Infant Feeding Dysfunction: An Overview

Introduction:

Feeding disorders are widespread in early infancy, with the reported frequency of minor feeding issues in normal children ranging between 25 % and 35 %, and more severe feeding problems documented in 40 % to 70 % of preterm infants or children with chronic diseases and medical problems. Early detection of eating issues, improved identification of underlying conditions, and good treatment results for the child and their family.

What is Infant Feeding Dysfunction?

Feeding disorders in infancy are common and, when severe, can be life-threatening. The child needs adequate nutrition to satisfy growth demands and permit brain development. For feeding to be successful, both the parent and the newborn must get enough social and emotional support. As the newborn grows, they will require more significant physical and emotional independence. There are several spots along this journey where feeding might go wrong. Knowledge of the historical context for the evolution of the understanding of internally regulated feeding and diagnostic classification systems, as well as various assessment and treatment strategies for feeding disorders, can assist primary care physicians in the care of families and may have a preventive effect on the incidence of eating disorders in young adulthood.

What Are the Stages of Feeding?

Feeding and swallowing is a complicated process that may be broken down functionally and into stages as follows:

1. The Pre-Oral Phase - Begins when the newborn or youngster detects and expresses hunger to the parent.

2. The Oral Phase - It is a food processing step during which the ingested substance is evaluated and shaped into a bolus that may safely pass through the throat, gaining access to the airway.

3. The Pharyngeal Phase - It occurs quickly. It starts with bolus contact with the tonsillar pillars and pharyngeal wall, followed by laryngeal elevation, vocal cord closure, and relaxation. Next, the sphincter of the upper esophagus undergoes a peristaltic contraction wave of the bolus that is propelled into the esophagus by the pharynx. During the bolus passage through the throat, excellent breathing coordination and swallowing are necessary to avoid aspiration. Through the esophageal cavity, the bolus is then delivered into the stomach.

4. The Gastrointestinal (GI) Phase - Food is broken down and absorbed into the gastrointestinal tract.

What Is the Mechanism of Feeding?

Successful feeding begins when a newborn or toddler detects hunger and desires to eat. The hypothalamic centers (for needs in the brain) receive signals from several sources. Following meals, the brain sensors transmit back via neuronal and endocrine pathways, resulting in a sensation of fullness. Food intake is controlled by newly identified leptin, which is generated in adipose tissue (fat tissue) and other feedback systems. Megestrol, glucocorticoids, cyproheptadine, which stimulate appetite, and amphetamines, which decrease appetite, can all affect hunger. Increased cachectin or inflammatory mediators linked to systemic disease may also suppress appetite.

What Causes Infant Feeding Dysfunction?

Although the regulatory systems appear in newborns, no adequate research has been conducted to characterize infant hunger processes. Without any GI, endocrine, or other chronic disorders, some newborns seem to have a defective hunger drive and fail to consume enough calories to attain adequate development. These newborns must have a malfunction in their appetite or hunger regulation systems. The emotional condition also influences appetite; neglected infants diminish their food intake. In otherwise healthy youngsters, specific dietary aversions may be noticed. For example, if a child's consumption of a particular meal is temporarily connected with a painful or unpleasant experience, they may refuse to consume it again.

If a newborn has a poor feeding experience, such as aspiration or choking, this might lead to more widespread feeding aversions. In addition, infants who have undergone prolonged airway intubation or tube feeding frequently learn that attempts by a caregiver to approach their mouths or faces are likely to cause discomfort, and the oral defensiveness might last long after the child is extubated or tube feedings are no longer required.

What Are the Characteristics of Infant Feeding Dysfunction?

• Inability to take necessary nutrients orally in a safe manner to satisfy nutritional demands.

• Inadequate suck and the inability to extract milk from a nipple due to weakness, anatomical issues, or a lack of skill.

• Poor tongue control causes issues such as formula leaks around the breast, coughing, and choking.

• Unrelated to illness, vomiting or regurgitation during or after feedings

• Swallowing dysfunction is the inability to swallow efficiently due to neuromuscular disorders or other physiological issues.

• Feeding has been associated with physiological compromise, including increased heart rate, respiratory rate, color change, and higher oxygen requirements.

• Gagging, rejection of stimulation source, and other symptoms of hypersensitivity to oral stimulation.

• There are no hunger or satiety cues, hence no response to hunger or fullness.

What Are Unsafe Feeding Practices?

To be completely functional, a child's eating abilities must be safe, age-appropriate, and efficient. Infant feeding dysfunction is defined as dysfunction in any of these categories. The symptoms of unsafe oral feeding are as follows:

• Choking.

• Aspiration.

• Bradycardia.

• Apnea.

• Unfavorable mealtime events.

• Adverse cardiorespiratory events.

• Vomiting.

• Weariness.

• Gagging.

• Refusal.

How to Treat or Manage Infant Feeding Dysfunction?

The treatment or management of infant feeding dysfunction depends on finding the correct etiological factor responsible for the condition. A few therapies can also be carried out as follows:

• Sessions for the mother to help her understand why the difficulties are occurring.

• Nutritional supplementing.

• Reflux treatment.

• Parent-infant counseling to help with eating.

• Family therapy to handle the situation.

• Occupational therapy examination.

Conclusion:

Feeding is a complicated process involving the interplay of the central and peripheral nerve systems, the oropharyngeal mechanism, the gastrointestinal (GI) tract, the cardiac system, craniofacial features, and the musculoskeletal system. This synchronized relationship necessitates learning and mastering skills suited for an infant's physiology and developmental stage. Feeding happens in the setting of the caregiver-child. A disturbance in any of these systems puts an infant at risk for a feeding problem and the consequences that come with it. More than one system is frequently disturbed, contributing to the development and persistence of infant feeding disorders. As a result, successful assessment and treatments need the participation of various disciplines.