Feeding problems in infants with gastro-oesophageal reflux disease: A controlled study

Objective: Gastro‐oesophageal reflux disease (GORD) in infants is commonly associated with feeding problems but has not been subject to systematic controlled study. We evaluated feeding, dietary, behavioural data obtained from systematic objective studies of six‐month old infants with and without GORD. Methods: Infants with GORD (defined by 24‐h pH monitoring, n = 20), and age, gender, gestation, and socio‐economic matched healthy infants (n = 20) had standardised assessments of dietary intake, oromotor function by videoanalysis (Feeding Assessment Schedule, FAS), and infant feeding behaviour by Testers and Maternal Ratings (TRIB and MRIB). Videofluoroscopic analyses of swallowing was undertaken in 11/20 GORD infants and analysed by standardised paediatric check list. Results: Compared with control data: GORD infants had significantly lower energy intakes; the FAS showed GORD infants to have significantly fewer adaptive skills and readiness behaviour for solids, significantly more food refusal and food loss; the TRIB showed GORD infants to be significantly more demanding and difficult with feeds; and the MRIB revealed that mothers of GORD infants had significantly more negative feelings, significantly less enjoyment of feeds, and reported significantly more crying behaviour. On videofluoroscopy, oral‐preparatory and oral phase problems predominated, particularly with solids, silent aspiration occurred during the pharyngeal phase in 2/11, and delayed oesophageal transit occurred in 4/11. Conclusions: Feeding problems affecting behaviour, swallowing, food intake, and mother–child interaction occur in infants with GORD, who displayed a lack of development of age‐appropriate feeding skills. The contribution of feeding problems to morbidity in GORD in infants has been underestimated in the past.