Forced feeding related aspiration pneumonia in well and healthy infants and toddlers – A case series

Forceful feeding well and healthy infants and toddlers can lead to aspiration pneumonia which can be life threatening, lead to long hospital stay and creates a negative feeding experience in this age group. The World Health Organization and UNICEF recommend responsive feeding practices part of which involves avoiding forceful feeding. We present 4 cases of infants and toddlers who were previously well with no co-morbidities who presented with features of aspiration pneumonia after they were forcefully fed by parents and caregivers at home. One of the 4 patients died and another required escalation of antibiotic regimen and had prolonged hospital stay, all of them stayed in the high dependency unit and/or intensive care unit and on follow up some reported change of practice and implementation of more responsive feeding practices. Forceful feeding is part of general cultural practices in many communities however it has a risk of causing aspiration pneumonia which can be life threatening. Caregivers express positive intent with forceful feeding however a lack of standardized implementation of responsive feeding guidelines greatly affects how these caregivers are educated on the dangers of forceful feeding. There is need to increase community awareness through education and community based studies on the risk of forced feeding related aspiration pneumonia among infants and toddlers. Adaptation and implementation of responsive feeding guidelines in low to middle income countries can address these gaps in knowledge and reduce risk of aspiration pneumonia in this population.