Tag Archives: pediatric feeding disorder

Durability of Intensive Feeding Therapy

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V Volkert et al. JPGN Reports. 2025;1–7. Long-term outcomes of intensive multidisciplinary intervention for feeding tube dependence and chronic food refusal

Methods: The researchers conducted a 17‐item Qualtrics survey of patients who participated in intensive multidisciplinary intervention treatment to improve the volume and variety of solid food intake and replace enteral feeding due to chronic food refusal an average of 6 years following intervention. 75 met eligibility criteria; 36 caregivers (48%) completed the survey

Key findings:

  • Most patients (80%) who achieved full wean from feeding tube dependence at program discharge maintained their wean at the time of the survey
  • Most caregivers (89%) described their child’s relationship with food as “good” or “neutral”

My take:

  • Our group works closely with the authors and appreciate all of their help
  • Survey studies have a lot of limitations and often conclusions are hampered by low participation
  • It looks like intensive feeding therapy has good durability. It would be interesting if we could know what would have happened to these children without therapy. How many would have gradually improved on their own?

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On top of Stone Mtn, Georgia.

Ten-Year Trends in Pediatric Pharmacology for Gastroesophageal Reflux and Pediatric Feeding Disorders

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S Hirsch et al. J Pediatr 2025;283:114628. Ten-Year Trends in Pharmacologic Management of Gastroesophageal Reflux Disease and Pediatric Feeding Disorders in Young Children

Methods: Single-center, retrospective cohort study of children less than 2 years (49,483) diagnosed with GERD or PFD (pediatric feeding disorder) between January 2014 and December 2023. Prescriptions were searched for proton pump inhibitors (PPI), H2-receptor antagonists (H2RA), cyproheptadine, erythromycin, metoclopramide, or prucalopride, and procedures were searched for intrapyloric botulinum injections.

Key findings:

  • There was an increasing number of patients seen annually (6516 in 2014 vs 9109 in 2023)
  • The percent of patients receiving any prescription for GERD or PFD declined by almost 50%, from 36.5% in 2014 to 18.7% in 2023 (P < .001)
  • There was a particular decline in PPI prescriptions, with 25.3% of patients receiving PPI in 2014 and 7.1% receiving PPI in 2023 (P < .001)
  • There was also a decline in H2RA prescriptions, with 17.0% of patients receiving H2RA in 2014 and 11.1% receiving H2RA in 2023 (P < .0001).
  • In their discussion, the authors note that: “in contrast to the current findings, prior studies typically have shown increasing PPI prescriptions, with some of these studies demonstrating declining H2RA prescriptions (9-17)…. However, it is notable that 3 more recent international studies did demonstrate declining PPI prescriptions specifically in the final years of the study (18-20).”
  • “Multiple studies have failed to demonstrate efficacy of acid suppression in infants with nonspecific gastroesophageal reflux symptoms, and there is no evidence that acid suppression affects feeding behaviors.(21-23)”
  • “In addition, there has been growing concern about PPI side effects, which include increased infections, decreased bone density, and increased allergy development
    including eosinophilic esophagitis, with numerous recent studies on these risks.(24-26)”

My take: I’ve been a big fan of the aerodigestive research from the pediatric GI group in Boston. This is another useful study showing less use of acid suppression, especially PPIs in young children and infants. This likely indicates better alignment of clinical practice with consensus recommendations that advise against acid suppression as first-line management in this population.

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Dr. Praveen Goday: Tips on Managing Feeding Problems (Part 2)

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Dr. Goday gave our group a great lecture on pediatric feeding disorders. I’ve included many of his slides along with some of my notes. There may be errors in omission and transcription on my part.

Feeding tubes:

  • If taking >75% of feeds orally, only 13% still needing tube feeds 6 months later.  If taking <25%, 81% still needing tube feeds 6 months later (needs a GT)
  • Bridle: Dr. Goday recommends using up to 8 weeks.  If needing longer, GT placement is recommended
  • If needing an NG tube more than 3 months (possibly 6 months), GT placement is recommended
  • Pre-op studies are not predictive of who will need GJ feedings vs GT feedings

Medications:

  • Cyproheptadine -Dr. Goday prefers single night time dose, usually cycles medicine (2 weeks on, 1 week off), uses as early as 8 months of age.  Watch for adverse effects on behavior.
  • Mirtazapine -often used in older children and adolescents though effects on appetite wane with usage.  Dosed as an oral disintegrating tablet.  Typically, 7.5 mg in older children and 15 mg in adolescents.
  • Vitamins -Gummy vitamins are NOT complete vitamins, Nano VM -minimal taste powder (costly)

Choking phobia

  • Can occur with pharyngitis
  • Usually needs EGD and sometimes anxiolytic

Formulas:

  • No clear nutritional role for toddler step-up formulas
  • Dr. Goday often will use infant formula between 1-2 yrs of life rather than pediasure in those without growth concerns.  Pediasure may reduce acceptance of solid foods (due to its sweet taste)
  • Get help from your nutritionists in kids with limited diets

Autism:

  • Avoid adding medication/vitamins to the ‘one food/formula that child will take.’  He may stop taking that food/formula too

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Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician.  Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.

Dr. Praveen Goday: Tips on Managing Feeding Problems (Part 1)

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Dr. Goday gave our group a great lecture on pediatric feeding disorders. I’ve included many of his slides along with some of my notes. There may be errors in omission and transcription on my part.

Differences between picky eating, pediatric feeding disorder, and ARFID

  • 70% of picky eating is inherited.
  • If there are sequelae from picky eating, this indicates that the child has a pediatric feeding disorder.  There are 4 potential domains to pediatric feeding disorders: medical dysfunction, feeding skills dysfunction, nutritional dysfunction and psychosocial dysfunction (this is more subjective than other domains)
  • Pediatric feeding disorder (PFD) is a better term than “behavior” feeding disorder because many children have underlying contributing disorders like eosinophilic esophagitis (EoE) or aspiration/swallow dysfunction
  • ARFID is a diagnosis used by psychologists. It is when purely psychosocial concerns leads to nutrition dysfunction. The diagnosis is likely best used in older children who are mostly neurotypical and have normal development.  In younger children, it is important to assess for underlying disorders like oromotor discoordination and EoE

Strategies to prevent picky eating:

  • Breastfeeding (varied tastes in breastmilk)
  • Responsive feeding (feeding when hungry)
  • Solids [lumpy] (especially 6-9 months)
  • Multiple-varied exposures
  • Prevention/treatment: Praise at meal times, non-food rewards, Ellyn Satter’s advice (parents decide when, where, and what is offered & child decides how much

Increased risk of developing picky eating: FPIES, multiple allergies

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Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician.  Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.