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Dietary considerations for reflux

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Question

My adult son with CdLS his daily diet for years has been oatmeal mixed with scrambled egg for breakfast; Lunch - two bananas, half melon or peaches/nectarines (3); Dinner-mashed potatoes with greens mixed in. He also gets two bottles of milk a day and cup or two of apple or other juice. We have taken him off all citrus. Is there anything wrong with this diet, in particular might the fresh fruit only be aggravating his reflux? He is often in pain and distress for unknown reasons and is arching back and swallowing repeatedly suggests reflux. He's doing better on Prilosec, but we wanted to check about his diet.

Answer of our experts

I am glad you made the decision to do away with citrus and tomato products that can aggravate reflux. Also not mentioned was the milk...usually lowfat or fat free milk and milk products are tolerated much better than whole milk.

To answer your question about fruits...fruits are the one food item that in any text you read it will describe it as "try as tolerated" because many people are fine with fruit but it also can cause distress in some. Bananas should be okay. It would be the apple juice, peach, nectarine, etc. that I would question on an empty stomach. If another protein food or starch were added to this meal, it may be okay. If you are questioning the fruit, I would suggest trying something different for that meal that he may eat and seeing if there is a difference in his behavior.

JR /TK 7-13-10

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Recommendation(s)

Feeding and Dental Difficulties

R12
In every CdLS individual with prolonged and marked feeding difficulties, the multidisciplinary assessment (from healthcare workers across many disciplines) should consider (temporary) placement of a gastrostomy (surgical opening through the abdomen into the stomach) as a supplement to oral feeding.
R13
In individuals with CdLS who have recurrent respiratory infections, reflux and/or aspiration (breathing foreign objects into airways) should be ruled out.
R14
The palate should be closely examined at diagnosis. In case of symptoms of a (submucous) cleft palate, referral for specialist assessment is indicated.
R15
Dental assessment and cleaning should take place regularly; a more thorough dental examination or treatment under anaesthesia may be necessary.

Recommendation(s)

Reflux

R32
Consider always gastro-oesophageal reflux disease (GORD) in any individual with CdLS owing to its frequency and wide variability in presentation, which includes challenging behaviour.
R33
Modification of nutrition and proton pump inhibitors (PPI) are the first-line treatments of GORD. Anti-reflux medications need to be used to their maximum dosage. Surgical interventions for GORD should be limited to those individuals with CdLS in whom nutritional and medical treatments have been unsuccessful or airway safety is at risk.
R34
If GORD symptoms persist, endoscopy should be strongly considered whilst an individual with CdLS is still in paediatric care.
R35
Surveillance for Barrett’s Oesophagus needs to be discussed with and decided together with the family, balancing the potential gain in health and burden for the individual with CdLS.

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