A pilot investigation of feeding problems in children with esophageal atresia

Abstract

While many long-term complications of esophageal atresia (EA) have been well investigated, little is known about feeding difficulties in children after surgical correction of EA and its impact on caregivers. This study investigates the feeding behaviors of children with EA through a validated feeding questionnaire. The Montreal Children's Hospital Feeding Scale (MCH-FS) was filled out by the primary caregiver during patient follow-up visits in the multidisciplinary EA clinic. Demographic information, EA subtype, associated anomalies and outcomes were recorded. Results were compared between groups and to a normative sample. Thirty caregivers have completed the MCH-FS; 26 patients had type C atresia (86.7%). In comparison to controls, 17.5% of EA cases are one standard deviation above the mean feeding difficulty score, while 6.7% (n = 2) cases are greater than two standard deviations above normative values. Typical EA patients (type C who were not born <30 weeks) had mean MCH-FS scores in the subclinical range, whereas one extremely premature child and the patients with non-type C EA (n = 4) all had scores in the severe range. Feeding difficulties of patients with typical EA appear mild. Likely explanations include the use of early protocolized care and intensive multidisciplinary care in follow up. Nonetheless, patients with complicated EA (non-type C) and their caregivers tend to experience significant feeding difficulties. Early targeted care may be required for this patient subset, and additional cases will be investigated to confirm these preliminary findings and explore further risk factors of feeding problem in this cohort.

How to Care for Patients with EA-TEF: The Known and the Unknown

“…[112] In a parent-completed questionnaire, Baird et al found that only 6.7% of patients had feeding scores greater than two standard deviations above the mean and the majority of these feeding difficulties were reported as mild. [110] Reflecting this mild spectrum, only 11% of patients report feeding concerns to their care providers. [112]…”

Feeding Problems and Their Underlying Mechanisms in the Esophageal Atresia–Tracheoesophageal Fistula Patient

“…Compared to normative sample controls, caregivers report significant feeding difficulties on validated feeding difficulty questionnaires: 17.5% of children with EA scored 1 SD above the mean and 6.7% scored 2 SDs above the mean (13). Even when present, the feeding difficulties were classified as mild in the majority of patients.…”

“…Even when present, the feeding difficulties were classified as mild in the majority of patients. Children with non-type C EA and those who were premature were more likely to have scores in the severe range (13). In a survey of 128 parents participating in an EA support group, 68% of parents reported that their children struggled with feeding difficulties including pain with eating, regurgitation of food, vomiting, burping, and avoidance of tough/bulky foods (14).…”

Feeding Difficulties in Children with Esophageal Atresia

“…Patients who have undergone primary repair of long-gap esophageal atresia achieve major feeding milestones in a similar pattern to normal control infants, although do have much greater variability in achieving these milestones [13]. Baird et al, [10] administered a validated feeding questionnaire to 30 care-givers of children with EA. They found that, in comparison to controls, 17.5% of children with EA have feeding scores one standard deviation above the mean feeding difficulty score and 6.7% of cases are greater than two standard deviations above the mean.…”

“…Feeding disorders in children with esophageal atresia are common in clinical practice but the literature supporting these observations is limited. Between 6% and 52% of patients have some abnormalities of feeding [7,10,11]. The majority of studies focus on esophageal abnormalities as source of feeding difficulties.…”