Food Aversion in Paediatric Population with Short Bowel Syndrome: Mechanisms and Treatment Strategies
Maria Chiara Cianci, Riccardo Coletta, Antonino Morabito
Azienda Ospedaliera Universitaria Meyer; Università degli studi di Firenze; Dipartimento di Chirurgia Pediatrica; Centro di Ricostruzione e Riabilitazione Intestinale.
Food aversion (FA) is a condition of extreme negative reaction towards food orally introduced and it is characterized by partial or complete refusal of food leading to growth and development delay. In paediatric population Short Bowel Syndrome (SBS) is reported as that most frequently leads to AF, about 25%. SBS is characterized by loss of small intestine resulting from congenital or acquired anomalies with consequent malabsorption and intestinal dysmotility. In most cases parenteral nutrition or enteral nutrition with nasogastric tube is required. In the most recent literature review regarding AF in this cohort of patients, Hopkins showed that AF is related to both physical and social factors. Adverse oral stimuli, failure to develop patterns of behavior related to nutrition, reduced ability to suck / swallow and lack of interaction with family members during the meal contribute to FA development in SBS children. A multidisciplinary approach is needed with the aim to desensitize the child from negative oral experiences, promoting positive stimulation interventions towards the introduction of food by mouth. No specific strategies however are reported for patients with SBS. According to the analysis performed by Hopkins, centres specialized in SBS treatment, as the Manchester Children Hospital and the Meyer Paediatric Hospital in Florence, structured a refeeding program called Messy Play Therapy (MPT). MPT is based on the gradual desensitization of children against smells and / or textures of foods generally introduced by mouth with play techniques. This psychological / playful expedient aims to make the patient familiar with food, gradually eliminating that psychological component of the negative stimulus. Results obtained in the reference centres for SBS showed that MPT in association with parents education regarding the approach to the disease leads to an increase in the tolerance of children towards oral food in 100% of cases with substantial nutritional and social benefit. Further studies and application in clinical practice are required, but MPT seems to be an effective protocol in the treatment of AF in paediatric patients with SBS.