Researchers studied 75 children who were born with a condition where their food pipe and windpipe didn’t form correctly. They found that about three-quarters of these children had trouble eating after surgery to fix the problem. The biggest issue was that kids struggled with the actual skills needed to eat, like chewing and swallowing properly. Children who were born early, weighed less at birth, or started eating later had more feeding problems. The study shows that these children need special help from doctors, speech therapists, and nutritionists working together to eat better.

The Quick Take

  • What they studied: How common eating problems are in children born with esophageal atresia (a condition where the food pipe doesn’t connect properly to the stomach) and what causes these problems.
  • Who participated: 75 children (average age 3.3 years old) who had surgery to fix their food pipe between 2005 and 2022 at four hospitals in Israel. Their parents answered detailed questions about their eating habits.
  • Key finding: About 76% of the children had eating difficulties, with the main problem being trouble with the physical skills of eating (like chewing and swallowing). Children born prematurely, with low birth weight, or who started eating later had significantly more problems.
  • What it means for you: If your child has this condition, eating problems are common but manageable with proper support. Early intervention with a team of specialists (doctors, speech therapists, nutritionists) can help. However, this study shows that only half the children received this coordinated care, suggesting families should advocate for comprehensive support.

The Research Details

This was a multicenter study, meaning researchers collected information from four different hospitals in Israel. Parents of children who had surgery for esophageal atresia between 2005 and 2022 filled out detailed questionnaires about their child’s eating abilities and challenges. The researchers used a standardized tool called the Montreal Children’s Hospital Feeding Scale to measure eating problems and categorized them into four types: problems with eating skills, getting enough nutrition, medical issues, and emotional/behavioral issues. The study looked back at medical records to identify factors present at birth (like gestational age and birth weight) that might predict eating problems later.

By asking parents directly about their experiences, researchers got real-world information about how these children actually eat at home, not just in a clinical setting. Using a standardized measurement tool ensures all children were evaluated the same way. Looking at birth factors helps doctors identify which children might need extra help early on.

This study has good strengths: it included children from multiple hospitals (making results more generalizable), used a validated assessment tool, and examined both current eating problems and early risk factors. However, the sample size is moderate (75 children), and the study relied on parent reports rather than direct observation by specialists. The study was conducted in Israel, so results may not perfectly apply to other countries with different healthcare systems. The researchers did not mention how they selected which families to invite, which could affect whether the results represent all children with this condition.

What the Results Show

Three-quarters of the 75 children (57 children, or 76%) had eating difficulties. The most common type of problem was impaired feeding skills (42% of children), meaning they struggled with the physical act of eating—things like chewing, swallowing, and coordinating mouth movements. The other types of eating problems were less common: nutritional issues (not getting enough calories or nutrients), medical problems (like reflux or pain while eating), and psychosocial issues (emotional or behavioral problems around eating). Children who were born earlier than expected had more eating problems (born at 37 weeks versus 39 weeks on average). Children with lower birth weights also struggled more (averaging 2,130 grams versus 3,084 grams). Children who started eating by mouth later after surgery had more difficulties (starting at 14 days versus 10 days after surgery). Interestingly, the study found that only about half of the children received coordinated care from multiple specialists (doctors, speech therapists, nutritionists) working together.

The study identified that eating problems persisted even years after surgery, suggesting this is a long-term challenge rather than something that resolves quickly. The fact that feeding skills were the primary issue (rather than medical complications) suggests that these children need specialized training and therapy to learn how to eat properly. The finding that only half received appropriate multidisciplinary care highlights a gap in current healthcare delivery for these children.

Previous research has noted that children with esophageal atresia have eating problems, but this study provides more detailed information about how common these problems are and what specifically causes them. The identification of birth-related risk factors (prematurity, low birth weight) aligns with general pediatric knowledge that premature and smaller babies often have more developmental challenges. This study adds to the evidence that coordinated, multidisciplinary care is important for these children.

The study relied on parent reports rather than direct evaluation by feeding specialists, which could mean some problems were missed or overestimated. The study looked back at medical records from 2005-2022, so some information may have been incomplete or forgotten. The study was conducted in Israel, so results may differ in other countries. The sample size of 75 children is moderate—larger studies might reveal additional patterns. The study doesn’t tell us whether the eating problems improved with specific treatments, only that they existed.

The Bottom Line

If your child has esophageal atresia: (1) Expect that eating difficulties are common and not your fault—this is a known complication of the condition (High confidence). (2) Seek coordinated care from a team including a pediatric gastroenterologist, speech-language pathologist, and nutritionist (High confidence based on study findings). (3) Start specialized feeding therapy early, especially if your child was born prematurely or with low birth weight (Moderate-High confidence). (4) Be patient—eating skills develop gradually and may take months or years to improve (Moderate confidence).

This research is most relevant for: parents of children with esophageal atresia or tracheoesophageal fistula; pediatric doctors and specialists caring for these children; speech-language pathologists and feeding therapists; and hospital administrators planning services for children with birth defects. This does not apply to children without these specific birth conditions, though some feeding therapy principles may be relevant for other feeding disorders.

Eating difficulties in these children are typically long-term challenges. Improvement usually occurs gradually over months to years with appropriate therapy. Some children may continue to have mild eating difficulties into school age or beyond. Parents should expect this to be a marathon, not a sprint, and celebrate small improvements.

Want to Apply This Research?

  • Track daily eating milestones: types of foods tolerated (purees, soft foods, regular foods), amount eaten at each meal, any choking or coughing episodes, and mood during meals. Rate eating difficulty on a simple 1-10 scale daily to monitor progress over weeks and months.
  • Set a specific feeding therapy goal each week (e.g., ‘introduce one new food texture’ or ‘practice chewing exercises 3 times daily’). Use the app to log completion of therapy exercises, meals attempted, and any positive changes observed. Share progress reports with your child’s therapy team.
  • Create a monthly summary showing trends in food variety, meal duration, and eating confidence. Set reminders for specialist appointments and therapy sessions. Track which foods your child tolerates best and which cause problems. Monitor growth metrics (weight, height) to ensure adequate nutrition despite eating difficulties.

This research describes eating difficulties in children with esophageal atresia but does not provide personalized medical advice. If your child has been diagnosed with esophageal atresia or tracheoesophageal fistula, discuss these findings with your pediatric gastroenterologist or surgeon. Do not use this information to diagnose or treat feeding problems without professional evaluation. Every child is different, and treatment should be tailored to individual needs by qualified healthcare providers. This study was published in 2026 and reflects current research at that time; always consult with your child’s medical team for the most up-to-date recommendations.