Introduction:

many children with life-threatening conditions (LTC) require, in their first months of life, prolonged stays in intensive care. Once the critical stage has passed, they frequently present difficulties in initiating feeding: food rejection or aversion and early satiety. This could be interpreted as a “neuropathic pain-like” mechanism secondary to the repeated painful and unpleasant oral stimuli of invasive procedures in the mouth and neck. The literature proposes that a therapeutic trial with drugs indicated for the treatment of neuropathic pain such as amitriptyline or gabapentin could contribute to the resolution of this problem.

Clinical case:

child, 1 year 9 months old, with Di George syndrome, complex congenital heart disease for which he underwent surgery on two occasions, severe chronic malnutrition, hypoparathyroidism, hypogammaglobulinemia with lymphopenia and tracheostomy. He had a persistent aversion to oral feeding and was treated with oral gabapentin with good clinical response: progressive acceptance of oral feeding that allowed removal of the nasogastric tube and sustained weight gain.

Discussion:

painful experiences secondary to invasive treatments performed on children with congenital heart disease and other LTC could determine sensitization of peripheral nociceptors, activation and excitation of the central nervous system and hyperalgesia with consequent oral discomfort, odynophagia, dysphagia, early satiety and rejection of meal. Gabapentin could be considered an effective drug to inhibit these mechanisms, prior to defining interventional measures such as a gastrostomy, which add greater complexity to the approach to children.

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