Physical Exam Key Points

1. Vital signs. Check for fever, tachypnea, or poor perfusion associated with respiratory distress, dehydration, or infection.

Decreased weight-for-height percentiles may indicate chronic poor oral intake (see Chapter 25, Failure to Thrive, p. 126).

2. Mouth. Inspect oral mucosa for lesions consistent with infection or ingestion.

3. Lungs. Auscultate for symmetric breath sounds, rales, rhonchi, or wheezes. Decreased breath sounds, especially in right lung fields, may be consistent with aspiration pneumonia.

4. Abdomen. Reproducible midline or epigastric pain may be present with reflux esophagitis (but is often absent in chronic conditions).

Laboratory Data. Generally not indicated in feeding disorders. CBC with differential may be obtained in patients with infectious processes (high WBC count) or chronic reflux (anemia secondary to mucosal erosion and blood loss). Radiographic and Other Studies

1. Modified barium swallow (MBS). The gold standard study used to delineate oral, pharyngeal, and esophageal phases of swallowing, but rarely indicated acutely unless anatomic considerations or persistent aspiration are suspected.

2. Plain film, chest X-ray. Warranted if pneumonia, ingestion pneumonitis, or anatomic abnormalities are suspected.

3. Routine neuroimaging. Not done to work up feeding disorders. Rare, direct CNS etiologies, such as mass effects from tumor or trauma, or pressure phenomena from congenital lesions such as Chiari malformations, warrant CT or MRI scan.

V. Plan. Evaluation of feeding problems in young children aims to assess acute impact on wellness. Life-threatening presentations secondary to feeding difficulties are rare. Aspiration, as well as unrecognized reflux, can result in nutritional inadequacy, failure to thrive, and immunologic compromise.

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