Q&A: Feeding Disorders

What are the typical signs and characteristics of feeding disorders in children?

Feeding disorders are classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR) officially as Feeding Disorder of Infancy or Early Childhood.  Official diagnosis requires:

  1. Feeding disturbance as manifested by persistent failure to eat adequately with significant failure to gain weight or significant loss of weight over at least one month.
  2. The disturbance is not due to an associated gastrointestinal or other general medical condition (e.g., esophageal reflux).
  3. The disturbance is not better accounted for by another mental disorder (e.g., rumination disorder) or by lack of available food.
  4. The onset is before the age of 6 years.

In everyday life, feeding disorders present themselves in numerous ways.  Children may be selective in the types of food that they eat by texture (smooth versus crunchy), type (carbohydrate versus fruits), presentation (food must be on certain plate or eaten in certain location), or brand.  Some children may refuse to eat or drink almost entirely.  Often these issues are compounded by inappropriate mealtime behavior such as crying, throwing things, aggression, gagging, and even vomiting.  Children may also show skill deficits in oral motor behaviors (i.e., chewing) or fine motor behaviors (i.e., self-feeding).

What can these disorders possibly indicate in terms of the child’s mental health? When should the disorder raise an alarm bell that it may be symptomatic of a more serious condition?

The occurrence of feeding disorders does not necessarily indicate any other deficit for an individual.  Feeding disorders can be seen in both typically and atypically developing children, although the prevalence is higher in children with developmental disabilities, including autism.

What are some creative ways (versus medical solutions) of dealing with feeding problems?

Many families try involving their child in the cooking of the meal or having them playing with food outside of mealtime in order to encourage their interest in food.  Although there is absolutely nothing wrong with these activities, they have not yet been shown to be successful in getting a child with a feeding disorder to change his behavior significantly.  Intervention that is tailored specifically to the child is the most successful way of changing eating patterns.

When should parents look for medical intervention?

Medical intervention should always be sought to ensure that the child is healthy and to rule out any physiological or biological reason for atypical eating.  Once a child is shown to be medically healthy by a physician, other explanations for disordered feeding can be explored.

Discuss the experience of possible self-enforced isolation of a family as a means of coping with a child with feeding disorders. Can you suggest some ways of working with this issue so that the family participates in mainstream socialization?

The stress placed upon a family with a child with a feeding disorder is often overlooked.  Families are often confined to their homes, unable to participate in community events, parties, or meals in restaurants.  Additionally, parents are bombarded with well-meaning friends and family members giving advice or recounting stories from their personal experiences with their children.  Unfortunately, this rarely helps, and often, it hurts the family.  This is truly a case where people need to “walk in their shoes” to truly empathize.

Given our digital world, parents should use the internet to connect with others in similar situations.  Connect with parents of other children, even if the other child does not have exactly the same diagnosis.  At a minimum, this allows the family to realize they are not alone in this battle.  There are many forums and listservs dealing with feeding disorders, behavior problems, and autism.

Quality intervention works not only to encourage healthy eating habits at home, but also out in the community and school.  Services should specifically address generalization to all possible environments where the family desires the child to eat.

Provide an overview of the theories explaining pediatric feeding disorders. Are they conflicting opinions or do the theories support each other?

Unfortunately, to date, the etiology of feeding disorders is unknown.  However, there are theories as to its existence.  First, biological factors may have produced an association between eating and pain.  This includes children who suffer from reflux, constipation or diarrhea.  Other biological factors include physical irregularities, such as a cleft palate, which make eating extremely difficult for a child.

A second theory involves behavioral learning.  Within this frame, children have learned that they can gain access to desired foods, toys, attention and avoid unpleasant foods by engaging in inappropriate mealtime behavior.

A third theory is the interaction of the two theories described above.  Many children may have had some medical complications during which they learned which behaviors can procure those preferred foods and activities.  At one point, a child may have experienced pain from reflux after eating.  He or she may have learned that food might produce pain and that food refusal avoided that pain and often gained the attention from those in the immediate environment

What are behavior analytic principles and how what role do they play in enabling a child with a feeding disorder to learn healthy eating habits. How do these principles support the child?

Behavior analysis can be a wonderful intervention to address feeding problems.  The goal of behavior analysis is to look at the child’s behavior within the environment in which it occurs and to figure out what maintains the undesired behavior.  With that information, a treatment plan can be developed.

Studies have shown consistently over time that there can be, and often are, social variables that maintain the food refusal or selectivity in children with feeding disorders.  Children may learn that they can avoid undesired foods to gain access to attention and toys if they engage in tantrum behavior.

Discuss the introduction of new foods and how this impacts on the child’s eating behavior.

When new foods are introduced to the majority of children with feeding disorders, they are not welcomed warmly.  Instead, children often engage in more crying, refusal, and other inappropriate behaviors than previously seen.  This should be expected and patiently worked through.  As the child begins to build a history in which the introduction of new food brings with it positive rewards, praise, and (possibly!) yummy tastes, the negative behaviors displayed during subsequent introductions of new food will fade.

Discuss the role of family members and what they can do to create higher success rates with interventions.

Consistency is the key!  With proper intervention, a protocol will be developed specifically for each child.  Family members are responsible for participating in training sessions to ensure that they can successfully run the protocol in the absence of the therapist.  Between therapy sessions, it is the family members’ job to run the protocol as best they can and as often as they can.  Only with repeated practice will significant changes in behavior be seen.

Discuss the success of interventions and what are the possible determining factors in this success?

Behavioral interventions have shown to be successful in the treatment of feeding disorders in peer-reviewed literature for over 30 years.  Unfortunately, there are a limited number of practitioners who are specifically trained in this area.  Recent review of 27 clients who received services through CARD’s feeding clinic showed that all clients benefited in terms of increased acceptance, decreased problem behavior, and increased variety of foods eaten. (Exact data can be provided upon request).

Current investigation addresses what factors produce favorable results.  There is speculation that treatment intensity, presenting problems, and family adherence to protocol could all greatly influence outcome.

 

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