Other Medical Issues
- GI Anatomy and Disease
- Nissen Fundoplication
- Pediatric Tube Feeding
- Medical Testing
While most pediatric feeding disorders are simple to treat, there may be medical complications that interfere with treatment possibilities. Before starting treatment, a child with a feeding disorder should be carefully evaluated by a physician to determine whether they are physically safe to eat. These evaluations are done both to ensure the safety of your child or baby, and also to optimize the treatment effects.
The most common medical conditions that interfere with the treatment of pediatric feeding disorders are reflux, allergies, aspiration, and motility problems (all explained below). These conditions are typically solved with medications, surgery, or special treatments.
In the case of reflux, medications are usually prescribed. In the most severe cases, a surgery called “Nissen fundoplication” is performed. This involves a repositioning of the stomach that results in a smaller opening into the organ, which in turn allows for a greater probability of food going in without reflux or vomiting.
Allergy testing is essential because if a child ingests a food that they are allergic to, lesions or irritations can form in the GI tract, which can make eating a very painful ordeal. There are several ways to test for allergies; talk to your pediatrician for advice on the best test to administer to your child.
Aspiration occurs when liquids enter the lungs. This occurs when a ligament over the passage to the lungs, which usually closes during oral intake, remains open. This can be dangerous because the liquid in the lungs can cause pneumonia. A speech pathologist or an occupational therapist can help determine if aspiration is occurring and which consistency of food is likely to lower the probability of aspiration occurring.
Lastly, with motility issues, food does not pass through the GI tract at a normal rate. This can cause food to stay in the stomach for too long, overfilling it, and causing vomiting, pain, and constipation. This can be treated with medications such as Reglan and Erythromycin.
Following are the common tests to do before seeking treatment to increase your child’s food/drink intake orally:
- Allergy testing – blood tests (RAST) or skin tests (prick tests or patch tests).
- Upper GI – liquid with barium is consumed to check for structural abnormalities in the esophagus, stomach, and small intestine.
- Swallow study – liquid with barium is consumed (starting with very thin liquid and getting thicker) to determine if aspiration is occurring and if there is a safe thickness for the child to eat without aspirating.
- PH probe – a thin tube is placed in the esophagus near the opening of the stomach to measure acid levels for several hours (may be used to confirm reflux).
- Gastric emptying study – radioactive material is added to food that the child ingests; the stomach is then monitored to see how long the radioactive material (and therefore food) remains in the stomach. This can be used to check for slow gastric emptying.
Endoscopy – the child is anesthetized and a small tube with a camera is passed into the esophagus, stomach, and small intestine to check for damage due to reflux or gastritis, or for physical abnormalities.