Children with genetic syndromes frequently have feeding problems and swallowing dysfunction as a result of the complex interactions between anatomical, medical, physiological, and behavioral factors. Feeding problems associated with genetic disorders may also cause feeding to be unpleasant, negative, or even painful because of choking, coughing, gagging, fatigue, or emesis, resulting in the child to stop eating and to develop behaviors that make it difficult, if not impossible, for a parent to feed their child. In addition, limited experiences with oral intake related to the medical or physical conditions, or other variables such as prematurity, often result in a failure of the child's oral motor skills to develop normally. For example, a child with Pierre Robin sequence may be unable to successfully feed orally, initially, due to micrognathia and glossoptosis. Oral-motor dysfunction may develop as a result of both anatomical problems, (e.g., cleft lip/palate), lack of experience (e.g., s/p. surgery), or oral motor abnormalities (e.g., brain malformation). Neuromotor coordination impairments such as those associated with Down syndrome (e.g., hypotonia, poor tongue control, and open mouth posture) frequently interfere with the acquisition of effective oral-motor skills and lead to feeding difficulties. Management of these phenomena is frequently possible, if an appropriate feeding plan exist that allows for three primary factors: (1) feeding program must be safe, (2) feeding program must support optimal growth, and (3) feeding program must be realistic. Researchers have demonstrated the utility of behavioral approaches in the treatment of feeding disorders, such as manipulations in the presentation of foods and drink and consequences for food refusal and acceptance (e.g., praise, extinction, contingent access to preferred foods). However, because a child's failure to eat is not frequently the result of a single cause, evaluation and treatment are typically conducted by an interdisciplinary team usually consisting of a behavioral psychologist, pediatric gastroenterologist, speech pathologist, nutrition, and sometimes other disciplines. This chapter provides an overview of some of the feeding difficulties experience by some of the more common genetic disorders including identification, interventions, and management.

A controlled crossover feeding study was conducted in eight males aged 20-36 y to compare the effects of skim milk and whole milk on blood lipids. For 6-wk diet periods, 236 mL/4191 kJ of skim or whole milk was consumed with a background diet designed according to the American Heart Association recommendations. Plasma lipids were analyzed at baseline and at 3 and 6 wk. After 6 wk, the mean total cholesterol concentration was 4.47 mmol/L with skim milk and 4.80 mmol/L with whole milk (P < or = 0.001); mean low-density-lipoprotein-cholesterol concentrations were 2.64 and 2.96 mmol/L, respectively (P < or = 0.001). Mean apolipoprotein B decreased with skim milk and increased with whole milk (P < or = 0.05). No statistically significant differences were observed for plasma high-density lipoprotein-cholesterol, triglyceride, apolipoprotein A-I, or fatty acids. Substitution of skim milk for whole milk may decrease the risk of coronary heart disease.

Procedures used to determine chemical composition and digestible organic matter in dry matter (DOMD) are slow and expensive. The possibility of using near‐infrared reflectance spectroscopy (NIRS) as an alternative procedure was investigated with annual legumes. Material from cultivars of Medicago murex, Trifolium balansae, T. resupinatum and T. subterraneum was harvested soon after plants had matured. Samples were sorted into stem, leaf and burr fractions and analysed chemically and by NIRS. Data were then sorted into two similar sets, one of which was for calibration and the other for validation. Data for each chemical fraction, in samples used for calibration, were regressed sequentially against the corresponding reflectance spectral data, the log of there reciprocal of which was transformed to first or second derivatives. Equations of best fit were then used to predict the composition of samples in the validation set. Standard errors of calibration and validation respectively, expressed as percentages of the mean, were 0·5 and 0·6 for dry matter (DM), 2·0 and 2·6 for organic matter (OM), 4·8 and 4·3 for DOMD, 6·0 and 7·2 for crude protein, 4·1 and 4·4 for acid‐detergent fibre (ADF), 2·5 and 3·1 for neutral‐detergent fibre (NDF) and 8·9 and 10·9 for lignin.