Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • age <1 year
  • poor growth (crossing downwards 2 percentiles)
  • time taken to feed >30 minutes
  • stressful mealtimes
  • food refusal
  • abnormal perinatal events
  • craniofacial abnormalities
  • abnormal neurodevelopmental assessment

Other diagnostic factors

  • inappropriate volume of feed
  • regurgitation
  • vomiting
  • abdominal pain, distension, or colic
  • apnoea, desaturations, and bradycardias in premature infants
  • irritability or lethargy at mealtimes
  • abnormal feeding pattern on observation
  • underlying illnesses and previous hospitalisations
  • previous oropharyngeal or GI surgery
  • FHx of atopy or feeding problems
  • recurrent pulmonary infections and wheeze
  • coughing or retching at meal times
  • posture changes during feeds
  • atopic features
  • apparent life-threatening event (ALTEs)
  • drooling
  • ankyloglossia (tongue-tie)
  • features of genetic conditions
  • abnormal cardiorespiratory signs

Risk factors

  • age <1 year
  • prematurity
  • intrauterine growth retardation
  • developmental delay
  • anatomical abnormalities of the oropharynx
  • post-surgical correction of oropharyngeal or GI abnormalities

Diagnostic investigations

Investigations to consider

  • trial of hypoallergenic feed
  • oesophageal 24-hour pH study
  • upper GI contrast study
  • oesophageal impedance study
  • CXR
  • abdominal x-ray
  • abdominal ultrasound
  • videofluoroscopic swallow
  • fibreoptic endoscopic evaluation of swallowing with sensory testing
  • upper GI endoscopy with biopsy
  • nuclear scintigraphy
  • bronchoscopy
  • radio-allergosorbent testing (RAST) to cows' milk protein
  • trial of lactose-free diet
  • faecal-reducing substances
  • tissue transglutaminase (TTG) antibodies
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant Neonatologist

Medway NHS Foundation Trust

Gillingham

Kent

UK

Disclosures

HM declares that she has no competing interests.

Dr Helen McElroy would like to gratefully acknowledge Dr Stephanie Gill and Dr Uma Sothinathan, previous contributors to this monograph. SG and US declare that they have no competing interests.

Peer reviewers VIEW ALL

Pediatric Consultant

Alberta Children's Hospital

University of Calgary

Alberta

Canada

Disclosures

AKCL declares that he has no competing interests.

Assistant Professor

Division of Neonatology

Medical University of South Carolina

Children's Hospital

Charleston

SC

Disclosures

SNT declares that she has no competing interests.

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