Disorders of infant feeding

Case history #1

A 3-month-old boy is brought to the clinic by his mother. She reports a history of vomiting after feeds, associated with facial grimacing, arching of his back and neck, and irritability. There is no history of fever, rash, or drowsiness. These symptoms have been worrying her for 6 weeks. The infant has a normal physical exam, including normal neurodevelopmental assessment, and is following the 25th percentile for weight, length, and head circumference.

Case history #2

A 10-month-old girl will only eat a very limited range of foods and often refuses food completely. Her weight has dropped from the 9th to the 2nd centile. Her parents report that mealtimes are very stressful. She was born prematurely at 27 weeks’ gestation and was intubated and ventilated in the neonatal intensive care unit. She received enteral feeds through a nasogastric tube for many weeks.

Other presentations

Other possible manifestations of feeding disorders in infants can include retching, regurgitation, or vomiting of food; abdominal pain (e.g., as a symptom of colic); grimacing and posture changes after feeds (e.g., arching the neck backward, turning the head away from food); irritability or lack of alertness during feeds; food or liquid refusal; slow feeding; coughing, choking, or gagging when eating; drooling or difficulty in chewing or swallowing; difficulty in coordinating breathing with feeding; recurrent chest infections or wheezing; or symptoms of food allergy, including rash, rhinitis, diarrhea, and constipation. Apparent life-threatening events are occasionally associated with recurrent regurgitation.

Faltering growth can be a long-term consequence of a feeding disorder of any etiology.

Additional manifestations of feeding disorders seen more commonly in premature infants, particularly those who are born with intrauterine growth restriction, include feed intolerance with poor absorption of feed and increased volume of aspirates from nasogastric tube; recurrent apneas, bradycardias, and desaturations (a temporal relationship with feeds may not be obvious); abdominal distension; or sequelae of necrotizing enterocolitis (e.g., bowel resection resulting in stoma formation or short gut syndrome).