Role of Development in Infant and Toddler Food Refusal The purpose of this manuscript is to inform clinicians working with infants who are tube fed about the brain-gut connections that may influence adaptation to oral feedings. Developmental changes in motility and sensory innervation are constant as brain and gut mature in the first several years. We hypothesized that chronically ... Article
Article  |   October 01, 2010
Role of Development in Infant and Toddler Food Refusal
Author Affiliations & Notes
  • Paul Hyman, MD
    Pediatrics, Louisiana State University, Baton Rouge, LA
    Pediatric Gastroenterology at Children's Hospital of New Orleans, New Orleans, LA
Article Information
Swallowing, Dysphagia & Feeding Disorders / Articles
Article   |   October 01, 2010
Role of Development in Infant and Toddler Food Refusal
SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), October 2010, Vol. 19, 64-67. doi:10.1044/sasd19.3.64
SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia), October 2010, Vol. 19, 64-67. doi:10.1044/sasd19.3.64

The purpose of this manuscript is to inform clinicians working with infants who are tube fed about the brain-gut connections that may influence adaptation to oral feedings. Developmental changes in motility and sensory innervation are constant as brain and gut mature in the first several years. We hypothesized that chronically ill neonates are exposed to multiple pain stimuli during hospitalization, leaving them susceptible to hyperalgesia and chronic pain. Hyperalgesia in the abdomen, chest, pharynx, or face may be cause for food refusal. In patients who are tube fed who failed behavioral modification to teach eating, treatment of peripheral nerve and central nervous system hyperalgesia may be required before behavioral modification will work. We designed a 14 week outpatient protocol for moving infants and toddlers who are tube fed from tube to oral feeding using pain rehabilitation strategies. We used 8 weeks of post-pyloric feeding, eliminating stimuli to the oropharynx, esophagus, or stomach. We treated with amitriptyline and/or gabapentin to desensitize sensory receptors and central nervous system arousal. After 8 weeks, we gave the appetite stimulant megesterol for another 6 weeks. Five days after initiation of megesterol, we initiated a 1-hour/night schedule to withdraw tube feedings. In a small, uncontrolled study, all 9 children moved from tube to oral feedings.

Become a SIG Affiliate
Pay Per View
Entire SIG 13 Perspectives on Swallowing and Swallowing Disorders (Dysphagia) content & archive
24-hour access
This Issue
24-hour access
This Article
24-hour access
We've Changed Our Publication Model...
The 19 individual SIG Perspectives publications have been relaunched as the new, all-in-one Perspectives of the ASHA Special Interest Groups.