Feeding Disorders
What is it?
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.
Who gets it?
Approximately 25% of all children experience
feeding disorders. However, they are most
common in children with developmental
disabilities.
What causes it?
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.
What are the symptoms?
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.
How is it diagnosed?
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.
What is the treatment?
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.
Self-care tips
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.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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