The term “feeding disorder” refers to a condition in which an infant or child is unable or refuses to eat, or has difficulty eating, which can result in frequent illnesses, failure to grow normally, and even death. Feeding disorders should not be confused with eating disorders, such as anorexia, which are more common in adolescence and adulthood. Some common types of feeding disorders in children include adipsia, which is the absence of thirst or the desire to drink; dysphagia, a real or imagined difficulty in swallowing; food refusal; inability to self-feed; taking too long to eat; choking, gagging, or vomiting when eating; inappropriate mealtime behavior; and picky eating according to food type and texture.
Approximately 25% of all children experience feeding disorders. However, they are most common in children with developmental disabilities.
There are many medical conditions that can cause feeding problems. Feeding problems often occur in infant and children who are tube fed for extended periods of time due to some other illness or disability. In premature infants, the underdeveloped sphincter muscle, between the stomach and esophagus, can cause the infant to spit up frequently during feedings. Because this is uncomfortable for the child, he or she may not want to eat. Disorders of the digestive system can also cause feeding problems, and include abnormalities of the throat and esophagus that cause pain during swallowing, inhaling food into the lungs (aspiration), constipation, and celiac disease, a hereditary disorder in which a cereal protein called gluten, which is found in wheat, causes an allergic reaction that results in poor absorption of fats from the diet. Other digestive-type disorders that can cause feeding problems include necrotizing entercolitis, a condition seen mainly in premature newborns where the inner surface of the intestine becomes injured and inflamed; Hirschprung disease, in which a section of the large intestine is abnormally developed; short bowel syndrome; pyloric stenosis, caused by a narrowing or blockage at the stomach outlet; and gastroesophageal reflux (GER), which occurs when the acid contents of the stomach flow back, or reflux, into the esophagus. Feeding disorders can be caused by food allergies, by difficulty with the movement of the mouth or tongue (oromotor), or may be a cry for attention by a neglected child or a child with a behavioral disorder.
A child with a feeding disorder may refuse to eat or drink at all; seem to have difficulty swallowing; be unable to feed him or herself at an appropriate age; take an abnormally long amount of time to eat; choke, gag, or vomit when eating; behave inappropriately at mealtime; or choose only to eat foods of a certain type, color, or texture. Because the feeding problems occur for a prolonged period of time, the child will not grow according to normal growth rates and may suffer from frequent illnesses. In severe cases, feeding disorders can result in death. A feeding disorder may include behavioral problems such as hitting, biting, kicking, and vomiting at mealtime as an attention-getting strategy.
A feeding disorder is diagnosed when an infant’s or child’s continuing failure to eat causes inadequate weight gain or significant weight loss over at least a one-month period and there is no known medical condition or withholding of food that would cause the failure to eat. The first step is to determine if the feeding problems are caused by any underlying medical condition. To do this, the doctor will check for disorders of the child’s digestive and neurological systems; for any abnormalities of the ear, nose, or throat; for problems with respiratory control; for oromotor difficulties, which relate to the movement of the mouth and tongue; and for any swallowing disorders. The most common test performed for children with swallowing difficulties is called a video swallow or videofluoroscopy. In this test, the child is given a barium solution of different consistencies to drink. X-rays show whether the barium is swallowed or aspirated (inhaled into the lungs). A speech pathologist usually assists with this test so he or she can detect any swallowing abnormalities. If these tests are normal and your doctor suspects a feeding disorder, he or she will carefully study the child’s developmental history, and perform an evaluation of the child’s feeding patterns.
Treatment for feeding disorders can involve a team including gastroenterologists, which are doctors who specialize in the treatment of disorders affecting the stomach and intestines; nutritionists, who specialize in food and nourishment; behavioral psychologists, who help the parent and child with behavioral issues related to feeding; occupational and speech therapists, who can evaluate and treat problems with food aversions, oromotor (mouth and tongue), and fine motor skills that might interfere with proper eating; and social workers to provide families with support and resources for children with these types of disorders. The first step is to treat any underlying medical condition that is causing a feeding problem. If an infant has been tube fed for a prolonged period of time, it is unrealistic to expect the child to begin to feed normally soon after the tube is removed. These children frequently miss a developmental period in which they are ready to accept changes in feeding methods, tastes, and textures. They also may not recognize feelings of hunger. In these children, it is extremely important to receive therapy from an occupational, speech, or physical therapist who specializes in infant feeding. Infants and children are also naturally afraid of new tastes and textures, called neophobia. It is important to be patient and continue to offer new foods in a non-threatening, positive manner. Offering infants and children new foods in a positive way can also help avoid picky eating later in life. Treatments for children with oromotor difficulties can include changing the position the child is in when he or she feeds. Food aversions are treated by positively offering foods with different consistencies. If your child is extremely sensitive to having things in his or her mouth, the speech pathologist will work with the child to overcome this sensitivity. This treatment may include some type of special adaptive feeding device. Force feeding or coaxing a child to eat with games or rewards are not recommended treatments for feeding disorders and can lead to eating disorders later in life.
Parents can help prevent feeding disorders with no underlying medical cause by feeding their children a wide range of foods before they reach the age of 15 to 18 months; being positive role models by eating a variety of healthy foods themselves; making sure more healthy than unhealthy foods are readily available to eat at home; making mealtime a relaxing, enjoyable occasion that is free of distractions such as television; and emphasizing good mealtime behaviors. Do not provide small children with an unending supply of juice to drink throughout the day. Children who take in large amounts of sugary liquids will be less likely to have a good appetite for a variety of foods. It is also important to recognize that a child’s growth slows between the ages of one and around four. During this time, the child may naturally eat less.
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