Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- time taken to feed >30 minutes
- stressful mealtimes
- faltering growth (crossing downward 2 centiles)
- food refusal
- craniofacial abnormalities
- abnormal neurodevelopmental assessment
Outros fatores diagnósticos
- inappropriate volume of feed
- vomiting
- abdominal pain, distension, or colic
- apnea, desaturations, and bradycardias in premature infants
- irritability or lethargy at mealtimes
- abnormal feeding pattern on observation
- underlying illnesses and previous hospitalizations
- previous gastrointestinal or cardiac surgery
- family history of atopy
- family history of 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
Fatores de risco
- prematurity
- intrauterine growth restriction
- developmental delay
- anatomic abnormalities of the oropharynx or gastrointestinal tract
- gastrointestinal surgery
- neonatal cardiac surgery
- Down syndrome
Investigações diagnósticas
Investigações a serem consideradas
- temporary exclusion of cows’ milk protein
- esophageal 24-hour pH study
- upper gastrointestinal contrast study
- esophageal impedance study
- CXR
- videofluoroscopic swallow
- fiberoptic endoscopic evaluation of swallowing with sensory testing
- upper gastrointestinal endoscopy with biopsy
- radioallergosorbent testing (RAST) to cows' milk protein
- trial of lactose-free diet
- fecal-reducing substances
- tissue transglutaminase (TTG) antibodies and total IgA
Algoritmo de tratamento
anatomic abnormalities
gastrointestinal disorders
short bowel syndrome
neurologic impairment
prematurity
respiratory disorders
cardiac disorders
behavioral problems
Colaboradores
Autores
Helen McElroy, MBChB, MSc, FRCPCH
Consultant Neonatologist
Medway NHS Foundation Trust
Gillingham
Kent
UK
Declarações
HM declares that she has no competing interests.
Agradecimentos
Dr Helen McElroy would like to gratefully acknowledge Dr Stephanie Gill and Dr Uma Sothinathan, previous contributors to this topic.
Declarações
SG and US declare that they have no competing interests.
Revisores
Alexander K.C. Leung, MBBS
Pediatric Consultant
Alberta Children's Hospital
University of Calgary
Alberta
Canada
Declarações
AKCL declares that he has no competing interests.
Sarah N. Taylor, MD
Assistant Professor
Division of Neonatology
Medical University of South Carolina
Children's Hospital
Charleston
SC
Declarações
SNT declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
Rommel N, De Meyer AM, Feenstra L, et al. The complexity of feeding problems in 700 infants and young children presenting to a tertiary care institution. J Pediatr Gastroenterol Nutr. 2003 Jul;37(1):75-84. Resumo
Arvedson JC. Assessment of pediatric dysphagia and feeding disorders: clinical and instrumental approaches. Dev Disabil Res Rev. 2008;14(2):118-27. Resumo
Delaney AL, Arvedson JC. Development of swallowing and feeding: prenatal through first year of life. Dev Disabil Res Rev. 2008;14(2):105-17. Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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