Early feeding resistance: A possible consequence of neonatal oro-oesophageal dyskinesia

Paediatricians. frequently find early feeding disorders in neonates and inf ants that result in poor weight gain and which sometimes have no clear orga nic basis. For many years, we have observed infants with unexplained poor f eeding skills and excessive regurgitation, and since 1992 we have prospecti vely performed oesophageal manometry in infants hospitalized for retarded g rowth and "unexplained" feeding disorders. From the group of infants hospit alized for growth failure in the General Paediatric Unit of Necker-Enfants Malades Hospital from 1992 to 1997, we identified 16 children (3%) with abn ormal feeding behaviour who had an abnormal oesophageal manometry. The mano metric data of these children were compared with those of a group of 16 age -matched children who underwent oesophageal manometry for other reasons, an d served as controls. The affected children had precocious feeding skills d isorders: prolonged bottle-feeding (75%), bottle refusal (75%), unexplained crying (63%) and excessive regurgitation (94%). Half of them had mild anat omical facial consequences of their poor foetal sucking, and mild pharyngol aryngeal hypotonia, which could not be considered as malformations. Apart f rom these disorders, their clinical status was normal. At inclusion, their oesophageal manometry was abnormal, showing in 70% of cases specific anomal ies: lower oesophageal sphincter hypertonia and/or partial failure to relax . and giant waves of oesophagus body. Their course was good and their feedi ng difficulties decreased around the end of the first year, with the acquis ition of normal voluntary mastication. Conclusion: We suggest that the early feeding resistance of this group of c hildren could be related to an organic and transient neonatal oro-oesophage al dyskinesia.