Röhrenpost 30

Achalasia in Childhood

 

Achalasia in childhood is extremely rare. The disease is already difficult to diagnose and more so in younger years as childhood achalasia is extremely rare and the little patients cannot precisely describe and locate their problems and symptoms.

Achalasia is not a psychological problem!!! It is very problematic, if the disease shows at an age, when a psychological factor seems possible...

Signs

• the breathing may become difficult, bubbly and “tight”

• the following regurgitation of the food is often without major convulsions and usually the child continues to eat

• the regurgitated food does not smell sour

• it is possible that remains of the last meal “come up” again later with some liquid – here, as well, no real signs of digestion

• especially dry food, vegetables with long fibres, certain fruits or raw vegetables tend to provoke regurgitation

• even toast and sweet rolls are difficult to eat (form a lump)

Nutrition

The criteria regarding the nutrition are similar to those of the adults. When the children are extremely young, it is again more difficult, as they cannot explain their problems accurately.

The kind of food that often causes difficulties are mentioned above, but in the end, each patient has got his individual situation.

Some procedures may be helpful:

it is good for the children to chew properly (though quite wearisome, as the children often do not succeed in chewing sufficiently until the early teenage years (not to mention very small children!))

• allow enough time to eat the meals without hectic and drink sufficiently

• food that turns into thin mush when eaten with liquid usually works quite well (plain biscuits, bread sticks...)

Though, children who still eat baby food might even regurgitate this. It is the trial and error method. Some kinds of milk pudding might work as well, because these turn quite liquid with beverages and saliva (in contrast to baby lunch meals, that are thicker and sometimes contain little chunks)

• puree ‘normal’ food to make it ‘thin’

if the food gets stuck, it might help to get up and walk around a little or to lift the arms above the head.

Tip: When the children are still small, they cannot control the regurgitation. It is then helpful to have a little bowl at hand. This reduces the hectic at the table (when the time has come) and also the mountain of dirty washing ... 

The way to the diagnosis

• it is very comforting for parents, when the paediatrician takes their worries seriously and acts resolutely (e.g. transfers the patient to hospitals/gastroenterologists, should he/she not be able to make a diagnosis)

• The children need the support of the family and it is a great burden for them, if other people think that they regurgitate on purpose.

• It has happened that the eating problems vanished after a gastroscopy had been made and then reappeared after 2-3 weeks. That was due to a small ‘dilatation’ made by the endoscope.

Examinations

Different examinations might be needed, either for diagnostic purposes or prior to a surgery.

To mention are:

• The manometry of the gullet (pressure measurement), in the course of which the muscle activity in the gullet and the cardia is being monitored.

• The barium swallow (x-ray with barium as contrast agent), where you drink barium liquid that shows up as white on the x-rays. The procedure of the barium while swallowing it can be observed and evaluated.

Both examinations are not very pleasant and, therefore, it is necessary that the children cooperate as best as possible. But the doctors in charge might have an idea how these examinations can be made a bit more pleasant (e.g. to improve the taste of the barium liquid...)

Therapy

Basically, children have the same treatment options as adults with achalasia:

• Surgery

• Dilatation

• Botox

Every patient can and has to make the respective decision himself, but a trusted surgeon who is familiar with the disease will probably make a suggestion and give good reasons for it. Maybe, the hospital offers a medical aftercare, so that the little patients can receive further care after the surgery.

Environment

Very often, it is an even greater burden not to be able to eat properly, if you are in company of other people.

With an understanding environment, it might prove good to handle the problems openly as this reduces unnecessary misunderstandings. Should it then happen that the food “takes the wrong path”, the alarm people not belonging to the family experience is much less pronounced and there is no sorrow to catch the stomach flu.

Especially in the kindergarten and in school, the nurses and teachers might ask you less frequently to pick your child up.

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