently due to behavioral and developmental factors, we suggest that the approach to such cases should involve particular attention to these areas. The child development literature and our surgical experience with esophageal atresia give supporting evidence.
Subject(s)
Child Behavior , Feeding Behavior , Parenteral Nutrition, Total/psychology , Parenteral Nutrition/psychology , Child Development , Female , Humans , Ileum/abnormalities , Infant , Intestinal Atresia/therapyABSTRACT
Severe methemoglobinemia developed in a healthy 14-month-old infant following the topical application of a benzocaine-containing gel administered for the relief of the discomfort of teething. Congenital methemoglobinemia and hemoglobin M disease were excluded by appropriate laboratory studies. The patient is considered to have a normal methemoglobin-reducing capacity and her response to the drug is one that presumably could occur in any other child of comparable age on receiving an equivalent dose of benzocaine. Parents should be cautioned against the indiscriminate use of similar medications, particularly since the process for which these medications are administered is both benign and physiologic.
