The Case of the Picky Eater: Gastroparesis

“Picky eater” has become the generic label for anyone who limits or refuses to consume certain foods. While pediatricians and dietitians acknowledge that this can be a normal phase of child development, parents often turn to dietitians for guidance through this frustrating time. The general advice is to keep offering the snubbed foods and they will eventually be accepted. However, this standard response could potentially dismiss a more serious underlying issue.

A child’s response to selected foods or his behavior at meal time may indicate something else is going on internally. Dismissing certain clues without exploring further can interfere with growth and delay much-needed diagnosis and treatment. In this and future posts on this subject, I will present some underlying conditions that are frequently dismissed as picky, but may be accurately uncovered with a dietitian's help.

What Is Gastroparesis?

Gastroparesis is a condition where the movement of food from the stomach into the intestines is delayed or at a standstill. This can lead to a feeling of early fullness, diminished appetite, abdominal discomfort and other problems that are mild, like silent reflux, to more severe, such as vomiting anything that is consumed.

What Causes It?

In adults the most common cause of gastroparesis is uncontrolled blood sugars in diabetics resulting in damage to the vagus nerve (which controls muscle contractions in the gut). However, in children, the origin of vagus nerve damage is hard to identify. It could be related to an injury, a childhood virus or other condition. In many cases the etiology remains a mystery. 

Symptoms to Look For

Gather information from parents and caregivers about the patient’s eating and elimination habits. Individually, the symptoms below may not be too concerning, but when combined, further testing may be necessary.

  • Refusal to eat certain foods (specifically high-fiber grains, fruits, vegetables or fatty foods that stay in the stomach longer)
  • Loss of appetite
  • Changes in growth velocity (slower than expected weight or height increases or perhaps no change at all)
  • Complaints of pain or discomfort in the stomach or chest, especially if a trial of reflux meds has not resolved the issue
  • Inconsistent intake at meals, e.g. skipping a couple meals and then eating a big one
  • Fatigues quickly
  • Abdominal distention
  • Gravitates toward or avoids specific textures of foods or prefers liquids (which pass through the stomach faster) over solids
  • Slow or incomplete bowel elimination, even if the child stools every day

Diagnosis

If your patient experiences two or more of the above symptoms, refer the family to a pediatric gastroenterologist for further evaluation. There are several tests that can be done to confirm a gastroparesis diagnosis, including:

  • Sitz markers: child swallows small radioactive markers (smaller than Cheerios), then takes x-rays every other day over 5 days to track movement through the gut.
  • Gastric emptying scan: child eats a meal (typically eggs or eggs and toast) marked with a very small amount of radioactive material. Then images of the stomach are taken over two hours or once an hour over four hours to determine how quickly food is squeezed out of the stomach.

Managing Diet and Nutrition

If gastroparesis is confirmed, you will need to modify your patient’s diet, in conjunction with his medical treatment, in a way that allows nutrition to move through the gut as easily and quickly as possible:

  • Change the composition of foods offered (low-fat, low-residue and high-calorie)
  • Change the meal schedule and volume (frequent and small)
  • Or recommend high-calorie liquid nutrition by mouth or through enteral feeding

For more information on gastroparesis, check out the American College of Gastroenterology.

Louise Goldberg, RDN, CSP, LD on FacebookLouise Goldberg, RDN, CSP, LD on Twitter
Louise Goldberg, RDN, CSP, LD
Louise Goldberg, RDN, CSP, LD, is a private-practice pediatric dietitian in Houston. Connect with her on her website, An Apple a Day Nutrition Consulting, or on Twitter or Facebook.