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A feeding disorder is a condition where an infant of child has difficulty with eating. The child is either unable to eat or rejects
food. Children with a feeding disorder normally experience a lack of growth; they are also low weight for their age. Infants
with the disorder do not cry when hungry or do not cry while being fed. A child with a feeding disorder is very fussy during
meals, and may consume foods or textures that are inappropriate.

Feeding disorders include problems gathering food and preparing to suck, chew, or swallow it. For example, a child who
cannot pick up food and get it to his/her mouth or cannot completely close their lips to keep food from falling out of the mouth
may have a feeding disorder. Some common forms of feeding disorders in children include adipsia, which is the absence of
thirst or the desire to drink; dysphagia, a real or imagined problem with swallowing; food refusal; inability to self-feed; taking
too long to eat; choking, gagging, or vomiting when eating; improper behavior during meals; and picky eating depending to food
type and texture. In some cases, a child may have behavior problems during meals (e.g., tantrums) that cause the meal to be
very stressful for the family.

Approximately 25 percent of all children experience feeding disorders. However, this disorder is more common in children with
developmental disabilities. There are many different types of feeding difficulties, and no two children have the exact same
problem. For example, some children do not eat anything at all. These children may be fed through tubes. Some children eat
very little and do not gain weight or grow. Other children do not have a healthy or balanced diet because they only eat a few or
certain types of foods.

Causes of Feeding Disorders

Feeding disorders typically develop for several reasons, including medical conditions (food allergies), anatomical or structural
abnormalities (defects of the palate), and behavioral mismanagement (e.g., early or delayed introduction of solid foods,
excessive parental anxiety during meals or results of inappropriate punishment for food rejection). In most cases, no single
cause explains a child’s feeding difficulties. Rather, several reasons interact to originate them.

It’s not exactly known why children have feeding problems. Studies suggest that some children have feeding difficulties
because they have medical problems (e.g., reflux disease) that cause eating to be painful. Some children who are premature or
who are very sick as infants may not be able to eat own their as infants and may miss the opportunity to learn how to eat or to
learn that eating is satisfying. Some children may have oral motor problems, and they do not seem to know how to eat; or they
may have oral sensitivities, and they appear fearful of food or things coming near their face or mouth. Other children may just
not get hungry and would rather not be disturbed with eating. In any case, children who do not eat enough or who do not eat
the right types of food may be at risk for learning and behavior problems in the future.

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 undeveloped 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. 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.

Feeding Disorder Symptoms

A child with a feeding disorder may decline to eat or drink anything; seem to have difficulty swallowing; be unable to feed him
or herself at an appropriate age; take an unusually long period of time to eat; choke, gag, or vomit when eating; behave
improperly at mealtime; or choose only to eat foods of a certain type, color, or texture.

Since the feeding problems occur for an extended time, the child will not grow at average rate and may suffer from frequent
illnesses. A feeding disorder may include behavioral problems such as hitting, biting, kicking, and vomiting at mealtime as an
attention-getting tactic. Parents should contact a specialist if the child has any of the following symptoms:

•        Failure to thrive

•        Weight loss

•        Failure to gain an appropriate amount of weight

•        Failure to eat a variety of foods to maintain a healthy diet

•        Inappropriate mealtime behavior that causes stress to the child or family

Feeding Disorder Diagnosis

A pediatric feeding disorder is diagnosed when a child fails to consume a sufficient quantity or quality of solids or liquids to
continue growing. The first step is to determine if the feeding problems are caused by any underlying medical condition. When
an infant’s or child’s refusal 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 a feeding disorder is usually
diagnosed.

For a diagnosis 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. Feeding disorders are fairly common in infants and toddlers, with
approximately 25 percent to 40 percent of these children experiencing some difficulties with feeding. Awareness of risk factors
of feeding disorders, combined with appropriate referrals at an early age, will produce the best outcomes for children and their
families.

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 teaching good mealtime behaviors.

Feeding Disorder 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 an
extensive period of time, it is unlikely to anticipate that the child will begin to feed naturally 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 specializing in infant feeding.

Infants and children are also usually are scared 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 eats. Food
intolerances 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 luring a child to eat with games or rewards are not
suggested treatments for feeding disorders and can lead to eating disorders later in life. By gradually overcoming dislikes to food
and learning proper eating habits, a child can grow up strong and healthy.