Feeding disorders of infancy and early childhood occur when a child fails to consume enough to gain weight and grow normally. Unlike children who are finicky but otherwise get sufficient nutrients, children with feeding disorders do not obtain some nutrients their bodies need.
During the first year of life, babies grow more rapidly than at any other stage of life. Parents give their babies breast milk or formula * until they are at least four months old, and then slowly start adding solid foods, first infant cereal and then baby food. Younger babies drink more often but in smaller amounts than older babies. A one-month-old baby, for instance, usually drinks two to four ounces of breast milk or formula six to eight times a day, whereas a five-month-old may drink six to seven ounces five to six times a day. During the first year on a healthful diet, a baby normally gains one to two pounds per month and about an inch in length for each of the first six months, then about a pound and half an inch per month from ages 6 to 12 months.
Throughout infancy and as the child grows up, the doctor continues monitoring the youngster's height and weight. The doctor uses these measurements and other tools to ensure that each child is healthy and developing well. Sometimes, doctors find that certain children are not developing well, and one of the reasons may be a feeding disorder.
Infants and children with feeding disorders do not eat or drink enough, or do not consume a wide enough range of foods to obtain a sufficient amount of the nutrients they need to grow up healthy. This pattern often becomes evident when children gain too little weight or even lose weight and show other signs that they are not developing properly. Medical professionals often call this condition “failure to thrive.” Besides a slowing down or complete stop in physical growth, children with feeding disorders sometimes also develop other problems, including difficulties with cognition, which includes learning, remembering, reasoning, analyzing, and other thought processes.
Feeding disorders often are the result of difficulties in one of a number of different parts of the digestive system that process food. These areas include the following:
A variety of feeding disorders occur in each of these parts of the digestive system.
While many feeding disorders are noticeable only after a baby begins to lose weight, cleft palate * and cleft lip are evident immediately at birth. Cleft palate and cleft lip are birth defects in which the two halves of the roof of the mouth, called the palate (PAL-ut), failed to join. The result ranges from a notch in the upper lip to a large gap in the front of the face that runs from the upper lip to the nose. Clefts are fairly common, affecting 1 in every 750 to 1,000 newborns. A child may inherit the condition as a result of a genetic mutation, or it may occur from such other causes as the mother's diet or use of drugs during the pregnancy. Infants with a cleft palate and/or lip usually have trouble eating because they cannot make a good seal with their lips and have difficulty forming the suction necessary to draw milk from a mother's breast or from a bottle. The treatment for these problems is surgery. Children who receive the surgery early in their lives usually do well. Unfortunately, some children's families, particularly those in developing countries, cannot afford surgery, and these individuals must go through their lives with the obvious facial defect. These children typically have difficulties speaking and may become withdrawn, sometimes developing behavioral problems.
Children may have other feeding disorders related to abnormalities in the mouth. For instance, a child may have ankyloglossia (AN-kih-loGLOSS-ee-uh), or tongue-tie. In this condition, the child's tongue cannot move normally because the piece of tissue (called a lingual frenulum) that anchors it to the floor of the mouth holds the tongue down. Because of this condition, the child may not be able to lift his or her tongue very much. In infants, this abnormality can affect their ability to suck from a mother's breast or from a bottle. Sometimes children outgrow the problem because the anchoring tissue may allow more movement by the time the child reaches six years of age. In other cases, the child can learn to live with the condition. Sometimes surgery is necessary.
In eating, food moves from the mouth into the pharynx and downward toward the esophagus. A ring of muscle at the top of the esophagus opens long enough for the food to enter. The food travels down to the bottom of the esophagus, where another ring of muscle opens temporarily to allow the food to enter the stomach. In some children, this process does not go smoothly. For example, the ring of muscle at the top of the esophagus—known as the cricopharyngeus (KRY-ko-fare-in-GEE-us) muscle—may not open far enough for food to move from the pharynx into the esophagus. This very rare birth defect is called cricopharyngeal achalasia (AK-uh-LAY-see-uh). Doctors sometimes prescribe drugs to relax the muscles.
A different feeding disorder may result from another birth defect when the esophagus ends in a pouch instead of connecting to the stomach as it should. This condition, called esophageal atresia (uh-TREE-zeeuh), affects about 1 in 2,500 to 3,000 newborns. A telltale symptom of this disorder is excessive drooling, sometimes accompanied by choking, coughing, sneezing, and/or a bluish tint to the skin. The treatment for esophageal atresia is surgery to connect the esophagus and stomach.
Experienced parents often slip a towel over their shoulder before picking up their infant because they are so used to their infants spitting up. This frequent regurgitation, which doctors call gastroesophageal reflux (REE-flucks), is normal among healthy babies. It occurs because the ring of muscle at the bottom of the esophagus opens up after a baby has eaten, so that gas in the stomach can exit up through the esophagus and out of the mouth as a burp. In infants, food in the stomach may also come up with the gas, which results in regurgitation.
Sometimes the spitting up can become severe and is a sign of a feeding disorder called pyloric stenosis (py-LOR-ik sten-O-sis), which affects between 2 and 4 of every 1,000 babies born in the United States. In this disorder, the infant not only vomits often but begins projectile vomiting, which means that the vomit shoots out of the mouth, sometimes to a distance of two or more feet. Other symptoms, all of which typically begin when the baby is about three weeks old, may include a noticeable decrease in the number and the size of stools, which occurs because too little food is remaining in and being processed by the baby's digestive system; a decrease in the number of wet diapers; no weight gain or an actual loss of weight; tiredness; noticeable rippling movements after a feeding (resulting from contractions of the stomach); and wrinkly skin on the stomach, upper arms, and upper legs.
Pyloric stenosis occurs when the muscles of the pylorus become thickened. This condition results in a smaller opening between the stomach and small intestine. Because of this narrower opening, food can no longer progress easily through the digestive tract, and the baby's system ejects it. To diagnose the condition, a doctor asks the parent about the vomiting, checks the baby's weight history, and may press on the right upper quadrant of the baby's abdomen to feel for a small bump. The doctor also may order an ultrasound * or blood tests. The treatment is surgery to widen the opening through the pylorus. After successful surgery, babies recover quickly, often returning home within two days.
One especially dangerous condition involving the large intestine is necrotizing enteritis (NEK-ro-ty-zing EN-ter-I-tis), which can also cause an infant to stop feeding. It occurs in one to two out of every 1,000 newborns in the United States, and the vast majority of its victims are premature babies. In this condition, the tissue of the large intestine dies. The treatment typically involves antibiotics and other medical care, and sometimes includes surgery. The exact cause of this disorder was not known as of 2016, but the occurrence of occasional outbreaks in the neonatal *
Disorders involving other bodily systems, such as the cardiovascular (heart and blood), endocrine (relating to hormones * ), and central nervous system (including the brain), also may interfere with food intake or nutrition and have an adverse effect on a child's growth and development. For instance, such nervous system disorders as cerebral palsy * or meningitis * can cause swallowing problems. In hypothyroidism * , symptoms may include choking and a large protruding tongue, which can make feeding difficult. In this condition, which sometimes occurs in infants and children, a hormone-producing gland called the thyroid gland does not produce a sufficient amount of thyroid hormone. Many other examples exist. Some diseases do not cause feeding problems but affect the body's ability to break down or use the nutrients that have already made their way into the stomach and small intestine.
Breast milk is very important to the growth and development of healthy babies. It not only provides them with all the nutrients they need to thrive, but also helps to protect them from illness because it transfers disease-fighting antibodies * from the mother to the baby. In some cases, infants may not take in adequate nutrition because they do not receive enough milk from their mothers. This inadequacy can happen for several reasons.
One reason is mastitis (mas-TITE-is), which is an inflammation (and sometimes an infection) of the breast tissue that can cause it to redden, swell, and become painful. Although mastitis usually affects only one breast, it still may cause women to cut back on or stop breastfeeding their babies. In the United States, mastitis affects about 10 percent of breastfeeding women. Another common problem may also occur. Two to five days after women deliver a baby, their breasts normally swell as they begin to produce milk for the nursing baby. Sometimes the breasts become very swollen, hard, and painful. The mother may also develop a fever. This condition, called engorgement, may happen if the baby is not nursing frequently enough or is not drinking enough when nursing. When breasts are engorged, the baby may have a difficult time breastfeeding, and even if the baby is able to breastfeed, engorgement may cause the breasts to stop producing as much milk. Women can work with their physicians to help prevent both mastitis and engorgement, and to treat these conditions should they occur.
Although the majority of women produce enough milk for their babies, occasionally mothers do not. This lack of milk may result because the woman does not feed her baby often enough (or alternately does not use a breast pump frequently enough to remove the milk, which will be fed to the baby later by bottle). Infrequent feeding can trigger the breasts to slow their milk production. Low breast milk production can also stem from other factors. For instance, a mother who is taking certain drugs or herbal supplements or is a cigarette smoker may not produce enough milk. Mothers with this problem should talk to a medical professional who may be able to help them increase their milk production.
Many feeding disorders are diagnosed when the parent or the doctor notices that the child is not growing at the expected rate. This possibility is why doctors check a child's weight and height so frequently. Parents may alert a doctor to a possible feeding disorder by reporting any difficulties they notice when their child is eating, such as excessive vomiting or a refusal to eat an entire group of foods. Depending on the specific symptoms, a doctor may then order blood tests or other tests to help identify the particular feeding disorder and its cause.
For some feeding disorders, the doctor may simply advise the parent to monitor the child carefully because the condition often disappears on its own. For others, the doctor may prescribe antibiotics or other drugs, recommend surgery, or advise one of a variety of other treatments. The exact course of therapy is determined by the particular feeding disorder the child has as well as the child's age and overall health.
See also Birth Defects: Overview • Cleft Palate • Growth and Growth Disorders • Maldigestion and Malabsorption Syndromes: Overview • Malnutrition • Mouth Disorders: Overview • Pica
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* formula is a prepared, nutritious drink or a dry drink mix designed
* cleft palate is a gap or split in the roof of the mouth (the palate). It occurs when the palate of a fetus does not develop properly during the first months of pregnancy.
* ultrasound, also called a sonogram, is a diagnostic test in which sound waves passing through the body create images on a computer screen.
* neonatal (ne-o-NAY-tal) means pertaining to the first four weeks after birth.
* hormones are chemical substances that are produced by various glands and sent into the bloodstream carrying specific messages that have specific effects on other parts of the body.
* cerebral palsy (se-RE-bral PALzee) is a group of conditions, all of which affect a person's ability to move. They are usually caused by injury to the brain before or soon after birth.
* meningitis (meh-nin-JY-tis) is an inflammation of the meninges, the membranes that cover and protect the brain and the spinal cord. Meningitis is most often caused by infection with a virus or a bacterium.
* hypothyroidism (HI-po-THY-roydih- zum) is an impairment of the functioning of the thyroid gland that causes too little thyroid hormone to be produced by the body. Symptoms of hypothyroidism can include tiredness, paleness, dry skin, and in children, delayed growth as well as delayed mental and sexual development.
* antibodies (AN-tih-bah-deez) are protein molecules produced by the body's immune system to help fight specific infections caused by such microorganisms as bacteria and viruses.