Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- time taken to feed >30 minutes
- stressful mealtimes
- faltering growth (crossing downward 2 centiles)
- food refusal
- craniofacial abnormalities
- abnormal neurodevelopmental assessment
Otros factores de diagnóstico
- 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
Factores de riesgo
- prematurity
- intrauterine growth restriction
- developmental delay
- anatomic abnormalities of the oropharynx or gastrointestinal tract
- gastrointestinal surgery
- neonatal cardiac surgery
- Down syndrome
Pruebas diagnósticas
Pruebas diagnósticas que deben considerarse
- 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 tratamiento
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
Divulgaciones
HM declares that she has no competing interests.
Agradecimientos
Dr Helen McElroy would like to gratefully acknowledge Dr Stephanie Gill and Dr Uma Sothinathan, previous contributors to this topic.
Divulgaciones
SG and US declare that they have no competing interests.
Revisores por pares
Alexander K.C. Leung, MBBS
Pediatric Consultant
Alberta Children's Hospital
University of Calgary
Alberta
Canada
Divulgaciones
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
Divulgaciones
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.
Referencias
Artículos principales
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. Resumen
Arvedson JC. Assessment of pediatric dysphagia and feeding disorders: clinical and instrumental approaches. Dev Disabil Res Rev. 2008;14(2):118-27. Resumen
Delaney AL, Arvedson JC. Development of swallowing and feeding: prenatal through first year of life. Dev Disabil Res Rev. 2008;14(2):105-17. Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
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