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Key Features

  • Inadequate or disordered intake of food due to any of the following conditions:

    • Poor oral-motor coordination

    • Fatigue resulting from a chronic disease

    • Lack of appetite

    • Behavioral issues relating to parent–child interaction

    • Pain associated with feeding

Clinical Findings

  • Depression in children may be expressed through food refusal

  • Food refusal may develop when the infant's cues around feeding are not interpreted correctly by the parent

  • The infant who needs to burp more frequently or who needs time between bites but instead is rushed often passively refuses to eat

  • Some will be more active refusers, turning their heads away to avoid the feeder, spitting out food, or pushing away food


  • Obtain a complete history, including a social history

  • Second, a complete physical examination should be performed, with emphasis on oral-motor behavior and other clues suggesting neurologic, anatomic, or physiologic abnormalities that could make feeding difficult

  • The child's emotional state and developmental level must be determined

  • When chief complaint is failure to lose weight, laboratory studies may include

    • Complete blood cell count

    • Erythrocyte sedimentation rate

    • Urinalysis and urine culture

    • Blood urea nitrogen

    • Serum electrolytes and creatinine

    • Stool examination for fat, occult blood, and ova and parasites

    • Some practitioners also include liver and thyroid profiles

  • Occasionally an assessment of swallowing function or evaluation for the presence of gastroesophageal reflux may be indicated


  • Goal of intervention is to identify factors contributing to the disturbance and to work to overcome them

  • Guidelines for treating the child with poor weight gain include the following:

    • Establish a comprehensive diagnosis that considers all factors contributing to poor weight gain

    • Monitor the feeding interaction and ensure appropriate weight gain

    • Monitor the developmental progress of the child and the changes in the family dynamics that facilitate optimal weight gain and psychosocial development

    • Provide support to the family as they seek to help the child

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