Picky-Eating, Just a Phase or Something More Serious?

August 31, 2009
Insights on Feeding Disorders from Kennedy Krieger’s Experts

Catering to a child who is a picky-eater is like being a short-order cook: chaotic. Dinnertime becomes a war zone, with hopeless battles fought over vegetables and macaroni and cheese.

Picky-eating is as normal as potty-training, a right of passage in childhood development. Taste-buds evolve and food preferences expand in these early years. Even the best of parents can have a difficult time getting their child to eat. In fact, picky-eating is one of the most common occurrences in children, often outgrown as the child reaches adolescence. But if eating behavior inhibits normal developmental and physical growth processes, it could be something much more severe - a pediatric feeding disorder.

"The difference between a fussy eater and a child with a feeding disorder is the impact the eating behavior has on a child's physical and mental health," says Peter Girolami, Ph.D., Assistant Director of the Pediatric Feeding Disorders Program at the Kennedy Krieger Institute in Baltimore, Maryland - one the first programs of its kind in the United States and the largest in the world to treat pediatric feeding disorders.

Pediatric feeding disorders are more common than most think, afflicting up to 10 percent of all infants and children, according to published literature. Children classified as having a feeding disorder do not consume enough calories and nutrients to promote healthy growth and development. It is important to differentiate between a picky eater, who may consume a restricted but still nourishing diet, from a child who consumes, for example, only three to four types of foods, eliminating entire food groups and compromising healthy growth.

Common symptoms of a pediatric feeding disorder are:

  • An abrupt change in eating habits lasting longer than 30 days
  • Delayed development of skill set necessary to self feed or consume higher textures
  • Weight-loss or failure to gain appropriate weight
  • Choking/coughing during meals
  • Unexplained fatigue, loss of energy
  • Disruptive behavior during mealtime

Feeding disorders are not all created equal. Some children can have aversions to food groups or certain textures and colors, while others lack the skills to self-feed or refuse to eat any food at all. The assortment of behaviors that constitute a feeding problem vary from child to child and include food refusal (e.g., crying, head turning, spitting out food, throwing utensils, packing or holding food in mouth, aggression, and getting out of the seat), coughing/gagging, and vomiting. Many children with feeding disorders also suffer from a serious medical, behavioral or psychological condition that can contribute to the onset of the feeding disorder - 30 percent of children with development delays have difficulty feeding at some point during their childhood. Other common medical conditions that are associated with feeding disorders include gastroesophageal reflux disease (GERD), food allergies, cancer, and complications from premature birth. Children that undergo surgeries unrelated to food may also develop feeding problems, as feeding tubes can throw them off track.

Early diagnosis and treatment is extremely important when it comes to feeding disorders. The longer it is left untreated, the more complex it can become-in extreme cases, children can even require feeding tube assistance. Children with feeding disorders can also have serious complications from nutritional deficiencies such as anemia. Undernourished children are also at risk for developmental delays including the inability to crawl, walk and talk, which could lead to oral, motor and sensory problems.

Since there is no common cause or symptom that is characteristic of all pediatric feeding disorders, each case is unique with varying challenges to effective treatment. Both biological and social interactions need to be individually addressed for each child during diagnosis and when developing an appropriate treatment program. Kennedy Krieger's Pediatric Feeding Disorders Program takes an interdisciplinary approach. A team of professionals with expertise in many specialties - from gastroenterology to behavioral psychology and speech pathology- work together to help each child modify behavior, build motor skills and treat associated medical conditions.

"It's not a one-size fits all model," insists Dr. Girolami. "Our team addresses the many causes of feeding disorders and their associated complications so we can give the child and family the best care available."

For more information on feeding disorders and treatment options, visit http://feedingdisorders.kennedykrieger.org/.

For additional information or to schedule an interview with Dr. Girolami, please contact Shellie Byrum at 202-955-6222 x2516
or sbyrum@spectrumscience.com.