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A Treatment Package without Escape Extinction to Address Food Selectivity
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Beyond Picky Eating.

Tammy S H Lim1, Marion Aw2,3, Laura Slosky4

  • 1Division of Developmental and Behavioural Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore.

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|August 23, 2020
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Summary
This summary is machine-generated.

Avoidant Restrictive Food Intake Disorder (ARFID) in a pediatric case highlights the critical role of nutritional support. Early intervention with enteral nutrition significantly improved growth and development, underscoring its importance in managing severe feeding issues.

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Area of Science:

  • Pediatric Nutrition
  • Gastroenterology
  • Developmental Pediatrics

Background:

  • A 20-month-old boy experienced failure to thrive after hospitalization for paralytic ileus.
  • Feeding refusal led to significant weight loss, iron deficiency anemia, and zinc deficiency.

Observation:

  • The child presented with cachexia, developmental stagnation, fragmented sleep, and irritability.
  • Anthropometric z-scores indicated severe malnutrition (weight-for-age < -3).
  • Diagnosis of Avoidant Restrictive Food Intake Disorder (ARFID) was made after excluding organic causes.

Findings:

  • Enteral nutrition via nasogastric (NG) tube rapidly improved weight gain (z-score to -1.85) and developmental milestones within 2 weeks.
  • The child regained motor skills, speech ability, and improved disposition and sleep patterns.
  • Discontinuation of NG tube at 20 months led to faltering growth, indicating continued need for nutritional support.

Implications:

  • Early and sustained nutritional intervention is crucial for managing ARFID in children.
  • Multidisciplinary feeding clinics are essential for comprehensive care of complex feeding disorders.
  • The case underscores the impact of feeding issues on overall child well-being and development.