Does My Child have a Pediatric Feeding Disorder?

Feeding difficulties in children have existed for many years and have gone by many other names, such as failure to thrive, anorexia, dysphagia, food aversion disorder, and malnutrition, to name a few. The Journal of Pediatric Gastroenterology and Nutrition defines PFD as the “inability to consume sufficient food and liquids to meet nutritional and hydration requirements.” Parents of children with PFD define it as “stressful,” “frustrating,” and “scary.”

Mealtimes for children with PFD are upsetting for the entire family. Parents often inaccurately blame themselves for their “picky” eater or criticize the child for being “uncooperative.”  However, PFD is neither the parents’ nor the child’s fault.

Many things can cause PFD, and often the cause is unknown. PFD can result from conditions like cerebral palsy, cleft palate, brain injury, or premature birth which impact the control of muscles involved in swallowing. These are known causes of PFD; however, children with otherwise typical development can also develop PFD affecting any of the following domains: medical, nutritional, feeding skill, or psychosocial behaviors.

Medical issues associated with PFD include reflux or indigestion, food allergies, respiratory difficulties, ineffective chewing or swallowing, and weak or uncoordinated muscle movements. Sometimes eating is painful for children with PFD, causing them to avoid meals or behave in ways that help them avoid the discomfort associated with eating and/or drinking. Not eating, or expending more calories trying to eat than the child is able to consume, can result in nutritional deficits. Feeding skills (e.g., holding utensils/cups) are negatively impacted when development of both sensory and motor skills is delayed or disordered and can impair the physical tasks of biting, chewing, and swallowing liquids and solids. Lastly, negative psychosocial behaviors such as refusing to eat or try new foods and pushing away from the table create anxiety and stress around mealtimes.

Picky Eater or PFD?

A pediatrician may suspect PFD at annual check-ups if a child is not growing as anticipated or if the child is not transitioning or progressing with her/his diet as expected. However, the parents are often the first ones to identify signs of PFD due to difficulties they experience during nursing, bottle-feeding, or mealtimes. Below are common signs of PFD:

• Difficulty transitioning to baby food from the bottle or from the bottle to a cup
• Facial grimacing or turning the head away from food or liquids
• Crying during feedings or frequent temper tantrums during meals
• Coughing, gagging, retching, and/or choking during or after swallowing
• Taking longer than 30 minutes to finish a meal or snack
• Refusing foods of certain textures or colors, or only eating certain types of food with a complete unwillingness to try new foods or different brands
• Holding food in the mouth, stuffing the mouth, or spitting out partially chewed food

A resource for parents who suspect PFD is the Infant and Child Feeding Questionnaire© developed by Feeding Matters, LLC. It is available on the Family Support page in the Resources & Support section of their Feeding Matters website.* Parents who fill out this questionnaire will be alerted to “red flags” for PFD.

What if PFD is suspected?

If PFD is suspected, parents should discuss their concerns with their child’s pediatrician. Printing a resource like this article or the results of the Feeding Matters questionnaire can help guide the discussion. Early diagnosis is important–children with PFD will not grow out of it without intervention.

What Next?

If it has been determined that there is a problem, depending on the complexity, your pediatrician will give you referrals to specialists. The Centers for Disease Control and Prevention (CDC) has recognized and developed a unique billing code enabling health care providers to evaluate and treat children with PFD. A gastrointestinal (GI) specialist will further evaluate the entire GI system, ruling out negative contributing factors such as reflux, constipation, diarrhea, or malabsorption. A dietician may be consulted to calculate how many calories to consume or supplements to provide in order for your child to thrive and grow. An occupational therapist can help your child build skills to get the food to his/her mouth or work on sensory issues. A speech-language pathologist can teach your child safe ways to swallow and can suggest diet modifications and safe feeding postures. All of these professionals want to help you create a new mealtime routine that is not stressful for you and your family.

If you have a child that you suspect may have PFD, you are not alone. Feel free to contact the Speech-Language Pathology team at the Midwestern University Therapy Institute for more information, or you can also locate providers in your area at the Feeding Matters website.

The information contained in this article is not intended to be a substitute for professional medical advice, diagnosis, care, or treatment. Always consult a qualified healthcare provider with questions regarding any possible health or medical condition.

Stephanie Teale-Sanchez, M.S., CCC-SLP, Speech-Language Pathology Program.

Reference

*Silverman AH, Kristoffer BS, Linn C, et al. Psychometric Properties of the Infant and Child Feeding Questionnaire. Journal of Pediatrics. 2020 August;223:81-86.e2. DOI: 10.1016/j.jpeds.2020.04.040.

This article was originally published in the June 2022 issue of Arizona Parenting magazine.