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Gastroenterology (Feeding)


Pregunta

I'm wondering if it's common for children with CdLS who had no trouble with bottle-feeding and no known gastroesophageal reflux (GERD) to later have trouble with solids. Do feeding difficulties as infants and feeding difficulties as older children tend to go hand in hand? My daughter seems to have virtually no interest in eating either baby foods or table foods. She has always done great with bottle-feeding and still does, and we don't know of any GERD with her, although we've only had an upper GI series (no Endoscopy or PH Probe). I'm wondering if this could just be due to general developmental delaymaybe she's just not ready (the OT says she is at a 5-month level), although her fine motor skills are more like a 10-month-old.

Respuesta de nuestros expertos

Feeding difficulties as infants and feeding difficulties as older babies tend to go hand in hand, but feeding difficulties can be identified in children, as they get older, who did not have them previously

There could be a number of different reasons why a child has difficulty with oral management (feeding) of solids. Especially if a child has a smaller mouth, or smaller relationship between the lower and upper jaws where the tongue still pretty much fills the mouth, then oral feeding of solids may present challenges because of limited space. What is more common, though, is that for some children, as the mouth grows and there is now space, not to have the same internal support for management of food that they did with a smaller mouth, in which the tongue filled the oral cavity. Now that there is more space, the food moves around more and is more difficult to control. For some children, this can be scary. This is a more common scenario than the one previously mentioned

Also, if a child does have developmental delays, then it may take the child longer to have an interest in and be able to orally manage solid foods. Sometimes texture is an issue, so thickening the milk or formula with baby cereal would be one way to see how your daughter manages textures

Gradually keep thickening the milk with baby cereal until it is a soupy consistency and see how this is tolerated. If it is tolerated well, continue to gradually thicken the cereal until an "oatmeal" consistency is tolerated. To see if taste is an issue, flavors could be added to the milk or formula. Also, be aware of any sensitivity. Since strawberry milk flavoring is available, that could be a start to rule out the last issue. Other flavors of baby food also could be used. For some children the issue is related to the spoon. Cutting a slightly wider hole in a nipple to allow thicker liquid to be expressed is an activity that could be used to assess whether she just prefers a bottle. All of the above should be initiated with support from the pediatrician. Ideally, your daughter should be seen by a speech pathologist that is familiar with feeding issues in children

CC/TK 7-13-10

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us

Recomendación (es)

Dificultades de alimentación y problemas dentales

R12
En cada paciente con SCdL que tenga dificultades graves y prolongadas para alimentarse, la evaluación multidisciplinar (profesionales sanitarios de varias disciplinas) debería considerarse la colocación (temporal) de una gastrostomía (abertura quirúrgica al estómago a través del abdomen) como un complemento a la alimentación oral.
R13
En pacientes con SCdL que sufren infecciones respiratorias repetidas, debe descartarse la existencia de reflujo gastroesofágico y/o la aspiración de jugo gástrico o alimentos a los pulmones.
R14
Debe examinarse detalladamente el paladar. En caso de síntomas sugerentes de fisura palatina (submucosa), está indicado remitir al paciente a un especialista.
R15
La exploración y limpieza de los dientes debe realizarse con regularidad; podría ser necesario un examen o tratamiento ortodóncico más exhaustivo bajo anestesia.

Recomendación (es)

Reflujo

R32
Hay que pensar siempre en la existencia de enfermedad por reflujo gastroesofágico (ERGE) en cualquier paciente con SCdL debido a su gran frecuencia y a la variabilidad en su presentación, incluyendo los cambios de comportamiento.
R33
La modificación de la nutrición y los inhibidores de la bomba de protones (IBP) son los tratamientos de primera línea del ERGE. Es necesario utilizar los medicamentos antirreflujo a su dosis máxima. Las intervenciones quirúrgicas por ERGE suelen limitarse a casos de pacientes con SCdL cuyo tratamiento nutricional y médico han fracasado, o bien en casos en los que la integridad de las vías respiratorias está en peligro.
R34
Si los síntomas del ERGE persisten, debería considerarse seriamente una endoscopia esofágica mientras el paciente con SCdL siga bajo atención pediátrica.
R35
La monitorización para el esófago de Barrett debe consensuarse con la familia, considerando los beneficios y riesgos para el paciente con SCdL.

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