Pediatric Gastroenterology

Feeding Disorders

Baby in a doctors coat

What is a Feeding Disorder?

Pediatric Feeding Disorder occurs when a child does not take in enough food to provide the necessary amount of nutrition, calories, and/or hydration required by the body in order to grow and thrive. Feeding disorders can occur in children with no underlying medical condition, in those who have or had an underlying medical cause such as a gastrointestinal disorder, GERD or food allergies, and those who have a physical abnormality such as a cleft palate.

In most feeding disorders, there is no one factor that accounts for the problem, but the most recent studies suggest that a patient is treated as a combination of social, psychological and organic factors.

Feeding disorders evidence themselves in a number of ways. The child may refuse all sustenance including liquids, just drink water, or only eat certain limited foods. Some children lack the skills to feed themselves, some may spit their food out, some may just cry. Sometimes a child has gotten used to having a feeding tube due to prior surgery or a physical abnormality and refuses to take in food any other way.

Additionally,  parents unknowingly reinforce refusal by rewarding the child with more attention after he or she has turned his or her head away from food. The child learns that there will be plenty of attention if the food is refused, and this can become a pattern that eventually evolves into a feeding disorder.

According to statistics, one in every four children has some form of eating disorder, but many of them are not harmful. For instance, one child may eat most foods without a problem, but will only eat two or three kinds of fruit. This is the mildest form of an eating disorder, while a severe form may mean a child who refuses to consume any kind of food at all.

Feeding disorders typically occur between ages 2 and 5 years old. More boys than girls suffer from feeding disorder (estimated 2/3 of patients are male). About 15% of children who are developing normally have feeding disorders, while 40% of children with delayed development have it. From 40% to 70% of babies born prematurely experience some type of feeding disorder.

Types of Feeding Disorders

In order to create a goal and an appropriate set of behaviors at mealtime, the precise method of refusal needs to be pinpointed.

  • Complete Food Refusal
  • Food Selectivity, also known as picky eating, this is when a child will eat a limited number of foods.
  • Low Volume Acceptance when the child will eat, but stop at a certain point at which not enough nutrition has been taken in
  • Texture the child will not eat foods with certain textures

Symptoms

The list of symptoms for a feeding disorder is lengthy and complicated by the fact that each child has a different combination of these symptoms, and has to be treated with an individual approach. The following symptoms are among the most common and most noticeable:

  • A sudden change in eating habits lasting more than 30 days
  • Delayed development of skill set needed to self-feed
  • Failure to gain weight
  • Refusal behaviors (turning the head, pushing away the spoon) during mealtimes
  • Disruptive behavior such as throwing food, bowls, or spoons from a table or highchair tray
  • Refusing to open mouth to be fed
  • Coughing during mealtimes
  • Vomiting during mealtimes
  • Tube dependency
  • Packing solids (keeping food in the mouth)
  • Pooling liquids (keeping liquids in the mouth)
  • Eating non-food items
  • Problems in eating chunkier textures

Treatment

There is no simple, one-size-fits-all approach or quick resolution to a feeding disorder. If the feeding disorder has become acute (and therefore dangerous), the child may need hospitalization for a period of time. Many current treatments combine physiological evaluation and treatment along with behavioral therapy that includes improving a child's appropriate eating behavior while decreasing inappropriate behavior.

Sometimes the treatment involves a number of specialists from different disciplines. For instance, a treatment team may consist of behavioral specialists with occupational and speech therapists, dieticians and physicians. Parents may try:

  • Consistency in using the time-out method when food is refused
  • Set limits by offering limited food choices at mealtime
  • Encourage family meals together to model appropriate eating behavior

Since patients respond differently to different treatments, there are a number of treatment approaches or a combination of treatments that can be used by professionals working with parents of the child with a feeding disorder. Some of the most common include:

  • direct feeding via a feeding tube
  • simple medical treatment (for example, a medicine prescribed for reflux)
  • nutritional changes (e.g., different foods, adding calories to food)
  • the gradual increase of exposure to and acceptance of new foods or textures
  • adjustment of food temperature and texture changes
  • positioning changes (e.g., different seating)