What are Feeding Disorders?

Imagine a child sitting at the dinner table, their tiny hands picking at the food on their plate. They grimace and wrinkle their nose at the sight and smell of certain foods. It is as if their taste buds are sending signals of alarm, rejecting the textures and flavors of certain foods that others find enjoyable. 

Another child struggles to chew and swallow their food. Every bite feels like an obstacle course in their mouth. They might have physical issues that make eating a challenge, causing them to take longer to finish a meal or even avoid certain foods altogether. 

In some cases, a child might develop a strong attachment to specific foods, unwilling to explore new flavors and textures. Their taste preferences become rigid and narrow, closing doors to a world of culinary experiences.  

Then there is the child who carries the weight of fear and anxiety when it comes to eating. A previous incident of choking has left them traumatized, creating a constant sense of unease around mealtimes. The thought of swallowing becomes a battle between hunger and the haunting memory. 

Any one of these behaviors could be a sign of a feeding disorder. When a child’s eating behaviors and food intake do not align with what is expected for their age, it serves as a signpost indicating the presence of a feeding disorder. Feeding disorders are not standalone problems but often coexist with other medical or developmental conditions. They can intertwine with gastrointestinal disorders, sensory processing disorders, and even autism spectrum disorder. As a result, this can lead to health issues, stunting their growth or making them more susceptible to illnesses. Recognizing these disorders becomes crucial, as children may need the expertise and guidance of doctors and therapists. With understanding and intervention, we can work towards ensuring every child has the opportunity to nourish their bodies and grow to their full potential. 

Types of Feeding Disorders

Limited intake – The child may eat extraordinarily little food and have poor weight gain or weight loss as a result. 

Restricted variety – The child might consume only a limited variety of foods and refuse to try new types of food. This is sometimes called food neophobia or selective eating. 

Dysfunctional feeding  – The child might have problems with the mechanics of eating, such as swallowing, chewing, or even holding utensils. 

Disruptive mealtime behaviors – The child might cry, scream, or throw tantrums during meals, or might take an exceptionally long time to eat. 

Sensory-Based Feeding Disorders – Some children might have problems eating due to the textures, tastes, or smells of certain foods. This can be related to Sensory Processing Disorder, where a child’s brain has trouble receiving and interpreting sensory information. 

Avoidant/Restrictive Food Intake Disorder (ARFID) – Previously known as Selective Eating Disorder (SED), this condition is characterized by a lack of interest in food, an avoidance based on the sensory characteristics of food, and fear of the consequences of eating (like choking or vomiting). It goes beyond typical “picky eating.”

Feeding Disorder of Infancy or Early Childhood – Now considered a subtype of ARFID, this was a diagnosis for children under the age of six who failed to eat adequately, leading to insufficient weight gain or weight loss. The condition was not due to a lack of available food or to an associated medical or mental condition. 

Dysphagia – This is a medical condition where children have difficulty swallowing. This could be due to anatomical abnormalities, neurological conditions, or other medical complications. 

Feeding Disorders Associated with Medical Conditions – Certain medical conditions, like gastrointestinal problems, food allergies, premature birth, or cleft lip and palate, can make eating difficult for children. 

Causes

Here is a straightforward way to understand some of the main causes: 

Medical conditions  – Sometimes, a child might have a medical condition like acid reflux, allergies, or a condition that affects their digestive system, which makes eating uncomfortable or painful. This can lead them to avoid eating all together. 

Sensory issues – Some children have sensory processing difficulties, which means they can be particularly sensitive to the texture, smell, or taste of certain foods. This might lead them to refuse these foods. 

Oral motor problems  – If a child has problems with the muscles in their mouth or throat, it could make chewing or swallowing food difficult. This could be due to a condition like cerebral palsy, or it could be something that they need to work on with a speech or occupational therapist. 

Behavioral or psychological issues – Sometimes, feeding disorders can stem from behavioral or psychological issues. For instance, a child might refuse to eat certain foods as a way of asserting control, or they might develop a fear around eating because of a past choking incident. 

Environmental factors – Certain environmental factors can contribute to feeding disorders too. For instance, if a child is frequently rushed during meals, or if meals are often stressful or unpleasant, they may develop negative associations with eating. 

Treatment

Treatment typically involves a multidisciplinary team that can include a pediatrician, a dietitian, a speech and language therapist, an occupational therapist, and a psychologist. These professionals work together to address the child’s physical health, their relationship with food, the dynamics around mealtimes, and their overall development.

Oral-Motor Feeding Therapy – Some children may have difficulty chewing or swallowing due to issues with muscle strength or coordination in the mouth and throat. A speech or occupational therapist often guides this therapy by helping children improve their chewing and swallowing skills and increase their acceptance of diverse types of food and textures. 

Behavioral Interventions – Techniques such as positive reinforcement, gradually introducing new foods, and reducing distractions during mealtimes. 

Nutrition Counseling – A registered dietitian can provide guidance on meeting nutritional needs, even if the variety of foods a child is willing to eat is limited. 

Family Education and Support – Therapists often work with the family to create strategies for managing the feeding disorder at home, including ways to make mealtimes less stressful and more enjoyable. 

Medical Intervention – If the feeding disorder is related to a medical condition, like GERD or a food allergy, treating that underlying condition can often improve the feeding disorder. 

Each feeding disorder can be different, so treatment should be individualized, often involving a team approach including physicians, dietitians, psychologists, and speech or occupational therapists. It is important to identify and address feeding disorders early to ensure the child receives proper nutrition for growth and development.