Original article A pilot investigation of feeding problems in children with esophageal atresia R. Baird, 1 D. Levesque, 2 R. Birnbaum, 3 M. Ramsay 4 Departments of 1 Pediatric General and Thoracic Surgery, 2 Pediatric Gastroenterology, 3 Occupational Therapy and 4 Psychology, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada SUMMARY. 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. Nonethe- less, 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. KEY WORDS: esophageal atresia, feeding difficulty, oral aversion. INTRODUCTION Esophageal atresia (EA) remains one of the most common surgically correctable congenital anomalies. While survival of this condition has steadily improved over time, considerable short-term morbid- ity has been appreciated. 1 As a result, a significant cohort of patients are now living with the long-term consequences of their disease, including the potential for significant feeding difficulties. It is well estab- lished that pediatric feeding problems result in signifi- cant distress for patients and caregivers in the context of other childhood diseases. 2,3 Despite these asso- ciations, infant feeding difficulties are frequently unrecognized, often under-treated and are certainly under-reported. 4 Feeding problems after repair of EA have been reported en passant by several investigators since its first repair in 1941. Puntis et al. reported specific feeding difficulties in these children, identify- ing the following difficulties: slow to feed, refusing meals, coughing or choking during eating, and vom- iting at mealtimes. 5 It is currently unclear whether advances in the neo- natal, peri-operative and surgical care of patients with EA may have reduced feeding problems in early childhood after surgical correction of EA. Proposed mechanisms of improvement include the proto- colization of care, a systematic approach to the aggressive treatment of gastro-esophageal reflux, improved techniques to treat strictures and/or altera- tions in the specifics of surgical techniques and mini- mally invasive approaches. The primary objective of this study is to explore feeding problems experienced by children born with EA, in the light of improved care after surgical correction. Identifying significant feeding problems within this population or a sub- population of patients with EA would allow for earlier targeted interventions to minimize this bur- densome complication. Address correspondence to: Dr Robert Baird, MDCM, McGill University Faculty of Medicine, Division of Paediatric General Surgery, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada H3H1P3. Email: robert.baird@mail.mcgill.ca Diseases of the Esophagus (2015) 28, 224–228 DOI: 10.1111/dote.12178 © 2014 International Society for Diseases of the Esophagus 224 Downloaded from https://academic.oup.com/dote/article/28/3/224/2328661 by guest on 29 June 2022