Prognosis

The prognosis for an infant feeding disorder is dependent upon its aetiology. Most disorders are multifactorial in nature, and their management is best approached by an interdisciplinary team. One study reported that interdisciplinary team intervention was therapeutic in 73% of patients (half of whom were referred in infancy) after 2 to 5 years’ follow-up.[3]

Gastrointestinal disorders

GORD tends to resolve spontaneously in most infants with normal neurodevelopment; 88% of infants followed up in one study had improved within 12 months.[79] Re-evaluation is advised if symptoms do not improve by 24 months.[80] One study found that infants who frequently regurgitated food at 6 months had ceased to do so by 18 months, but food refusal was more common in children who had had infantile regurgitation, compared with controls who had not had infantile regurgitation (odds ratio 4.2).[80] The severity of the symptoms of GORD has not been correlated to the degree of food refusal in later childhood.[81] Where symptoms persist beyond 18 months, the infant is also more likely to experience symptoms of GORD as an adult. Approximately 86% of children who have anti-reflux surgery achieve relief of GORD symptoms.[82]

Cows' milk protein allergy tends to resolve in early childhood, with tolerance to cows' milk protein occurring in 45% of children at 1 year, 60% at 2 years, and 85% at 3 years.[83] Children with atopy and positive radio-allergosorbent testing to cows' milk protein take longer to become tolerant than those with negative results.[42] Exclusion diets can usually be discontinued after 1 to 2 years of age under paediatric supervision.

Coeliac disease is a lifelong condition requiring a gluten-free diet.

Anatomical anomalies

Prognosis is generally good following surgical correction, although long-term follow-up by a multidisciplinary team may be required to detect problems that may evolve as the infant develops and grows.[51] Depending on the age at which surgery was undertaken, the infant may also develop behavioural issues that require input.

Some complications such as GORD, stricture, fistula formation, and oesophageal dysmotility are described following surgical repair of the primary problem.[10][12]

Short bowel syndrome as a complication of bowel resection (most commonly following necrotising enterocolitis) is associated with malabsorption and poor linear growth. The need for tube feeding at 18 months, and the risk of recurrent hospital admission, is significantly higher in these infants than in infants with medically managed necrotising enterocolitis.[33]

Neurodevelopmental, neurological, and neuromuscular abnormalities

Where an infant has severe neurodevelopmental delay, early nutritional intervention helps both weight and linear growth.[75] Quality-of-life assessments suggest that both patients and families respond well to nutritional interventions.[75]

Prematurity, cardiac conditions, and respiratory conditions

Prognosis depends on the degrees of prematurity and any associated complications, and the severity and nature of cardiac or respiratory disease. Patients should be closely monitored by an interdisciplinary team to optimise nutrition.

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