Infantile anorexia: how to avoid diagnostic errors?

Abstract

Food whims, some food refusals, food selectivity are issues for which parents often seek advice from a paediatrician. It is difficult to identify the reasons of the issues for just a few minutes of a visit. But the greatest challenges in the diagnosis arise when parents complain that they fail to feed both breastfed and non-breastfed young infants. Anorexia in young infants may be of a psychological and/or organic origin. The most complex and early forms often have a mixed etiology. A detailed history taking reveals cases of forced feeding, frequent changes of formula, and mother’s emotional instability. The article presents several clinical cases with different reasons for food refusals in children for which parents sought advice from a doctor. The first clinical case: a 11-year-old boy with complaints about lack of weight gain, as his weight did not exceed 6.8 kg, extremely slow growth rates. The child was diagnosed with moderate eosinophilic infiltration of the esophagus with eosinophils up to 10–12 per high-power field (hpf). Second clinical case: a 7-month-old girl M. with complaints about decreased appetite, food refusal, lack of interest in food and thirst, regurgitation during feeding. The examination showed eosinophilic infiltration of the duodenum up to 50 eosinophils per hpf. In the stomach there were up to 5 eosinophils per hpf. Third case: a boy Ya. with complaints about restlessness, more in the evening and at night, waking up frequently at night, regurgitation, hiccups, and periods of bloating. The article presents modern options for using specialized food products for this category of children according to the cause of anorexia.