Feeding Disorders in Infants & Young Children

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

Diagnosis

• 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

Treatment

• 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