Gastrointestinal problems and non‐Oral feeding in children evaluated for medical child abuse (fabricated and induced illness)

Abstract

AbstractVictims of medical child abuse (MCA) often have gastrointestinal (GI) complaints and nutritional difficulties, leading to non‐oral feeding methods. We documented the frequency of GI complaints, non‐oral feeding methods, medical complaints leading to them and difficulties experienced. They were compared with children evaluated preoperatively by a G‐tube protocol.Children with possible MCA at Children's Hospital, 2011–2015, were retrospectively reviewed. They were compared with a 5 per cent random sample of G‐tube protocol children, 2013–2015.Sixty‐five of 143 (45.5%) children evaluated for MCA were determined to be MCA victims. Twenty‐four out of 65 children with MCA (39.6%) had GI complaints compared to nine out of 60 G‐tube protocol children (15.0%). Gastroesophageal reflux and oral‐motor dysfunction were the most frequent GI problems in both groups. Fewer MCA children had prior non‐oral feeding methods than G‐tube protocol children. However, MCA victims had more prior GI investigations, non‐oral feeding types and complications thereof. MCA children were less likely to have feeding tubes placed, but caretakers took 30 per cent who did not receive a tube elsewhere for tube insertion. Interventions in MCA children restored many to oral feeding and resolved nutritional and developmental complaints.MCA victims had frequent GI complaints, numerous investigations and frequent complications. They had more uncommon GI complaints. MCA interventions improved feeding and nutrition.Key Practitioner Messages Gastrointestinal (GI) problems and non‐oral feeding methods are common in medical child abuse (MCA). MCA victims undergo many investigations and tend to have multiple GI complaints. Non‐oral feeding methods are common and often fail or are fraught with complications. Consider MCA in children with unusual primary and/or GI diagnoses. Intervention can relieve feeding and developmental problems and failure to thrive.