Feeding and swallowing problems are reported in 10-25% of all children, 40-70% in premature infants, and 70-90% in children with medical/developmental delays (Graham, 1985; Rogers & Arvedson, 2005; Sullivan et al., 2000). The etiologies of feeding disorders are as varied as the multiple disciplines, approaches, and interventions available. This paper illustrates, through case presentation, an interdisciplinary feeding team model that incorporates an oral, motor, medical, and behavioral approach to treating children with feeding disorders.

Parents of children of 89 children with pervasive developmental disorder were surveyed about their child's eating, gastrointestinal symptoms, and behavior problems. Results revealed potentially interesting relationships among self-injurious behavior, pica, feeding problems, and gastrointestinal symptoms in this population. Although over 60% of children were reported to have strong food preferences, only 6.7% of parents reported that their child had a feeding problem. Most children exhibited high rates of pica and self-injurious behavior that affected the family's quality of life. Some children experienced at least one symptom of gastrointestinal distress weekly, and bowel problems appeared to be related to some aspects of feeding. Although methodological issues limit these data, future research should focus on further relations among these factors in this population.

Children with developmental delays often have feeding difficulties resulting from oral-motor problems. Based on both clinical experience and a review of published studies, oral-motor interventions have been shown to be effective in improving the oral function of preterm infants and children with neuromotor disorders, such as cerebral palsy. However, oral-motor problems may be under identified in other populations of children with developmental difficulties. The purpose of this paper is to provide a conceptual framework for understanding oral-motor skill deve lopment and problems that can occur in any infant and young child and to review oral-motor treatment techniques and their empirical support.

Although eating is considered an automatic physiologic process, many children experience feeding difficulties.The purpose of this paper is to provide a framework for assessment, treatment and preve ntion of feeding difficulties in children.Identification and treatment of any factors actively interfering with feeding success is a critical cornerstone for effective behavioral interventions for feeding.Using variables that comprise the structure of a meal, this paper discusses how these variables might be manipulated in behavioral interventions for feeding problems.Recommendations for prevention of feeding problems are also presented.

OBJECTIVES:To delineate feeding dysfunction in a population of children with a 22q11.2 deletion and report the associated findings noted during the modified barium swallow (MBS).STUDY DESIGN:Seventy-five children with a chromosome 22q11.2 deletion and history of persistent feeding difficulty received a feeding evaluation, including an MBS for those children for whom there was concern about airway penetration.RESULTS:A consistent pattern of feeding difficulty, independent of palatal or cardiac involvement, emerged from the evaluations. This group typically has trouble coordinating the suck/swallow/breath pattern, resulting in slow nipple feedings interrupted by gagging or regurgitation. Recurrent vomiting and constipation are common. With advancement to chewable table foods, gagging or refusal develops, related to an immature oral transport pattern. The MBS studies demonstrate pharyngeal hypercontractility, cricopharyngeal prominence, and/or diverticula.CONCLUSIONS:Because of the consistency of dysphagic symptoms and MBS findings, we propose that dysmotility, especially through the pharyngoesophageal segment, is central to the dysphagia affecting this group. Dysphagia related to dysmotility may be underdiagnosed in this population or erroneously attributed to cardiac disease. Therefore attention to feeding status and investigation with MBS and gastrointestinal studies as warranted are recommended for all patients with a 22q11.2 deletion and feeding problems.

A submicroscopic deletion of chromosome 22q11.2 has been identified in the majority of patients with the DiGeorge syndrome, velocardiofacial syndrome, conotruncal anomaly face syndrome, and in some patients with isolated conotruncal cardiac anomalies, Opitz G/BBB syndrome, and Cayler cardiofacial syndrome. We have evaluated 181 patients with this deletion. We describe our cohort of patients, how they presented, and what has been learned by having the same subspecialists evaluate all of the children. The results help define the extremely variable phenotype associated with this submicroscopic deletion and will assist clinicians in formulating a management plan based on these findings.