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Gastroenterology (Feeding)


Question

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.

Réponse de nos experts

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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Recommandation(s)

Difficultés d'alimentation et difficultés dentaires

R12
R12 : Chez toute personne SCdL présentant des difficultés d'alimentation prolongées et marquées, l'évaluation multidisciplinaire (par des professionnels de la santé de plusieurs disciplines) doit envisager la pose (temporaire) d'une gastrostomie (ouverture chirurgicale à travers l'abdomen jusqu'à l'estomac) en complément de l'alimentation orale.
R13
R13 : Chez les personnes atteintes de SCdL qui présentent des infections respiratoires récurrentes, il faut écarter la possibilité d'un reflux et/ou d'une aspiration (respiration de corps étrangers dans les voies respiratoires).
R14
R14 : Le palais doit être examiné de près lors du diagnostic. En cas de symptômes d'une fente palatine (sous-muqueuse), il est indiqué de consulter un spécialiste.
R15
R15 : L'évaluation et le nettoyage dentaire doivent avoir lieu régulièrement ; un examen dentaire plus approfondi ou un traitement sous anesthésie peuvent être nécessaires.

Recommandation(s)

Reflux

R32
Consider always gastro-oesophageal reflux disease (GORD) in any individual with CdLS owing to its frequency and wide variability in presentation, which includes challenging behaviour.
R33
R33 : La modification de l'alimentation et les inhibiteurs de la pompe à protons (IPP) sont les traitements de première intention du RGPD. Les médicaments anti-reflux doivent être utilisés à leur dose maximale. Les interventions chirurgicales pour les troubles gastro-intestinaux doivent être limitées aux personnes atteintes de SCdL chez qui les traitements nutritionnels et médicaux ont échoué ou chez qui la sécurité des voies respiratoires est menacée.
R34
R34 : Si les symptômes de troubles gastro-intestinaux persistent, l'endoscopie doit être fortement envisagée pendant que la personne atteinte de SCdL est encore sous soins pédiatriques.
R35
R35 : La surveillance de l'œsophage de Barrett doit être discutée et décidée avec la famille, en équilibrant le gain potentiel de santé et le fardeau pour la personne atteinte de SCdL.

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