INFANT FEEDING DIFFICULTIES

Transcription

1 INFANT FEEDING DIFFICULTIES

2 Important to EXCLUDE FAILURE TO THRIVE (FTT) Look at RED BOOK If any uncertainty need up to date weight and plot on chart. HV can help with this. FTT can occur AS A RESULT of feeding difficulties but may be secondary cause

3 INFANT FEEDING DIFFICULTIES IN THRIVING CHILD (25% of normal children) Diagnosis made on CLINICAL grounds with normal growth chart CONSISTENT HISTORY Observation of a feed Paediatric dietician assessment EARLY DIAGNOSIS IS IMPORTANT

4 Diagnoses to think about Oral thrush Tongue tie Simple regurgitation Behavioural difficulties GORD CMPI Lactose intolerance Coeliac disease Pyloric stenosis Systemic illness Acute surgical diagnosis Neurodevelopmental disorder

5 General History Review prenatal history (polyhydramnios, scan abnormalities) Prematurity < 37/40 increases risk Exclude history of surgical correction of oropharynx/gi tract IUGR increases risk of feeding difficulties and weight gain Cerebral palsy can present with feeding difficulties as child develops

6 Cause and Effect of Behavioural difficulties on Infant feeding Regular hospital attendance due to co-morbidity can increase stress, reduce coping mechanisms and in turn lead to feeding difficulties Behavioural component found in 80% of infant feeding disorders: is primary cause in 10% Early diagnosis and management of feeding difficulty reduces impact and home and behavioural consequences Look for maternal depression, family stress, coping mechanisms at home

7 NORMAL CHILD will cry up to 2 HRS a day Child with feeding difficulty can be much more than this Behavioural difficulties may be reflected in history of refusal to feed, stressful interaction between mum and baby. Feed observation over 20 minutes can be helpful in eliciting this

8 Family History Family History Atopy; more likely to have infant with Cows Milk Protein Intolerance Family history Pyloric stenosis or coeliac disease predisposes to both these conditions.

9 Detailed Feeding History Diet since birth Formula feed : which? when started? amount? Feeding intervals Time taken to feed Regurgitation Vomiting (timing, volume, bile, force) Abdominal pain Abdominal distension Posture change during feed (arching back, facial grimace, turning head) Cough/wheeze/stridor Atopy (rash, rhinitis) Constipation/loose stool

10 If BREAST FEEDING: think about latching on; awareness of milk supply; time spent feeding; nipple pain/discomfort.

11 General Examination Red Book; weight, height, plot on graph Observed feed: 20 min; watch latch, interaction, suck, length of feed (THINK ABOUT SIGNS OF DELAYED NEURODEVELOPMENT or CONCURRENT ILLNESS) Failure to feed effectively can be first sign of neurodevelopmental delay: infant position, posture, tone, drooling, weal suck.

12 REGURGITATION 67% normal infants < 4 months Simple regurgitation with no other symptoms is NORMAL; no tests or treatment needed 24% parents/guardians raise it as a concern especially if > 2 /day, large volume

13 RECURRENT VOMITING Exclude FTT If BILIOUS indicates upper GI obstruction: acute surgical emergency Projectile, non-bilious around 6 weeks age suggests Pyloric Stenosis Sudden onset; think systemic illness ie infection; UTI, meningitis Common with GORD and CMPI

14 COLIC Paroxysms of irritability or crying lasting > 3hrs/day and for more than 3 days/week. Disorganised feeding patterns, less rhythmic suck, less responsive during feeds as uncomfortable Can be a sign of GORD

15 COUGHING/RETCHING GORD can lead to recurrent wheeze due to acid reflux: treatment of GORD can reduce this ACID REFLUX can present with croup, stridor, hoarse cry Think about chronic aspiration and pneumonia in neurodevelopmentally delayed infant

16 GORD Recurrent vomiting Recurrent crying/irritability during or immediately after feeds Unhappy when lying flat Colic (posture changes, prolonged crying) Respiratory symptoms ie wheeze, cough Treat; gaviscon trial, ranitidine, domperidone Quick response to treatment over a few days.

17 COWS MILK PROTEIN INTOLERANCE Clinical diagnosis Family history CMPI/atopy Rash/rhinitis Recurrent vomiting with abdominal pain, constipation, colic Trial treatment HYPOALLERGENIC milk such as Nutramigen, Neocate Quick response in a few days

18 Lactose Intolerance Clinical history Watery stool ( may have streaks of blood reported), abdominal distension, flatulence Therapeutic trial of Lactose Free Feed (Aptamil lactose free) Stool sample would be positive for faecal-reducing substances

19 Coeliac disease Family history FTT Screen with Tissue transglutaminase assay Refer

20 SUMMARY Exclude FTT Diagnosis is in Clinical history and Feed Observation Health visitor should be involved for support and advise If changing milk or considering treatment involve paediatric dietician If uncertain ASK as EARLY DIAGNOSIS key to maintain family harmony and maternal well being.

21 Q&A?