|
Causes of Feeding Disorders
Leo Leonidas MD, FAAP
Why Have a List of Differential Diagnosis?
It is important for clinicians to frequently refer
to a list of differential diagnosis so they could
ask good questions from the patient or parent. A
good clinical history depends on a complete list of
differential diagnosis of the chief complaint or
main problem.
DISORDERS THAT AFFECT APPETITE, FOOD-SEEKING BEHAVIOR, AND INGESTION
Depression
Deprivation
CNS disease (diencephalic syndrome)
Poverty (inadequate food available)
METABOLIC DISEASES
Hereditary Fructose Intolerance
Urea Cycle Disorders
Organic Acidemias
SENSORY DEFECTS
Anosmia
Blindness
Neuromuscular Disease
Oral hypersensitivity or aversion resulting from a lack of feeding experience during crucial sensitive periods (long-term parenteral or enteral tube feeding)
CONDISIONED DYSPHAGIA
Aspiration
Oral Inflammation
Gastroesophageal Reflux
Dumping syndrome or gastric bloating after gastric surgery
Fatigue (heart disease, lung disease)
ANATOMIC ABNORMALITIES OF THE OROPHARYX
Clip lip and/or palate
Macroglossia
Ankyloglossia
Pierre Robin Syndrome
Retropharyngeal mass or abscess
Velophryngeal insufficiency
Tonsillar Hypertrophy
Dental Caries
ANATOMIC/CONGENITAL ABNORMALITIES OF THE LARYNX & TRACHEA
Laryngeal cleft
Laryngomalacia
Laryngeal cyst
Subglotic stenosis
Tracheomalacia
Tracheoesophageal compression from vascular ring/sling
ANATOMIC ABNORMALITIES OF THE ESOPHAGUS
Traheoesophageal fistula
Congenital esophageal atresia
Congenital esophageal stenosis because of traheobronchial remnnats
Esophageal stricture, web, or ring
Esophageal mass or tumor
Foreign body
Vascular rings and dysphagia lusorum
DISORDERS AFFECTING SUCK-SWALLOW-BREATHING COORDINATION
Choanal atresia
Bronchopulmonary dysplasia
Cardiac Disease
Tachypnea (respiratory rate > 60 breaths/min)
DISORDERS AFFECTING NEUROMUSCULR COORDINATION OF SWALLOWING
Cerebral Palsy
Bulbar atresia or palsy
Brain stem glioma
Arnold-Chiari malformation
Myelomeningocele
Familial dysautonomia
Tardive dyskinesia
Nitrazepam-induced dysphagia
Postdiphtheretic and polio paralysis
Mobius syndrome
Myasthenia gravis
Infant botulism
Congenital myotonic dystrophy
Oculopharyngeal dystrophy
Muscular dystrophies and myopathies
Cricopharyngeal achalasia
Poliomyositis/dermatomyositis
Rheumatoid arthritis
DISORDERS AFFECTING ESOPHAGEAL PERISTALSIS
Achalasia
Chgas disease
Diffuse esophageal spasm
Pseudo-obstruction
Scleroderma
Mixed connective tissue disease
Systemic lupus erythematosus
Polymositis/dermatomyositis
Rheumatoid arthritis
MUCOSAL INFECTIONS AND INFLAMMATORY DISORDERS CAUSING DYSPHAGIA
Adenotonsillitis
Deep neck space infections
Epiglottis
Laryngopharyngeal reflux from gastroesophageal reflux
Gastroesophageal reflux
Caustic ingestion
Candida pharyngitis or esophagitis
Herpes simples esophagitis
HIV
Cytomegalovirus esophagitis
Chrohn's disease
Bechet disease
Chronic graft-versus-host disease
OTHER MISCELLANEOUS DISORDERS ASSOCIATED WITH FEEDING AND SWALLOWING DIFFICULTIES
Xerostomia
Hypothyroidism
Neonatal hyperparathyroidism
Idiopathic neonatal hypercalcemia
Trisomy 18 and 21
Velocardiofacial syndrome
Rett syndrome
Prader-Willi syndrome
Allergies
Lipid and lipoprotein metabolism disorders
Neurofibromatosis
Williams syndrome
Coffin-Siris syndrome
Optiz-G syndrome
Cornelia de Lange syndrome
Interstitial deletion (q21.3q31)
Globus sensation
Epidermolysis bullosa dystrophica
Reference: PEDIATRIC CLINICS OF NORTH AMERICA, Feb. 2002, page 98
Belly Pain Air Leaks From Lungs Acute Crying Back Pain Bed Wetting Big Lymph Node Big Spleen Blood in Urine Chronic Diarrhea Chest Pain Cough Coughing Up Blood Constipation Droopy Eye Enlarged Glands Eye Swelling Excessive Thrist Facial Paralysis Fainting Spell Feeding Problem GI Bleeding Headache Head Tilt Hives High ESR Hoarseness Joint Pain Limp Leg Pain Muscle Weakness Noisy Breathing Nose Bleeding Nose Obstruction Pyuria Recurrent Infection Red Green Urine Ringing in the Ears Scrotal Swelling Seizures Stiff Neck Swelling of the Parotic Gland Toe Walking Toeing In Toeing Out Unequal Pupils Vomiting Wheezing
Leo Leonidas, MD, FAAP
Assistant Clinical Professor in Pediatrics
Tufts University School of Medicine, Boston
Attending Pediatrician
Eastern Maine Medical Center, Bangor
Bangor, ME: First City with EBPP (Evidence Based Pediatrics for Parents) Website
|
