Occasionally, all kids can be picky at the dinner table. Sometimes, picky eating can take on an extreme and become a pediatric feeding disorder. But what exactly is pediatric feeding disorder, and how do you recognize your child needs help?
Some parents question if their child’s eating is outside of typical development. This article will deal with Pediatric Feeding Disorder – what it looks like, its definition, signs and symptoms, and what to do if you are worried about your child’s eating.
Meet Zoey & Kent
Zoey is a 4-year-old girl with autism who was born prematurely. In the NICU, she struggled to learn to eat. She went home with a feeding tube that helped her food travel through her nose to her tummy. Reflux and frequent vomiting made it challenging for her to gain weight at home. After a few months, her doctors, concerned with her swallowing issues, recommended a more permanent feeding tube that allowed her to take food straight to her stomach.
Now, Zoey is older. She is comfortable with tube feeding and prefers not to eat by mouth even though she is medically cleared, and her parents wish she would. Usually, she doesn’t feel like joining the family at mealtimes because she is not hungry, and all the foods are unfamiliar. If her parents are persistent, she may have a few bites of applesauce or lick some peanut butter from bread. Her mom and dad worry that Zoey will never eat enough by mouth to transition off her feeding tube.
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Kent is a 7-year-old boy who is diagnosed with autism. He’s particular about his clothes; he only likes to wear V-neck tees and cargo shorts. He is also particular about his food. He wants to eat crackers and drink chocolate milk from a red cup every meal. He’s very resistant when his mother asks him to try what she eats at a meal. He might cry or even yell. He refuses to join her at the table and doesn’t come around until his mom gives up and serves his favorites. His mother worries that Kent doesn’t get the nutrients he needs and will never learn to eat fruits and vegetables.
Though they struggle with eating differently, Zoey and Kent are children with significant feeding challenges. Both struggle to get enough nutrients orally, to eat a varied diet, to accept an array of food textures, and to participate in family mealtime routines. For these reasons, both children have been diagnosed by their feeding team with a pediatric feeding disorder.
What is a Pediatric Feeding Disorder?
To eat is a process that requires the use of many systems in the body. We use our fingers, hands, arms, mouth, muscles, and GI tract. And that’s just the tip of the iceberg! Developmental processes, mental health considerations, and family dynamics are also at play during mealtimes.
The term Pediatric Feeding Disorder (PFD) considers all of this complexity and the need for multiple experts who understand these systems. PFD is defined as impaired oral intake that is not age-appropriate, lasts at least 2 weeks, and is associated with medical, nutritional, feeding skill, and/or social-emotional challenges.
Said another way, your child may have PFD if they struggle to eat with similar skill, in similar amounts, and with a similar variety of foods as other children of their age. These differences may be accompanied by concerns in one of these four areas: medical, nutritional, skill, or behavioral concerns.
Signs and Symptoms
If your child has a pediatric feeding disorder, you may have one or more of the following concerns related to your child’s eating:
- Highly selective food choices based on texture, color, and/or taste
- Limited appetite
- Food refusal
- Choking, gagging, coughing, or vomiting related to feeding and eating
- Weight loss
- Difficulty using a spoon, fork, or cup
- Disruptive mealtime behavior
- Difficulty eating outside of the home
- Your own stress or overwhelm related to your child’s eating
What about Avoidant Restrictive Food Intake Disorder (ARFID)?
If your child struggles with feeding difficulties and has previously been diagnosed with ARFID, you may be wondering if PFD is the same thing or something different.
ARFID, Avoidant Restrictive Food Intake Disorder, is a mental health diagnosis given to children with concerns in only 2 areas included in the definition for PFD. Kids with ARFID are diagnosed using the following criteria:
- Weight loss
- Significant nutritional deficiency
- Dependence on a feeding tube or oral supplements (e.g., Carnation Instant Breakfast, PediaSure)
- Significant daily challenges resulting from feeding issues (e.g., challenging behavior, refusal to eat outside the home, etc.)
The ARFID diagnosis may be appropriate if a child with feeding challenges has one or more of these symptoms.
You may notice these challenges only touch on concerns in the nutritional and psychosocial areas of the PFD diagnosis. They do not touch on concerns in the remaining two areas: medical and feeding skills. So, if your child has been diagnosed with ARFID, it can be worth re-evaluation to rule out concerns in the remaining two areas.
Both the ARFID and PFD diagnoses are relatively new. Providers, researchers, and families are still trying to understand how ARFID and PFD are the same and different to improve care for children.
How Can You Help Your Child With a Pediatric Feeding Disorder?
If you suspect your child may have a pediatric feeding disorder, begin by speaking with your pediatrician. They can evaluate your child and make referrals as needed. Likely, they will refer you to a feeding team.
Because so many contributing factors impact a child’s ability to eat, it’s recommended that children with feeding challenges have a team-based assessment, including team members from all areas outlined in the definition of the pediatric feeding disorder. This includes the following: medical, nutritional, feeding skill, and psychosocial areas.
Following a team assessment of your child’s eating, you will have a set of recommendations to guide your child’s care. One or more assessment team members may continue to work with you and your child as you move into treatment.
Feeding challenges in children with pediatric feeding disorders can be diverse. Like Zoey or Kent, your child may struggle to eat orally or be extremely selective. Though all children with this disorder have oral eating impairments that are not appropriate for the child’s age, they may have unique concerns in medical, nutritional, feeding skill, and/or psychosocial skill areas. Given the individual nature of each child’s challenges, a thorough team assessment is currently the best practice.
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Overcome Picky Eating
Autism and pediatric feeding disorders often intersect, making mealtime challenging for many children and their families. While these challenges can be daunting, early intervention, professional guidance, and a patient, individualized approach can help children with both conditions progress and lead healthier, happier lives.
Q: What is the relationship between autism and pediatric feeding disorders?
A: Autism and pediatric feeding disorders can often co-occur. Children with autism may be more prone to feeding difficulties due to sensory sensitivities, rigid behaviors, or communication challenges, which can complicate their relationship with food.
Q: What are the common signs of pediatric feeding disorders in children with autism?
A: Common signs include extreme food selectivity, limited food variety, resistance to trying new foods, and difficulty with specific textures. Children with both conditions may exhibit aversions to certain tastes, smells, or temperatures, making mealtime challenging.
Q: How can parents and caregivers help children with autism and pediatric feeding disorders?
A: It’s essential to seek support from speech therapists, occupational therapists, and registered dietitians specializing in autism and feeding disorders. A multi-disciplinary approach can help create individualized strategies for improvement.
Q: Are there specific dietary interventions for children with autism and feeding disorders?
A: Dietary interventions should be tailored to the child’s needs and preferences. Some may benefit from texture modifications, while others may require a gradual exposure approach to new foods. It’s crucial to work with specialists who can develop a personalized plan.
Q: Can children outgrow pediatric feeding disorders, especially when combined with autism?
A: With early intervention and proper therapy, many children can significantly progress in overcoming feeding difficulties. While some may outgrow these issues, others may continue to require support throughout their lives.
This article originally appeared in our September 2023 issue (issue 156): https://www.autismparentingmagazine.com/issue-156-picky-eating/