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Selective Eating and Food Refusal 149
Diarrhoea malrotation/twisting of the small intestine –
usually giving rise to green bile in the vomit)
Toddler diarrhoea may occur in children who are
otherwise healthy and growing well. The condition ●● 24-hour pH (acid) monitoring with a probe
is thought to be due to a degree of immaturity of inserted through the nose with acid-sensitive tip
gut function and often improves spontaneously at in the lower oesophagus, giving a continuous
around 3 or 4 years of age. Frequent loose stools 24-hour record of when acid stomach contents
containing recognizable food matter (peas, carrots, spill back into lower oesophagus
sweetcorn) may be passed up to eight times a day.
●● endoscopy (flexible ‘telescope’) examination
Dietary causes include: under anaesthetic of the oesophagus and
stomach, with tissue samples to look at under
●● the consumption of large quantities of some the microscope for inflammation, including
squashes and fruit juices (e.g. clear apple juice) allergy.
because they contain large quantities of
non-absorbable monosaccharides and Drug treatment is usually instigated in children
oligosaccharides (Hoekstra 1998) aged 1–4 and includes:
●● cow’s milk protein allergy – a trial elimination ●● suppressing acid secretion in the stomach (e.g.
diet will prove whether this is the cause or not ranitidine; omeprazole)
(see Chapter 7.1, page 192).
●● stimulating stomach emptying (e.g.
Dietary advice should be a healthy balanced diet domperidone).
with a limit on squash and fruit juice intake.
Dietary treatments include giving 5–6 small meals
Continued diarrhoea (>7 days) after acute each day rather than 3 larger meals and small
gastroenteritis may be associated with a temporary snacks. Continuous nasogastric tube feeding may
intolerance to lactose (Davidson et al. 1984). This be tried in children with this disease who have
might require the exclusion of dairy products and faltering growth as a result of eating insufficient
other lactose containing foods for a few weeks. calories and nutrients.
Lactose-free milks, such as Lactofree or calcium-
fortified soya milk, can be used as a direct Anti-reflux fundoplication surgery is reserved
substitute for cow’s milk. for severe complications resistant to medical
management. It is major surgery that carries
Gastro-Oesophageal Reflux inherent risks and is performed much less
Disease frequently now than in previous decades.
Most children grow out of gastro-oesophageal Selective Eating and Food Refusal
reflux disease (GORD) around their first birthday,
however, for a small minority it may continue and As discussed in the previous chapter, most toddlers
may be diagnosed after the age of 1 year rather than pass through this normal developmental stage of
during infancy. It may be: food neophobia and eventually widen the range of
foods they eat if their parents manage mealtimes
●● a symptom of cow’s milk protein allergy well.
●● a cause of faltering growth. Older toddlers from 2 years may refuse foods for
other reasons:
Investigations to aid diagnosis include:
●● They may begin to associate things that look
●● X-ray of a barium swallow to rule out something similar and may associate a food with something
wrong with the way the gut has formed (e.g. that is disgusting to them. Noodles may
hiatus hernia; narrowing in the bowel; resemble ‘worms’ or sausages may look like ‘dog
