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ICAN: Infant, Child, & Adolescent Nutrition
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The Case of the Wretched Retcher

Robin C. Cook, MS, RD, LDN

Department of Clinical Nutrition, Department of Pediatric General, Thoracic, and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

Thane A. Blinman, MD

Department of Clinical Nutrition, Department of Pediatric General, Thoracic, and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, blinman{at}email.chop.edu

Fundoplication is an effective treatment for severe gastroesophageal reflux disease (GERD) because it provides a mechanical solution to what is essentially a mechanical, not a medical, problem. However, manifestations of feeding intolerance postfundoplasty are well known and include dysphagia, gastric dysfunction, retching, gagging, intestinal dysfunction, and gas bloat syndrome. These difficulties are exacerbated by feeding plans that disregard the mechanical constraints imposed by the operation, particularly limited gastric volume, decreased gastric compliance, diminished ability to burp, sensitivity to osmolarity, and formula composition. These complications are preventable and treatable by informed construction of feeding plans that limit boluses (around 15 mL/kg/bolus), promote proper motility, manage intraluminal air, and limit polypharmacy. This case presentation describes a postfundoplasty infant with severe retching and intolerance treated according to these principles.

Key Words: Nissen fundoplication • pediatric nutrition • retching • gastroesophageal reflux • feeding intolerance

ICAN: Infant, Child, & Adolescent Nutrition, Vol. 1, No. 2, 94-97 (2009)
DOI: 10.1177/1941406409332670
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