Feeding Disorders in Children

Feeding Disorders

• Feeding disorders occur in over 60% of children, indicating a significant public health concern that necessitates awareness and intervention strategies.
• Causes can be neurological (62%), structural (53%), behavioral (43%), cardiorespiratory (34%), and metabolic (12%), highlighting the multifaceted origins of these disorders.
• Most children with feeding disorders have causes in two or more categories, which complicates the diagnosis and treatment processes and emphasizes the need for comprehensive evaluations.
• Feeding disorders are prevalent among children with autism spectrum disorder, cerebral palsy, and Down syndrome, emphasizing the need for tailored interventions for these vulnerable groups.

Causes of Feeding Disorders

• Children with chronic medical problems directly affecting the digestive system may develop feeding disorders, which can be exacerbated by these conditions.
• Examples of these medical problems include gastroesophageal reflux disease, where stomach acid frequently backs up into the esophagus, delayed gastric emptying that hampers efficient digestion, food allergies or food intolerances that can provoke painful or uncomfortable reactions, malabsorption syndromes that prevent the body from adequately absorbing nutrients, and metabolic disorders that impact how the body processes food.
• Children with gastroesophageal reflux disease may associate eating with pain caused by acid reflux, leading to anxiety around meals and a reluctance to eat.
• Nausea plays an important role in developing food aversions, significantly affecting a child's willingness to try new or previously enjoyed foods.
• A single or few experiences of nausea paired with eating can lead to taste aversions, which are strong and can result in lifelong negative associations with certain flavors and foods.
• Taste aversions generalize to different foods and are difficult to treat, making early intervention and treatment strategies crucial for preventing long-term feeding issues.

Maintaining Factors in Feeding Disorders

• Inappropriate feeding behavior can be maintained by access to adult attention or tangible items as positive reinforcement, often leading to a cycle where negative behaviors are inadvertently encouraged.
• Escape from food presentation and mealtime demands can also function as reinforcement, where a child may learn that refusing to eat or engaging in disruptive behavior results in the cessation of pressure to eat.
• Environmental events may reinforce inappropriate mealtime behavior, even if the underlying cause of the feeding disorder is complex; this suggests that mealtime settings and parental expectations should be evaluated as part of a treatment program.

Treatment of Feeding Disorders

• Even if the underlying cause of a feeding disorder is unknown, treatment is possible by changing responses to the child's inappropriate mealtime behavior, thus promoting a healthier eating environment.
• Stimulus fading can be used to increase acceptance and decrease inappropriate mealtime behavior, gradually introducing changes that help children adapt to more appropriate eating habits.
• Examples of stimulus fading include changing the texture of food from liquid to baby food, spoon to cup, syringe to spoon, and syringe to cup, which helps children adjust to new methods and textures of eating.
• Antecedent interventions such as utensil manipulation can be used to increase mouth cleanliness and decrease packing, which refers to the tendency of a child to hold food in their mouth rather than swallowing it properly.
• Examples of utensil manipulation include presenting food on an upright spoon, a flipped spoon, or a Nuk device, which encourages proper mouth movement and improves feeding efficacy.

Chewing

• Chewing emerges in typically developing children around 12 months of age as caregivers introduce foods with increasing texture; this developmental milestone is vital for transitioning to solid foods.
• Children with feeding disorders often do not begin chewing at 12 months of age, which may lead to difficulties in establishing healthy eating patterns and habits.
• Caregivers often base the texture of food on the child's age rather than their chewing skills, leading to potential mismatches that can hinder the child's feeding development.
• A mismatch between food texture and chewing skills increases the risk of aspiration, a serious concern that can lead to respiratory issues or choking if not addressed properly.
• Children with poor chewing skills may develop inappropriate compensatory behavior, such as using their tongue to push food against the roof of their mouth, which can create further feeding complications and impede the natural progression of chewing abilities.

This quiz explores the prevalence, causes, and implications of feeding disorders in children. It highlights key factors such as neurological, structural, and behavioral causes, as well as associations with conditions like autism and cerebral palsy. Test your understanding of how these disorders affect children's eating habits and overall health.