Feeding problems are some of the most common issues that families share with their pediatrician or other healthcare providers. They are so common that they have their own awareness month: Pediatric Feeding Disorder (PFD) Awareness Month is observed in May. Here is how to tell the difference between developmentally common picky eating and more serious feeding disorders.
What is a Pediatric Feeding Disorder?
A child with a feeding disorder may not:
Eat or drink enough volume or variety of foods to maintain growth or meet their nutrition needs, and/or
Behave during meals like most children their age.
Feeding disorders are more likely in children who have other developmental, medical and behavioral concerns, such as autism spectrum disorder or cerebral palsy.
Feeding disorders often make it hard to participate in mealtimes and social activities involving food, which increases family stress.
Your child may have a pediatric feeding disorder if they have one or more of the following:
Trouble with keeping food in the mouth, chewing, and/or swallowing. This includes choking, gagging, coughing, holding food in their cheek pockets, spitting food out, mashing or sucking on food, or struggling with certain textures
Difficulty gaining weight
Needs supplements in order to grow
Gets enteral feeds (e.g., NG tube, G-tube)
Limits their diet by refusing to try new foods or certain types of foods and/or is picky about flavors, brands, texture, appearance of food, or utensils/containers
Throws tantrums at mealtime. Appears more stressed or upset at meals than non-mealtimes
Won’t drink or eat from age-appropriate containers, such as a preschool-age child drinking from baby bottle
Has a sudden, large decrease in eating/drinking after an event such as a choking incident, surgery, or illness
Eats fewer than five foods as a toddler, fewer than 15 foods by preschool age
Drops foods they used to eat without returning to them or replacing them with new foods
Has a long history of extreme picky eating that persists into school age
Social impairments such as mealtime conflicts, or limiting social experiences (avoiding restaurants, family or community gatherings, activities with peers, summer camp)
What is Picky Eating?
Picky eating is developmentally common from about 18 months through 5 years old. Your child may be a picky eater if they:
Will eat more than 15 different foods on a consistent basis, even if they complain about it
Eat from a variety of food groups, even if only 1-2 foods in some food groups
Suddenly stop eating a food they used to like, but goes back to it in the future
Eat small amounts at some meals, but tend to eat more at other meals to make up for it with appropriate weight gain/growth
Are able to accept having preferred and less preferred foods on their plate even if they don’t eat all of the foods
Have difficulty trying new foods, but will sometimes add new foods to their diet
Eat with the family, even if picky about what’s offered. Sometimes eats something different than the rest of the family but can eat some foods with the family
Who Can Help Me Understand How to Support My Child’s Feeding?
Pediatric feeding disorder is best diagnosed by a team of professionals including medical providers, occupational therapists, speech therapists, clinical dietitians, and pediatric psychologists. These people should all have special training in feeding disorders in children. Your pediatrician can make a referral to a feeding clinic specializing in feeding disorders.
Children who are picky eaters do not always need the support of a medical provider or dietitian, but families may want to discuss the benefits of a medical or nutritional evaluation with their pediatrician. Some picky eaters may benefit from therapy with feeding therapists and/or psychologists if the problems are causing significant stress. Not all picky eaters need therapy. It’s best to start by talking to your pediatrician about your concerns.
Sean Tams, PhD, is a pediatric psychologist in the Department of Pediatric Psychology and Neuropsychology and the Comprehensive Pediatric Feeding and Swallowing Program. He is also a Clinical Assistant Professor of Pediatrics at The Ohio State University College of Medicine. He provides psychological interventions to children and families presenting with feeding difficulties and other comorbid psychological and medical concerns.
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