Childhood Disorders: Feeding and Other Disorders of Infancy or Early Childhood

Childhood Disorders: Feeding and Other Disorders of Infancy or Early Childhood

In the literature, the term “feeding disorder” generally encompasses a variety of conditions ranging from problem behaviors during feed-ing – poor appetite, food refusal, food selectivity, food avoidance, and pica to rumination and vomiting – and is generally used to em-phasize the dyadic nature of eating problems in infants and young children. Feeding disorder cannot be attributed to a medical condi-tion and appears most often during the first year of life and before the age of six. Its hallmarks are the failure to eat with resultant inability to gain weight or a significant weight loss for at least one month.

Some authors have used various diagnostic methods and assigned different labels to address the heterogeneity of feeding problems associated with failure to thrive. The pediatric litera-ture has focused primarily on failure to thrive as a diagnostic label. The term “failure to thrive” describes infants and young children who demonstrate failure in physical growth, often as-sociated with delay of social and motor development.

Because of the diversity of feeding disorders associated with failure to thrive and the lack of a subclassification of feeding disorder as defined in DSM-IV-TR, Chatoor proposed a classifica-tion of feeding disorders based on the definition of psychiatric dis-orders. A psychiatric disorder has three properties: it is a limited syndrome with possible links to etiological and pathophysiological factors; the use of treatment depends on proper diagnosis; and the diagnosis is linked to prognosis. Considering these criteria, five different feeding disorders will be described. The first three feed-ing disorders are associated with various developmental stages. In addition, two feeding disorders are described that are not linked to specific developmental stages: 1) sensory food aversions, a com-mon feeding disorder which becomes evident during the introduc-tion of different milks, baby food, or table food with various tastes and consistencies, and 2) post traumatic feeding disorder, which is characterized by an acute disruption in the regulation of eating and can occur at various ages and stages of feeding development.

Epidemiology

It is estimated that up to 25% of otherwise normally developing infants and up to 80% of those with developmental handicaps have feeding problems including food refusal, eating “too little” or “too much”, restricted food preferences, delay in self-feeding, objectionable mealtime behaviors and bizarre food habits. It has also been reported that 1 to 2% of infants under 1 year of age demonstrate severe food refusal and poor growth.

Course and Natural History

Those infants who at 3 to 12 months of age are identified for re-fusal to eat for at least 4 weeks with no apparent medical cause have significantly more problems in eating patterns, behavior and growth, and are more susceptible to infection at 2 and 4 years of age. A study by Marchi and Cohen (1990), who observed a sample of more than 800 children for a 10-year period from early child-hood to late childhood–adolescence, found that feeding problems in young children were stable over time. They reported that gas-trointestinal symptoms and picky eating during early childhood correlated with anorectic behavior during adolescence, while problem behaviors during mealtime and pica early in life were associated with bulimia nervosa during the adolescent years.

Etiology

Hampering our understanding of the etiology, symptoms and treatment of specific feeding disorders are the lack of a standard classification, overlap between feeding disorders and failure to thrive, and the tendency of investigators to address different as-pects of the disorders while using differing criteria and method-ologies. To clarify the specificity in etiology and its implication for treatment, each feeding disorder as defined by Chatoor and colleagues (1985) is discussed separately.

Diagnosis

The diagnostic assessment of feeding disorders should include assessment of the infant’s temperament characteristics; the in-fant’s medical, developmental and feeding history; the caretak-er’s psychological functioning and past history, socioeconomic background, stressors and social support system; and the rela-tionship of the infant and his or her primary caretakers during feeding and play.

Treatment

Treatment begins with the first contact with the infant and his or her caregivers. The establishment of a therapeutic alliance with the caregivers is critical to any successful treatment. The diag-nostic evaluation needs to identify the specific dynamics of each feeding disorder in order to develop a specific treatment plan. This is discussed in more detail for each feeding disorder.