Diagnosis and treatment of feeding disorders in children with developmental disabilities

Objectives. To determine the results of diagnostic evaluation and the effec ts of nutritional intervention on energy consumption, weight gain, growth, and clinical status of children with neurodevelopmental disabilities and su spected feeding disorders. Methods. We studied 79 children with moderate to severe motor or cognitive dysfunction (male: female, 38: 41; age, 5.8 +/-3.7 years) who were referred for diagnosis and treatment of feeding or nutritional problems. Initial as sessments included a 3-day calorie intake record, videofluoroscopic swallow ing study (VFSS), 24-hour intraesophageal pH monitoring, milk scintigraphy, and esophagogastroduodenoscopy. Results. These studies demonstrated gastroesophageal reflux (GER) with or w ithout aspiration in 44 of 79 patients (56%), oropharyngeal dysphagia in 21 (27%), and aversive feeding behaviors in 14 (18%). Diagnosis-specific appr oaches included medical GER therapy in 20 patients (25%), fundoplication pl us gastrostomy tube (GT) in 18 (23%), oral supplements in 17 (22%), feeding therapy only in 14 (18%), and GT only in 10 (13%). After 24.6 +/-3.0 month s, relative calorie intake, expressed as intake (kcal/d)/recommended daily allowance (RDA, kcal/d), improved significantly (initial: final = 0.78 +/-0 .36: 1.23 +/-0.27). The z scores increased significantly for both weight (i nitial: final = -2.80 +/-1.33: -0.81 +/-0.69) and height (-3.14 +/-0.98: -2 .00 +/-0.67). Improved subcutaneous tissue stores were demonstrated by incr eased thickness of both subscapular skinfolds (change =71%+/- 26%) and tric eps skinfolds (38%+/- 17%). After nutritional intervention, the acute care hospitalization rate, compared with the 2-year period before intervention, decreased from 0.4 +/-0.18 to 0.15 +/-0.06 admissions per patient-year and included only 3 admissions (0.02 per patient-year) related to feeding probl ems. Conclusions. In children with developmental disabilities, diagnosis-specifi c treatment of feeding disorders results in significantly improved energy c onsumption and nutritional status. These data also indicate that decreased morbidity (reflected by a lower acute care hospitalization rate) may be rel ated, at least in part, to successful management of feeding problems. Our r esults emphasize the importance of a structured approach to these problems, and we propose a diagnostic and treatment algorithm for children with deve lopmental disabilities and suspected feeding disorders.