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This is a condensed version of the Feeding Family Matters Guide. If after reading you want more information, follow the link at the end of the article to view the full PDF.
What is a Pediatric Feeding Disorder?
As defined by the Journal of Pediatric Gastroenterology and Nutrition, a Pediatric Feeding Disorder, or PFD, is impaired oral intake that is not age appropriate, lasts at least 2 weeks, and is associated with medical, nutritional, feeding skills, and/or social-emotional challenges. When a child does not have the same intake of food like other children their age, problems like the ones mentioned above are subject to occur. PFD affects the entire family, and can make daily life difficult at home and on the go. If you are concerned as to whether or not you think your child might have a feeding disorder, follow this link to fill out a feeding questionnaire for your child’s habits. This can help parents determine what issues the child might have and allow a pediatrician to have a better understanding of the problem.
Four Domains of PFD
When it comes to a Pediatric Feeding Disorder, there is usually an underlying cause or causes to the issue at hand. We can categorize these causes or reasons into four groups: medical, nutrition, feeding skill, or psychosocial.
Medical
Eating requires muscles working within the face to all be working together in order to complete the process properly, and starts right when the child begins feeding in infancy. A medical issue can cause problems with swallowing and breathing while eating. When a child is having issues feeding, some things to look for can be choking, coughing while eating, little weight gain, and fatigue during or after eating. Someone who can help diagnose these issues would typically be your primary care provider, but they can also refer you to a specialist to provide more in-depth information for your child’s needs. Different doctors and specialists have a myriad of tests that can help diagnose the issue at hand, and while this might seem scary, know that they have your child’s best interests at heart and want to help make an appropriate plan of action for the care of your child so that the issue does not become more severe. If you are concerned about your child’s feeding habits, it might be best to schedule an appointment with their doctor sooner rather than wait for the next wellness visit.
Nutrition
Having a nutrient-rich diet is extremely important for the growth and development of any child. The common signs of an under-nourished child are having a lack of energy, little weight gain, and/or dehydration. A registered dietitian nutritionist, or RDN, is among the most qualified person to talk to about your child’s needs when it comes to their dietary needs for proper development. They can help you put a plan together to ensure that the child is not only getting the correct quantity, but working with medical staff to help determine the best diet overall for their age and condition. Sometimes a feeding tube is necessary and helpful in getting your child the nutrition they need, so it is important to talk with your child’s team about your concerns.
Typically your primary care provider will track your child’s growth at their wellness visits, and if you have concerns for how much or what type of food your child is eating it is important to contact them for their advice on the next steps you can take. Your RDN can help with dietary restrictions within the family and other things that will ease the process.
Feeding Skill
Learning how to eat at any age is an important skill that will be with your child for the rest of their lives, and will determine how it evolves over time. Learning how to do this comfortably not only helps with integrating the senses into mealtime, but helps with motor coordination within their mouths. Feeding with families trying to work with PFD can be a challenge, as multiple scenarios may interfere with feeding properly. Feeding therapy can help with this and increase confidence in your child. Some signs to look for can include difficulty chewing, becoming drowsy during feeding, picky eating, and continued reliance on a feeding tube (if one is already in place).
Different specialists can help with these issues, especially occupational therapists and speech language pathologists. Certain specialists can help your child with coordination and motor function, body positioning and posture while eating, helping to increase tolerance to sensitivity during feeding, and improve communication and swallowing skills. How often you attend therapy and how long it lasts can depend on multiple factors like medical needs and challenges within the family and feeding. There are a myriad of ways to attend therapy, so there is some way that works for everyone.
Psychosocial
When a child begins to exhibit behaviors that are challenging during feeding time, it is a sign that this process may be uncomfortable for them. An increase in confidence can help them in the long run, which will lead to better successes down the line. Things to look for include the child outright refusing to eat/drink, difficulty eating, tantrums or difficult behavior during mealtime, and caregivers feeling overwhelmed.
Someone who can help with these kinds of problems are psychologists, social workers, and board-certified behavior analysts (or BCBAs). They have the ability to diagnose and treat these concerns. Other specialists such as the RDNs, SLPs, and OTs mentioned earlier can also come in and provide support for your child and your family in other areas if the issue is not confined to one domain. In order to make the best possible decision for your child and the family at large, a specialist may request to evaluate these behaviors at mealtime, and ask several questions about your family dynamics, beliefs, stress levels, etc. This way, they can make the best approximation of a plan to benefit not just your child, but everyone affected within the family to ensure everyone can get back on track to a happier, healthier process. Being open and honest about the situation can make a workable plan come to fruition.
When it comes down to the four domains, one area alone may not be the best fit for figuring out your child’s needs. One factor from one side may affect another on the other. This is why it is important to have a team of specialists to look at all sides of the problem at hand.
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