Last reviewed: 28 Dec 2020
Last updated: 13 Mar 2018
Summary
Definition
History and exam
Key diagnostic factors
- age <1 year
- time taken to feed >30 minutes
- stressful mealtimes
- abnormal perinatal events
- poor growth (crossing downwards 2 percentiles)
- food refusal
- 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
Treatment algorithm
Contributors
Authors
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
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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