Feeding Disorders Q&A

Learn more about Feeding Disorders and how to recognize and treat them with the below Q&A.

Q: What is a pediatric feeding disorder?

A: Feeding problems refer to a child’s inability to eat or refusal to eat an age-appropriate amount, variety, and/or range of textures of food and drink. Feeding problems are considered a disorder when they are severe enough to affect a child’s health or growth, cause him or her to be underweight or overweight, cause specific nutrient deficiencies, or lead to significant child and family disruption on a daily basis.
 

Q. How does a “picky eater” differ from a child with a feeding disorder?

A: It is not uncommon for a child, at some point in his or her development, to be characterized as a picky eater. What sets a child with a feeding disorder apart from a child who is picky about a particular food (or foods) is the impact the eating behavior has on the child’s physical and mental health.

A picky eater may eat a limited variety of foods across food groups and still maintain adequate nutritional status, whereas a child with a feeding disorder may consume only three or four foods or eliminate entire food groups (e.g., vegetables, proteins or fruits), compromising physical and cognitive development.
 

Q. What causes feeding disorders?

A: Feeding disorders often involve a complex interaction of medical and environmental factors. Many pediatric feeding disorders can be attributed to a combination of underlying causes, such as medical issues, behavior problems, oral-motor issues and even sensory challenges. Children who require a feeding tube for medical reasons often develop an oral aversion to food and/or drink, and they may experience a delayed development of feeding skills. These children often need treatment in order to help them meet all of their nutrient and fluid needs by mouth and to eventually discontinue tube feeding.
 

Q. What are some symptoms of a feeding disorder?

A: Common symptoms of a pediatric feeding disorder include:

  • Weight loss or failure to gain appropriate weight
  • Disruptive behavior during mealtimes (e.g., crying, tantrums, throwing food)
  • Difficulty swallowing
  • Food refusal
  • Difficulty chewing
  • Food selectivity (i.e., extreme preferences for food)
  • Gagging, choking or coughing during meals
  • Texture selectivity or sensitivity
  • Vomiting during meals or when non-preferred foods are presented
  • Oral aversion to food and/or drink
  • Delayed development of the skill set necessary to self-feed or consume more complicated textures
  • Long meal durations
  • Inappropriate or disruptive behavior at mealtimes
 


Q. How is a feeding disorder diagnosed?

A: Kennedy Krieger Institute conducts a formal interdisciplinary evaluation involving specialists from the fields of pediatrics, behavioral psychology, nutrition, speech-language pathology and/or occupational therapy. The evaluation includes taking a comprehensive history regarding the child’s feeding problems and observing the child’s feeding skills during a meal. Feeding team members discuss their impressions at the end of the evaluation and present an interdisciplinary assessment and recommendations to the family. Team members assess growth, weight relative to height, caloric intake, variety of foods consumed, the need for modified food textures, signs and symptoms of aspiration, chewing skills, ability to self-feed, food refusal and inappropriate mealtime behaviors. Attention is also focused on the negative impact feeding problems can have on a child’s functioning, both psychosocially and within his or her family.
 

Q. How are feeding disorders best treated?

A: Since there is no single cause or symptom characteristic of all pediatric feeding disorders, each case is unique and presents its own challenges to effective treatment. Both biological and social interactions need to be individually addressed during diagnosis and when developing an appropriate treatment plan. The Pediatric Feeding Disorders Program at Kennedy Krieger Institute takes an interdisciplinary approach. Team members—professionals with expertise in many specialties, including pediatrics, behavioral psychology, occupational therapy and speech-language pathology—work together to help each child improve his or her acceptance and consumption of food, build oral motor and feeding skills, and treat associated medical conditions.
 

Q. What is a parent’s role in treating a feeding disorder?

A: Parents and other caregivers play an essential role in the treatment process. After their child’s admission to the program, parents or caregivers are asked to conduct meals at Kennedy Krieger as they normally would at home so that staff members, after observing a few meals, may begin to develop individualized treatment options. Once an effective feeding protocol has been developed and evaluated, parents are trained in how to use the feeding protocol designed specifically for their child. Long-term gains are not possible without parent and/or caregiver involvement.
 

Q. What is the difference between pediatric eating disorders and pediatric feeding disorders?

A: The two most common eating disorders are anorexia nervosa and bulimia nervosa. With both anorexia and bulimia, an affected person’s body image is significantly distorted, and he or she is intentionally trying to lose weight or prevent weight gain. With pediatric feeding disorders, something else, other than a desire to lose weight or prevent weight gain, is at work. Another difference between eating and feeding disorders is that eating disorders typically begin during or after adolescence, whereas pediatric feeding disorders often begin in infancy or early childhood.

The latest revision of the Diagnostic and Statistical Manual of the American Psychological Association defines a new disorder, avoidant-restrictive food intake disorder (ARFID). A child with ARFID fails to meet appropriate nutritional and/or energy needs in the absence of a medical condition or mental health disorder, and he or she does not have a distorted body image.

Some children have both ARFID and a pediatric feeding disorder. ARFID may be a better term for children who develop feeding problems after early childhood, especially those who experience a relatively acute onset of symptoms. We have seen and treated children between ages 6 and 13 with ARFID who have decreased oral intake due to a lack of appetite; due to fear of abdominal pain, vomiting, choking or food getting stuck in airways; or due to an inappropriate fear of food becoming contaminated by germs or by things they are supposed to avoid, such as gluten or foods to which they have allergies.

 

For a complete overview of our Feeding Disorder Program, please visit the Pediatric Feeding Disorders Program homepage.

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