As promised, this is a follow up BLOG post from our last BLOG, “GI Motility“. It is always nice to define our medical terms for our patients, but even better to offer explanation for ways that we can help manage this type of GI dysfunction.
For motility disorders, we use medical and nutritional treatments, combined together, to enhance movement through the GI tract to aid in decreasing the likelihood of reflux as well as increasing emptying of the stomach and the intestines. We like food to go into the mouth, down the esophagus through the lower esophageal sphincter and into the stomach, empty from the stomach and flow through the small and large intestines, and out of the body with as few “hiccups” as possible. We often explain this to our patients as a part of achieving “gut comfort,” something we aim for before initiating any type of behavioral feeding therapy. We don’t believe in training kids to eat who we don’t believe feel well.
Part of feeling well is actually not feeling your food flow through your GI tract! Digestion should be a bodily activity that easily flows and occurs without pain. Any disruption to this process, whether in the form of acid splashing in the esophagus or stool settling into an oversized colon refusing to come out except with extreme force and pain, decreases a child’s desire to go through the process of eating again. Do you blame them?
Our superb pediatric dietitians use specialized formulas that are made up of broken down proteins (primarily milk proteins) that are easier for our patients to digest. When our patients consume these formulas, their GI tracts have less work to do, experience less likelihood of difficulties with constipation or reflux and often have decreased irritation and inflammation throughout their GI systems. Simply put, these formulas empty better and are absorbed more quickly, thus enabling increased comfort and a better environment for optimal nutrition. This is a win-win for an impaired, angry or plain ole’ tired GI tract. (Corkins M, ed. 2011).
We always aim to treat our patients first with formula change. However, sometimes, medical management is necessary. We often use medications, such as erythromycin or bethanechol. Both of these medications assist the GI tract in performing its wavelike activity (peristalsis) via different mechanisms. We see these medications decrease reflux symptoms, increase ability to tolerate tube feedings without vomiting or retching, increase frequency and consistency of bowel movements and increase amount of formula a child is able to consume in one sitting. We choose which medication we recommended based on many factors, specific to each individual patient.
There are other medications we use less commonly to assist the GI tract in its motility, such as metoclopramide (Reglan) or cyproheptadine (Periactin). We are very judicious in recommending any medication and do so with a risk/benefit balance each and every time. Some medications are not appropriate for some patients yet provide excellent outcomes for others. Because we treat patients with a wide range of impairment in their GI motility, each plan for each little patient is different.
In summary, when treating GI motility, it takes both the dietitian and the medical provider to provide the best case scenario for the easiest flow and comfort during the digestive process to allow for optimal absorption of nutrients for the best growth outcomes.
Corkins M, ed. Dietary Sources in Pediatric Nutrition Support Handbook. ASPEN; 2011.