Common in children under 1 year of age. Causative conditions may persist, leading to ongoing feeding difficulties during childhood.
Results in the inadequate intake or intolerance of fluids or nutrients necessary to meet the requirements for healthy growth in the long term. Failure to thrive may be a consequence of unresolved feeding problems of any etiology.
Etiologies are often complex and multifactorial, and are best managed by a multidisciplinary team. Causes include anatomic, neuromuscular/neurodevelopmental, immunologic, physiologic, and behavioral factors.
Diagnosis is usually clinical, with a consistent history supported by dietetic assessment. Complementary diagnostic tests and subsequent management are guided by physical findings and severity of symptoms.
Feeding disorders are usually subacute to chronic in nature. A sudden change in feeding habit may be associated with other conditions, notably infections, which need to be excluded.
History and exam
- inappropriate volume of feed
- 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 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)
- ankyloglossia (tongue-tie)
- features of genetic conditions
- abnormal cardiorespiratory signs
- trial of hypoallergenic feed
- esophageal 24-hour pH study
- upper GI contrast study
- esophageal impedance study
- abdominal x-ray
- abdominal ultrasound
- videofluoroscopic swallow
- fiberoptic endoscopic evaluation of swallowing with sensory testing
- upper GI endoscopy with biopsy
- nuclear scintigraphy
- radio-allergosorbent testing (RAST) to cows' milk protein
- trial of lactose-free diet
- fecal-reducing substances
- tissue transglutaminase (TTG) antibodies
Helen McElroy, MBChB, MSc, MRCPI (Pediatrics)
Medway NHS Foundation Trust
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.
Alexander K.C. Leung, MBBS
Alberta Children's Hospital
University of Calgary
AKCL declares that he has no competing interests.
Sarah N. Taylor, MD
Division of Neonatology
Medical University of South Carolina
SNT declares that she has no competing interests.
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