akronchildrens.org

Understanding feeding problems in children

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Speech therapist and swallowing specialist Christy Jordan assesses Maria Stamos, as her father looks on.

Looking back, Katina and Dionisios Stamos, of Poland, Ohio, worried almost from the start about their daughter’s feeding.

Maria wouldn’t take the bottle and, when she did, made sounds like she was choking.

“It was the sound of drowning – like we had thrown her in a swimming pool. We were sick with worry,” said Katina. “I don’t think we ever slept.”

Maria is among the 35 percent of infants who suffer from feeding problems. Common causes include:

  • Prematurity
  • medical conditions such as gastrointestinal, heart or lung disorders
  • swallowing problems
  • developmental delays
  • allergies and food intolerances
  • anxiety and learned behaviors (in older children)

“Feeding problems can be stressful for parents. They worry about their infant’s weight gain, growth and development. But there are numerous interventions available. Parents should never feel alone in this,” said Barb Kline, a board-certified swallowing disorder expert and supervisor of speech pathology at Akron Children’s Hospital.

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Dietitian Michele Gresser meets regularly with Katina Stamos and daughter, Maria.

Several weeks after birth, Maria still resisted feeding, and, if she did take a few ounces, it was typically followed by bouts of projectile vomiting.

Katina and Dionisios took her to see a variety of specialists and made several ER visits.

The lowest point came on Christmas Eve 2012 when Maria was about a month old. She turned blue after aspirating on her food.

Staff at Children’s ER in Boardman life-flighted her to the Akron campus hospital where she was admitted.

Katina and Dionisios felt they were finally making progress when they met with Dr. Samuel Albert, an ENT specialist. He diagnosed Maria with a serious condition called laryngomalacia, which is characterized by floppy tissue above the vocal cords that falls into the airway when she breathes in.

Dr. Albert didn’t want to delay surgery to open an obstructed airway.

The next turning point came when Maria joined Akron Children’s Feeding Program, which is led by speech therapists with extensive training and certification in feeding and swallowing disorders.

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After a rough few months struggling with their baby’s feeding problems, Katina and Dionisios Stamos are now feeling better about her progress.

The team, which may also include a dietitian, occupational therapist, pediatric radiologist and pediatric psychologist, works closely with the child’s pediatrician or family doctor.

After the team took a complete medical history, Maria underwent an oral/motor feeding evaluation and a video-fluoroscopic swallowing function study, a moving x-ray that allowed therapists to watch while she fed.

Swallowing is actually a complex process involving 26 pairs of muscles and 6 cranial nerves to receive food into the mouth, prepare it, and move it to the stomach.

Maria was also diagnosed with dysphagia, a common swallowing disorder in infants that results in liquid or food “going down the wrong pipe” into the lungs. This can be frightening and cause the baby to cough, choke or gag.

Even scarier is silent aspiration, which means food or liquid enters the airway and lungs and the baby doesn’t cough.

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Maria is now able to take much more formula, is gaining weight and starting “first foods.”

“In these cases, breathing always trumps feeding so the baby will resist feeding,” said Kline.

Getting treatment for feeding issues

Interventions can be as simple as changing bottle nipple size to slow the flow of the formula or, with a physician’s approval, adding a product to thicken it.

Some children, such as Maria, require more serious interventions, such as surgery and/or reliance on a nasogastric (NG) or gastrostomy (G) tube to meet their nutritional needs, which are important to growth and development.

“Christy [Jordan], our speech therapist, immediately saw in Maria’s body language that she was tense during feeding,” says Katina. “Everything has to feel safe for her or she won’t eat.”

Maria was put on a high-calorie diet and responded well when her formula was thickened to the consistency of honey. She began visits with Jordan and dietitian Michele Gresser, who regularly observes her feeding and charts her weight gain.

“At the beginning, it would take an hour to feed Maria 2 oz.,” said Katina. “It was gut-wrenching to see her eat so little and grow so slowly.”

Today, Maria, now 5 months old, takes 3.5 oz. in 20 minutes. She weighs 12 lbs. and gains a respectable 5 oz. a week. With guidance from Jordan and Gresser, she is starting “first foods,” such as apple sauce.

Most importantly, feeding time is finally the positive, pleasant experience it should be for all three of them.

  • Irene Pizanias

    She truly is a little angel <3