Fact Sheet: Pediatric Feeding Problems

Pediatric feeding disorders are indicated if a child’s eating behavior results in insufficient growth or leads to significant nutritional deficit. Feeding problems can manifest as food refusal, food overselectivity or other disruptive behaviors incompatible with eating. Etiological contributors include medical, anatomical, developmental, social and environmental factors, and a biopsychosocial model best accounts for their overlapping nature.

Prevalence and Course

Feeding problems are seen in approximately 25 percent to 45 percent of the general population, in as high as 80 percent of children with developmental disabilities, and in 40 percent to 70 percent of children with chronic medical conditions. Feeding problems are seen most commonly in children 15-36 months of age and can persist into school-age and adolescence if unaddressed. Often, despite optimal medical management or skill remediation, learned mealtime behavior problems remain, necessitating ongoing intervention.

Health and Psychosocial Consequences

Maladaptive mealtime behavior can result in poor nutrition, subsequently impacting weight gain and linear growth. Poor nutritional status can adversely impact cognitive development and emotional regulation. Additionally, significant caregiver stress is common with childhood feeding problems.

Evidence-based Assessment

Important domains for assessment include the child’s medical and nutritional status, anatomical/physical functioning, developmental level, mealtime behavior, mealtime routine and environment, and family functioning. Optimally, assessment is interdisciplinary in nature and includes medical record review, clinical interview, diet record, standardized questionnaires and mealtime observation. A review of empirically supported assessment tools for use with the population of children with pediatric feeding problems is available by request through the GI Special Interest Group of the Society of Pediatric Psychology.

Culture, Diversity, Demographic and Developmental Factors

The impact of race and ethnicity on prevalence and course of pediatric feeding problems has not been well-studied. Many intervention studies do not report race and ethnicity; however, a study examining the efficacy of a behavioral intervention included a sample comprised predominantly of Caucasian children (68 percent), with 15 percent of the sample identifying as Hispanic, 7 percent as African American, and 10 percent as other.

Evidence-based Interventions

Behaviorally-based intervention has been determined to be an empirically validated treatment approach to managing pediatric feeding problems. Antecedent and contingency management, appetite manipulation, differential attention, escape prevention, and systematic desensitization are included as treatment components. Behavioral intervention can take place in an outpatient, day treatment or inpatient hospital environment.

References

Davis, A.M., Bruce, A., Cocjin, J., Mousa, H., & Hyman, P.  (2010). Empirically supported treatments for feeding difficulties in young children. Current Gastroenterology Reports, 12, 189-194.

Kerwin, M.E. (1999). Empirically supported treatments in pediatric psychology: Severe feeding problems. Journal of Pediatric Psychology, 24(3), 193-214.

Linscheid, T. R. (2006). Behavioral treatments for pediatric feeding disorders. Behavior Modification, 30(1), 6-23.

Miller, C. K., Burklow, K. A., Santoro, K., Kirby, E., Mason, D., & Rudolph, C. D. (2001). An interdisciplinary team approach to the management of pediatric feeding and swallowing disorders. Children’s Health Care, 30(3), 201-218.

Silverman, A. H. & Tarbell, S. (2009). Feeding and vomiting problems in pediatric populations. In M.C. Roberts & R.G. Steele (Eds.), Handbook of pediatric psychology, (4th ed., pp. 429-445). New York: Guilford Press.