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Feeding Disorders, Childhood

Problems associated with feeding occur in 25% to 35% of all young children, particularly when children are acquiring new skills and are challenged with new foods or mealtime expectations (Linscheid, Budd, & Rasnake, 1995). Feeding problems may occur in as many as 60% to 80% of children with developmental disabilities. Most feeding problems are temporary and are easily resolved with little or no intervention. However, feeding problems that persist can undermine children's growth, development, and relationships with their caregivers, leading to long-term health and developmental problems (Keren, Feldman, & Tyano, 2001).

Feeding problems not only often interfere with adequate growth, sometimes leading to malnutrition, but can also disrupt family interaction patterns, often through stressful mealtimes. The most common feeding problem is food refusal, sometimes associated with low appetite and early satiety. Children use many strategies to reject food, including refusing to open their mouths, turning away, spitting, throwing, crying, holding food in the mouth, and vomiting. Another common problem is selectivity, or the picky eater. Some children are selective by texture, refusing to advance to more complex textures; others are selective by type of food, refusing to eat anything beyond a limited range of preferred foods or drinks. A third feeding problem is difficulty related to oral-motor problems. Some children cannot handle specific textures or types of food and may choke, gag, cough, or have difficulty swallowing. Finally, some children display inappropriate mealtime behavior, including dawdling (not eating at a reasonable pace, playing, or attending to other things), disrupting the meal, refusing to remain seated, or high distractibility.

Classification of Feeding Disorders

Childhood feeding disorders can be divided into three major categories: (1) family, (2) parent-child, and (3) child.

Family

The family category includes conditions at the household or family level that may undermine children's feeding behavior. The family category includes lack of access to healthy food, lack of knowledge about developmentally appropriate food and feeding behavior, lack of mealtime structure (e.g., no regular eating time or place), family chaos and dysfunction, and caregiver psychopathology. When family routines and mealtimes are replaced by irregular eating patterns or frequent snacks, children do not learn healthy mealtime patterns. They may not get enough food, or they may become accustomed to snack foods and refuse to eat other foods (Birch, 1992). Feeding disorders can also emerge when care-givers lack emotional control and become angry or frustrated or when they are burdened with their own psychopathology or personality disorders.

Parent-Child

The parent-child category includes relationship and communication problems that may influence feeding. Feeding is a partnership in which caregivers are responsible for providing healthy food on a predictable schedule in a pleasant setting, and children are responsible for determining how much they will eat (Satter, 2000). When caregivers are unresponsive to their children's signals, children do not receive the guidance they need to establish a healthy feeding relationship. A disruption in the communication between children and caregivers may indicate that the attachment bond is not secure, and feeding may become an occasion for unproductive, upsetting battles over food.

Infants who do not provide clear signals to their care-givers or who do not respond to their caregivers' efforts to help them establish predictable routines of eating, sleeping, and playing are at risk for a range of problems. Infants who are premature or ill may be less responsive than healthy, full-term infants and less able to communicate their feelings of hunger or satiety. Caregivers who do not recognize their infants' satiety cues may overfeed them, thereby causing infants to associate feelings of satiety with frustration and conflict.

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