High-resolution Esophageal Manometry Patterns in Children and Adolescents With Rumination Syndrome.

BACKGROUND: Rumination is defined by effortless regurgitation within seconds or minutes of ingested food. The aim of this study was to determine the high-resolution esophageal manometry (HREM) pattern in children with rumination syndrome. METHODS: HREM was evaluated in 15 pediatric patients with rumination syndrome according to the Rome criteria and compared with 15 controls. Primary rumination was defined as a clinical rumination episode associated with a rise of gastric pressure above 30 mmHg. Secondary rumination was defined as a clinical rumination episode associated with a rise of gastric pressure above 30 mmHg during a transient lower esophageal sphincter relaxation (TLESR). RESULTS: Ninety-two episodes of rumination were demonstrated during HREM study in 12 of the 15 patients (80%; 1-29 episodes per patient; median intragastric pressure 49.6 mmHg). Primary rumination occurred in 3 patients and secondary rumination in 5 patients. One patient had primary and secondary rumination episodes. In 3 patients, classification of rumination episodes was not possible due to repetitive swallowing leading to lower esophageal sphincter relaxation. In the control group, no episodes of rumination occurred. The sensitivity and the specificity of the HREM study (association of a clinical rumination episode with a rise in gastric pressure >30 mmHg) to confirm the diagnosis of rumination were 80% and 100%, respectively. CONCLUSIONS: HREM allows confirming diagnosis of rumination syndrome and to differentiate between primary and secondary rumination in the presence of objective rumination episodes. Further research is needed to study whether HREM results may influence treatment and outcome of children with rumination syndrome.

Feeding problems in infancy and early childhood: evolutionary concept analysis.

AIM: The aim of this study was to report an analysis of the concept of pediatric feeding problems. BACKGROUND: Reviews of the literature on pediatric feeding problems and disorders repeatedly reference the lack of a shared conceptualization of feeding problems. It is difficult to track aetiology, prevalence and incidence of a phenomenon when available definitions and diagnoses lack practical utility. DESIGN: An evolutionary concept analysis. DATA SOURCES: A search was conducted in October 2014 of Google Scholar, CINAHL, PubMed and Web of Science databases, with MeSH terms and key words including: failure to thrive, feeding disorder/difficulty/problems, infantile anorexia, oral aversion, mealtime behaviour and dysphagia. Inclusion criteria were: subject of feeding problems, index children 0-10 years of age, English language and full text. METHODS: The articles (n = 266) were sorted into disciplines of authorship, including Psychology, Medicine, Nursing, Nutrition, Occupational Therapy, Speech Language Pathology or Other. The sample was divided into a historical sample (n = 42) for pre-2000 articles and current for those published post-2000. The current sample was later reduced to 100 and coded for surrogate terms, related concepts, attributes, antecedents and consequences. RESULTS: The historical view of pediatric feeding problems shows a tradition of mother blame or parental culpability, both direct and indirect. Currently, there exist many different definitions and typologies, but none have sound validity or generalizability. Areas of attribute consensus across disciplines are problematic feeding behaviours and selective or restrictive intake. CONCLUSION: A spectrum conceptualization of feeding problems is suggested for further development, with attributes that would be critical to have a feeding problem.

Eating disorders.

Twenty years have passed from the International Classification of Diseases, Tenth Revision (ICD-10) to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and, in the meanwhile, a lot of research data about eating disorders has been published. This article reviews the main modifications to the classification of eating disorders reported in the "Feeding and Eating Disorders" chapter of the DSM-5, and compares them with the ICD-10 diagnostic guidelines. Particularly, we will show that DSM-5 criteria widened the diagnoses of anorexia and bulimia nervosa to less severe forms (so decreasing the frequency of Eating Disorders, Not Otherwise Specified (EDNOS) diagnoses), introduced the new category of Binge Eating Disorder, and incorporated several feeding disorders that were first diagnosed in infancy, childhood, or adolescence. On the whole, the DSM-5 revision should allow the clinician to make more reliable and timely diagnoses for eating disorders.

Change Is Never Easy, but It Is Possible: Reflections on Avoidant/Restrictive Food Intake Disorder Two Years After Its Introduction in the DSM-5.

One of the most significant changes to the section on Feeding and Eating Disorders in the DSM-5 was that feeding disorder of infancy or early childhood was renamed avoidant/restrictive food intake disorder or ARFID, and the criteria was significantly expanded. This diagnostic category was informed by field studies, analysis, and expert opinion. To date, research exploring the prevalence, clinical characteristics and utility have helped substantiate the recognition and need for the diagnostic category of AFRID as a distinct eating disorder diagnosis in the DSM-5.

A practical approach to classifying and managing feeding difficulties.

Many young children are thought by their parents to eat poorly. Although the majority of these children are mildly affected, a small percentage have a serious feeding disorder. Nevertheless, even mildly affected children whose anxious parents adopt inappropriate feeding practices may experience consequences. Therefore, pediatricians must take all parental concerns seriously and offer appropriate guidance. This requires a workable classification of feeding problems and a systematic approach. The classification and approach we describe incorporate more recent considerations by specialists, both medical and psychological. In our model, children are categorized under the 3 principal eating behaviors that concern parents: limited appetite, selective intake, and fear of feeding. Each category includes a range from normal (misperceived) to severe (behavioral and organic). The feeding styles of caregivers (responsive, controlling, indulgent, and neglectful) are also incorporated. The objective is to allow the physician to efficiently sort out the wide variety of conditions, categorize them for therapy, and where necessary refer to specialists in the field.

Patrón socioeconómico en la alimentación no saludable en niños y adolescentes en España / Socioeconomic pattern in unhealthy diet in children and adolescents in Spain

OBJETIVO: Investigar la posible asociación de patrones alimentarios relacionados con la obesidad y la posición socioeconómica en la población infantil y adolescente española. DISEÑO: Estudio descriptivo transversal. Participantes: Los datos proceden de la Encuesta Nacional de Salud de 2007, realizada a una muestra representativa española de 0 a 15 años. En este estudio se han analizado 6.143 sujetos de 5 a 15 años. Mediciones principales: Se ha estimado la prevalencia de omisión de desayuno, la prevalencia de bajo consumo de fruta y verdura y la prevalencia de alto consumo de comida rápida, snacks y bebidas azucaradas. Los indicadores de posición socioeconómica han sido el nivel de estudios y la clase social de la persona que aportaba más ingresos económicos al hogar. En cada consumo de alimentos se han estimado las diferencias socioeconómicas mediante la razón de prevalencia, tomando como referencia la categoría socioeconómica más alta. RESULTADOS: Tanto en la infancia como en la adolescencia la magnitud de la razón de prevalencia muestra un gradiente socioeconómico inverso en todos los consumos de alimentos investigados: la menor y la mayor razón de prevalencia se observa en los sujetos de familias de posición socioeconómica más alta y más baja, respectivamente. CONCLUSIÓN: En la población infantil y adolescente española la alimentación no saludable relacionada con la obesidad muestra un patrón socioeconómico claro

OBJECTIVE: To investigate the possible association of dietary patterns associated with obesity and socioeconomic status in Spanish children and adolescents. DESIGN: Cross-sectional study. Participants: Data were drawn from the 2007 National Health Survey, conducted on a representative sample of Spanish 0-15 years. In this study we have analyzed 6143 subjects from 5 to15 years. Main measurements: It has been estimated prevalence of breakfast skipping, the prevalence of low consumption of fruit and vegetable and the prevalence of high fast food, snacks and sugary drinks consumption. Socioeconomic status indicators were educational level and social class of primary household earner. In each type of food consumption socioeconomic differences were estimated by prevalence ratio using the higher socioeconomic status as reference category. RESULTS: Both in childhood and adolescence, the magnitude of the prevalence ratio shows an inverse socioeconomic gradient in all foods consumption investigated: the lowest and highest prevalence ratios have been observed in subjects from families of higher socioeconomic status and lower, respectively. CONCLUSION: Unhealthy food related with obesity show a clear socioeconomic pattern in Spanish children and adolescents

[Changes to the classification of Eating Disorders in DSM-5]. / Essstörungen.

The fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) resulted in substantial changes with regard to the classification of Eating Disorders. In DSM-5, Feeding and Eating Disorders are for the first time subsumed in a single category. The Binge Eating Disorder (BED) was established as the third classical eating disorder in addition to Anorexia Nervosa (AN) and Bulimia Nervosa (BN). The criteria for AN changed remarkably, whereas there were only minor changes to the BN criteria. The criteria for BED differ only marginally from the DSM-IV research criteria. There are now subtypes of AN, BN, and BED in the new category "Other Specific Feeding and Eating Disorders." The rest category "Eating Disorders Not Otherwise Specified" has been renamed to "Unspecified Feeding or Eating Disorders." The practicability of the DSM-5 criteria for Eating Disorders, and for AN in particular, for both clinical practice and research remains to be seen.

Feeding disorders of early childhood: an empirical study of diagnostic subtypes.

OBJECTIVE: The aim of this study was to examine the differences among three subtypes of feeding disorders (FD), defined through the criteria of the DC:0-3R: "Infantile Anorexia" (IA), "Feeding Disorder Associated with Insults to the Gastrointestinal Tract" (FDIGT), and "Sensory Food Aversions" (SFA), by exploring mother-child interactions during feeding, children's temperament and emotional-adaptive functioning, and mothers' psychological profile and eating attitudes. METHOD: The sample consisted of 146 Italian mother-child pairs, of which 51 children with IA, 47 children with FDIGT, and 48 mothers and their children with SFA. All dyads were videotaped during feeding; mothers completed questionnaires assessing their psychological profiles and eating attitudes, as well as their children's temperament and emotional/behavioral functioning. RESULTS: Analyses revealed significant differences between the diagnostic groups of FD in relation to mother-child interactions during feeding, children's temperament and emotional-adaptive functioning, and mothers' psychological profile and eating attitudes. DISCUSSION: Both interactional and individual variables may contribute differently to specific FD and outcomes during childhood. Definitions by FD subtypes, using operational diagnostic criteria, and the assessment of mother-child interactions are relevant to target interventions strategies to treat specific disorders.

Pervasive refusal syndrome. Three German cases provide further illustration.

Pervasive refusal syndrome (PRS) has been proposed as a new diagnostic entity among child and adolescent psychiatric disorders. It is characterized by a cluster of life-threatening symptoms including refusal of hood intake, decreased or complete lack of mobilization, and lack of communication as well as retreat from normal life activities. Active refusal to accept help as well as neglect of personal care have been core features of PRS in the limited number of cases reported in the last decade. There have, however; been cases with predominantly passive resistance, indicating the possibility that there may be a continuum from active refusal to passive resistance within PRS. Postulating this continuum allows for the integration of "depressive devitalization" -- a refusal syndrome mainly characterized by passive resistance -- into the concept of PRS. Here, three case vignettes of adolescent patients with PRS are presented. The patients' symptomatology can be allocated on this continuum of PRS. PRS and dissociative disorders are compared in greater detail and contrasted within this discussion of differential diagnoses at the poles of such a continuum. PRS is a useful diagnosis for cases involving symptoms of predominating refusal and retreat which cannot satisfactorily be classified by existing diagnostic categories, and which can mostly clearly be separated from dissociative disorder.

Eating disorders of infancy and childhood: definition, symptomatology, epidemiology, and comorbidity.

This article describes a range of problem feeding and eating presentations seen in infants and children. In diagnostic terms some fall under the category of "feeding disorder," whereas others are childhood presentations of the eating disorders "anorexia nervosa," "bulimia nervosa," and atypical forms of these. Several other commonly occurring presentations that are difficult to fit into existing diagnostic categories are additionally described here, including "selective eating," "food avoidance emotional disorder," "food phobias," "functional dysphagia," and "food refusal."

[Eating disorders in childhood and early adolescence]. / Troubles des conduites alimentaires de l'enfant et du préadolescent.

During childhood and early adolescence, eating disorders are mainly of the restrictive type and general practitioner plays a central role in treatment. Parental counseling and medical care should be administered to selective and restrictive children without growth retardation. When growth and puberty are delayed a multidisciplinary approach is recommended. Somaticians, psychiatrists and psychotherapists will work together in the fight against the eating disorder. Family approaches yielded the best results in the management of these disorders for the younger subjects but individual therapies are also recommended. If vitamin and calcium supplements are necessary, it is not the case for psychotropic medications, which can have a dangerous impact if nutritional status is not stabilized. Outcome of selective and restrictive disorders in childhood is good however picky eaters need special care because of the risk of anorexia nervosa in later adolescence. Outcomes of prepubertal anorexic patients seem to be better than those of pubertal anorexic subjects but it is not the case for subjects affected by very-early-onset anorexia nervosa.

Feeding disorders in infants and toddlers: diagnosis and treatment.

Each of the six feeding disorders described presents with specific symptoms, has a different origin, and responds to different interventions. Consequently, it is important to establish an accurate diagnosis and use the appropriate intervention for the specific feeding disorder. As the study by Benoit et al [7] demonstrates, an intervention that may be helpful for one feeding disorder can be completely ineffective for another.

Attachment and feeding problems: a reexamination of nonorganic failure to thrive and attachment insecurity.

OBJECTIVE: To examine the relationship between attachment patterns, degree of security, and feeding problems. METHOD: Three groups of toddlers (age range = 12-37 months) were included: toddlers with infantile anorexia (n = 33), picky eaters (n = 34), and healthy eaters (n = 34). Participants in each group were matched for age, socioeconomic status, gender, and ethnicity. Attachment patterns and degree of attachment security were assessed through the Ainsworth Strange Situation. RESULTS: The infantile anorexia group exhibited a higher rate of insecure attachment relationships than the picky eater and healthy eater groups. When measured on a continuous scale, the infantile anorexia group also displayed a higher degree of insecurity than the other groups. Contrary to previous research, elevated rates of type D attachments were not present within the infantile anorexia group. CONCLUSIONS: Feeding problems and growth deficiencies can occur within the context of organized and secure attachment child-parent relationships. However, insecure attachment relationships may intensify feeding problems and may lead to more severe malnutrition. Implications for the treatment of specific feeding problems are discussed.