“A feeding problem can be defined as a deficit in any aspect of taking nutritional elements that result in undernutrition, poor growth, or stressful mealtimes for children and their caregivers” (Arvdson & Brodsky, 2002, pg. 570).
Feeding problems in young children appear to be common, although estimates of frequency have varied considerably in the literature. The lack of reliable, consistent diagnostic criteria continues to impede research-based progress in this area (Benoit D. Services and programs proven to be effective in managing young children’s (birth to age 5) eating behaviours and impact on their social and emotional development: Comments on Piazza and Carroll-Hernandez, Ramsay, and Black. In: Tremblay RE, Barr RG, Peters RdeV (eds.) Encyclopedia on Early Childhood Development, 2004;1-4).
Estimates range from 12% to 35% of children as having reportable feeding problems (Kessler, J.W. 1966), (Manikam R & Perman JA. Journal of Clinical Gastroenterology, 2000; 30(1): 34-46), (Palmer, S, & Horn, S. 1978, 107-129) with 1 to 2% of infants and young children having more severe, prolonged difficulty (Dahl, M. Acta Paediatrica Scandinavia, 1987; 76: 872-880). Data from Nova Scotia is in line with these estimates. In a normative sample designed to screen out children with major medical or developmental issues, 21% of parents reported four or more feeding behaviours as problematic for them (Crist, W, Napier-Phillips, A. Journal of Developmental and Behavioral pediatrics, 2001: 22(5): 279-286).
Children with neurological and developmental disabilities are especially prone to having feeding difficulties, with an estimated prevalence of 33% or more within that population (Schwarz SM. Infants and Young Children. 2003; 16:317-330).
Questions about eating are among the most common concerns that parents raise with their pediatrician (Stickler, GB, Simmons, PS. Clinical Pediatrics, 1995;384-387). Thirty-seven percent of parents are worried about whether their child is eating right and 24% worry that their child does not eat enough.
Determining if a feeding problem exists is easier with physical evidence such as poor growth. Deciding that there is a feeding problem based on stressful mealtimes for children and their caregivers is a judgement call. Here are some things that you might consider in making this judgement. “Because of the wide variety of problems that can arise between parent and child over food, the following only provides common “red flags” and is not an exhaustive list.”
Long mealtimes. Most family mealtimes last between 15-30 minutes. Mealtimes longer than 30 minutes often indicate feeding difficulties (Crist, W, Napier-Phillips, A. Journal of Developmental and Behavioral pediatrics. 2001; 22(5): 279-286), (Reau NR, Senturia YD, Lebailly SA, Christoffel KK. J Dev Behav Pediat 1996; 17:149-153).
Parents who report that they dread mealtimes. Mealtimes are important social times for families. When parents report that they dread mealtimes, significant difficulties usually exist.
Parents who are very worried that their child is not eating enough, despite evidence of good growth. Pay attention to any discrepancy between how worried a parent is about whether or not a child is getting enough to eat and the child’s actual growth pattern, particularly when such growth is quite good. In such a case, the parent’s worry often reflects significant battles over food.
Parents who report unusual strategies in trying to get their child to eat. Parents should not have to try to get their child to eat. Unusual strategies, such as leaving small bowls of food around the house or chasing their child around the house with a spoon, are good indicators of underlying feeding problems.
Children who appear to be narrowing their diet over an extended period of time. It is common for toddlers to have food jags — times when they have a few favourite foods. However, these food jags are typically short (i.e. a couple of weeks). If a child’s narrow diet lasts longer than six months, it is probably worthwhile to ask more questions about the situation.
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