MOTOR DEVELOPMENT IN INFANTS WITH ESOPHAGEAL ATRESIA: THE CRITICAL IMPORTANCE OF ORAL FEEDING EXPERIENCE

Abstract

To study the effects of altered oral experience on development, five children with unrepaired esophageal atresia were observed from birth for periods of 8 months to 9 years. Three children were fed only by gastrostomy while two had a full range of oral experiences including sham oral feedings of milk and baby foods (which drained through a cervical esophagostomy), given simultaneously with gastrostomy feedings so as to retain the oral reflexes and cyclic hunger and satiation. The influence of maternal deprivation on the infants' development was anticipated, evaluated, and minimized by supportive assistance to the family. Direct observations of the mothers and infants were supplemented by films, developmental testing and the parents' written observations.

The 3 infants in whom oral experience was severely deficient from birth had marked gross motor retardation without neurological or mental deficits. In addition they rarely showed intense responses, such as anger, had little attachment to toys and had nonspecific responses to their parents' presence or absence. Despite adequate caloric intake these 3 children were all below the third percentile in weight and body length after the sixth month. In sharp contrast, the 2 children who had a full range of oral experience were normal in every respect. The results suggest that early oral feeding experiences may profoundly influence motor development.

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