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Feeding problems in infants with gastro-oesophageal reflux disease: a controlled study
B Mathisen1, L Worrall, J Masel
1Department of Linguistics, University of Newcastle, Australia.
Insights
Infants with gastro-oesophageal reflux disease (GORD) exhibit significant feeding and behavioral issues, including underdeveloped feeding skills and challenges with mother-infant interaction. These feeding problems contribute to GORD morbidity in infants.
Area of Science:
- Pediatric Gastroenterology
- Infant Nutrition
- Developmental Pediatrics
Background:
- Gastro-oesophageal reflux disease (GORD) in infants is frequently linked to feeding difficulties.
- Previous systematic studies on GORD-associated feeding problems in infants are limited.
- Objective evaluation of feeding, dietary, and behavioral aspects in infants with GORD is needed.
Purpose of the Study:
- To systematically evaluate feeding, dietary intake, and behavioral data in six-month-old infants with and without GORD.
- To compare objective feeding assessments between infants with GORD and healthy controls.
- To investigate the impact of GORD on infant feeding skills, swallowing, and mother-infant interaction.
Main Methods:
- A comparative study involving 20 infants with GORD (diagnosed via 24-h pH monitoring) and 20 age, gender, gestation, and socio-economic matched healthy infants.
- Standardized assessments included dietary intake, oromotor function (Feeding Assessment Schedule, FAS), and infant feeding behavior (Testers and Maternal Ratings, TRIB and MRIB).
- Videofluoroscopic swallowing analysis was performed on 11 infants with GORD.
Main Results:
- GORD infants demonstrated significantly lower energy intake compared to controls.
- FAS revealed fewer adaptive skills, less readiness for solids, and increased food refusal/loss in GORD infants.
- TRIB indicated GORD infants were more demanding during feeds; MRIB showed mothers experienced more negative feelings and less enjoyment, with increased infant crying.
- Videofluoroscopy identified predominant oral-preparatory and oral phase swallowing problems, silent aspiration in 2/11, and delayed esophageal transit in 4/11 GORD infants.
Conclusions:
- Infants with GORD experience feeding problems impacting behavior, swallowing, intake, and mother-child interaction.
- GORD infants exhibit a lack of age-appropriate feeding skill development.
- The contribution of feeding problems to infant GORD morbidity has been historically underestimated.
Objective:
Gastro-oesophageal reflux disease (GORD) in infants is commonly associated with feeding problems but has not been subject to systematic controlled study. We evaluated feeding, dietary, behavioural data obtained from systematic objective studies of six-month old infants with and without GORD.
Methods:
Infants with GORD (defined by 24-h pH monitoring, n = 20), and age, gender, gestation, and socio-economic matched healthy infants (n = 20) had standardised assessments of dietary intake, oromotor function by videoanalysis (Feeding Assessment Schedule, FAS), and infant feeding behaviour by Testers and Maternal Ratings (TRIB and MRIB). Videofluoroscopic analyses of swallowing was undertaken in 11/20 GORD infants and analysed by standardised paediatric check list.
Results:
Compared with control data: GORD infants had significantly lower energy intakes; the FAS showed GORD infants to have significantly fewer adaptive skills and readiness behaviour for solids, significantly more food refusal and food loss; the TRIB showed GORD infants to be significantly more demanding and difficult with feeds; and the MRIB revealed that mothers of GORD infants had significantly more negative feelings, significantly less enjoyment of feeds, and reported significantly more crying behaviour. On videofluoroscopy, oral-preparatory and oral phase problems predominated, particularly with solids, silent aspiration occurred during the pharyngeal phase in 2/11, and delayed oesophageal transit occurred in 4/11.
Conclusions:
Feeding problems affecting behaviour, swallowing, food intake, and mother-child interaction occur in infants with GORD, who displayed a lack of development of age-appropriate feeding skills. The contribution of feeding problems to morbidity in GORD in infants has been underestimated in the past.