Managing Feeding Problems and Feeding Disorders

James A. Phalen

doi:10.1542/pir.34-12-549

This article has a correction. Please see:

Correction - November 01, 2014

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James A. Phalen, MD*

^*Developmental Pediatrics, San Antonio Military Pediatric Center, San Antonio, TX; Department of Pediatrics, University of Texas Health Science Center at San Antonio; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD.

Author Disclosure
Dr Phalen has disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

BMI:: body mass index
CDC:: Centers for Disease Control and Prevention
GERD:: gastroesophageal reflux disease
g-tube:: gastrostomy tube
W/L:: weight-length ratio

Educational Gap

Up to 50% of typically developing children and up to 80% of those who have developmental disabilities have feeding problems. These may evolve into a feeding disorder, with potential effects on psychomotor and neurologic development. (1) (2)

Objectives

After completing this article, readers should be able to:

Understand normal feeding patterns in children.
Recognize that feeding problems are common.
Prevent or ameliorate feeding problems.
Distinguish between feeding problems and feeding disorders.
Treat a child who has a feeding disorder.

Introduction

Feeding plays a central role in the parent-infant relationship. The developmental progression of food selectivity is primarily determined by a child’s ability to manipulate, chew, and swallow food (Table 1). Functional, safe feeding requires coordination of sensorimotor function, swallowing, and breathing. Children self-regulate and may vary their oral intake up to 30% per day with no ill effect on growth. Caregivers are responsible for what, when, and where their children eat; the child is responsible for how much and whether they eat. Normal feeding depends on the successful interaction of a child’s health, development, temperament, experience, and environment. Altering any of these factors can result in a feeding problem. (1)

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Table 1.

Developmental Progression of Food Selectivity Based on Motor Skills

Common Feeding Problems

Symptoms of feeding problems include food refusal, regurgitation, gagging, or swallowing resistance (Table 2). (1) (3) Although the child maintains adequate growth, the behavior causes distress for caretakers. Factors that increase a child’s risk for feeding problems, particularly during transition to more advanced textures, are listed in Table 3.

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