Bellaïche Marc, Leblanc Véronique, Viala Jérôme, Jung Camille
Department of Pediatric Gastroenterology, Robert Debré Hospital, AP-HP, Paris, France.
Department of Clinical Research, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
Front Pediatr. 2023 Feb 15;11:1115787. doi: 10.3389/fped.2023.1115787. eCollection 2023.
Pediatric feeding disorders (PFDs) are common, and their great phenotypic variability reflects the breadth of the associated nosological profiles. PFDs should be assessed and managed by multidisciplinary teams. Our study aimed to describe clinical signs of feeding difficulties in a group of PFD patients assessed by such a team, and to compare them with children in a control group.
In this case-control study, case group patients 1 to 6 years old were consecutively recruited through the multidisciplinary unit for the treatment of pediatric feeding difficulties based at Robert Debré Teaching Hospital in Paris, France. Children with an encephalopathy, severe neurometabolic disorder, or genetic syndrome (suspected or confirmed) were excluded. Members of the control group, consisting of children with no feeding difficulties (i.e., Montreal Children's Hospital Feeding Scale scores below 60) or severe chronic diseases, were recruited from a day care center and 2 kindergartens. Data from medical histories and clinical examination related to mealtime practices, oral motor skills, neurodevelopment, sensory processing, and any functional gastrointestinal disorders (FGIDs) were recorded and compared between groups.
In all, 244 PFD cases were compared with 109 controls (mean ages: cases, 3.42 [±1.47]; controls, 3.32 [±1.17]; = 0.55). Use of distractions during meals was much more among PFD children (cases, 77.46%; controls, 5.5%; < 0.001), as was conflict during meals. While the groups did not differ in their members' hand-mouth coordination or ability to grab objects, cases began exploring their environments later; mouthing, especially, was less common in the case group (cases, = 80 [32.92%]; controls, = 102 [94.44%]; < 0.001). FGIDs and signs of visual, olfactory, tactile, and oral hypersensitivity were significantly more frequent among cases.
Initial clinical assessments showed that, in the children with PFDs, normal stages of environmental exploration were altered, and that this was often associated with signs of sensory hypersensitivity and digestive discomfort.
小儿喂养障碍（PFDs）很常见，其巨大的表型变异性反映了相关疾病谱的广度。PFDs应由多学科团队进行评估和管理。我们的研究旨在描述由这样一个团队评估的一组PFD患者喂养困难的临床体征，并将其与对照组儿童进行比较。
在这项病例对照研究中，通过法国巴黎罗伯特·德布雷教学医院的小儿喂养困难多学科治疗单元，连续招募1至6岁的病例组患者。排除患有脑病、严重神经代谢紊乱或遗传综合征（疑似或确诊）的儿童。对照组由无喂养困难（即蒙特利尔儿童医院喂养量表得分低于60）或严重慢性疾病的儿童组成，从一个日托中心和2所幼儿园招募。记录并比较两组之间与进餐习惯、口腔运动技能、神经发育、感觉处理以及任何功能性胃肠疾病（FGIDs）相关的病史和临床检查数据。
总共将244例PFD病例与109例对照进行了比较（平均年龄：病例组为3.42 [±1.47]；对照组为3.32 [±1.17]；P = 0.55）。PFD儿童进餐时使用分散注意力方法的情况（病例组为77.46%；对照组为5.5%；P < 0.001）以及进餐时的冲突情况要多得多。虽然两组在手部与口部协调或抓握物体的能力方面没有差异，但病例组开始探索周围环境的时间较晚；尤其是口部探索行为在病例组中较少见（病例组n = 80 [32.92%]；对照组n = 102 [94.44%]；P < 0.001）。FGIDs以及视觉、嗅觉、触觉和口腔过敏的体征在病例组中明显更常见。
初步临床评估表明，患有PFDs的儿童正常的环境探索阶段发生了改变，并且这通常与感觉过敏和消化不适的体征相关。
