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Caring for children with feeding disorders

About feeding disorders

Quite simply, this term describes any disorder that causes problems with intake of food. It could mean refusal to eat or to eat certain foods, or it could involve a physical inability to suck, chew or swallow food. Feeding problems are often associated with conditions such as reflux, esophageal achalasia or swallowing disorders. No two feeding disorders are the same, and each child’s case is often complex, involving a constellation of interrelated problems. The Feeding, Swallowing and Nutrition Program at Children’s Hospital of Wisconsin understands this complexity and provides a true interdisciplinary approach to treat each child’s feeding disorder.

What causes feeding disorders?

It all depends on your child’s medical history. Feeding disorders can result from an underlying physiological condition, a psychological/behavioral problem, or a combination of both. Children with developmental disorders or other medical conditions are much more likely to experience feeding issues.

Some children are born with physical defects that make eating difficult. There could be an anomaly in the brain center that controls swallowing, poor tone of oral-motor muscles, or problems with texture because of sensory disturbances. Children with autism often develop very ritualistic eating patterns, such as rejecting any food that isn’t cut into a triangle or eating only one kind of food.

Sometimes parents attempt to introduce an eating milestone (such as spoon-feeding or table foods) too early, which can trigger a feeding aversion. Children who have experienced choking or other bad feeding experiences can develop a fear of eating.

How often do feeding disorders occur?

Feeding and swallowing problems affect between 25 to 45 percent of typically developing children, though the prevalence is much higher (up to 80 percent) for children with other medical and behavioral disorders. Between 25 to 30 percent of children with cardiac issues have persistent feeding problems.

How do feeding disorders develop?

Sometimes feeding problems start at birth, while other times they develop later in life. They often emerge during the toddler years, between ages 2 to 4. Older children with feeding problems tend to have trouble with anxiety or may have a developmental disorder such as autism

What are the symptoms of feeding disorders?

Symptoms can vary depending on the underlying cause of your child’s eating problem, but they can include: 

  • Choking, gagging on food or certain textures
  • Aspirating on food (getting food into the respiratory tract)
  • Food refusal
  • Intense behavioral outbursts with meals
  • Vomiting
  • Coughing
  • Pocketing of food in the child’s cheek

Who is at risk of developing a feeding disorder?

Children who have genetic syndromes such as DiGeorge syndrome, Down syndrome or other chromosomal disorders, autism and heart conditions are at higher risk of developing feeding disorders. In addition, premature babies or any other child with a complicated medical history who required a long-term feeding tube after birth may have trouble with feeding. But many otherwise healthy kids can also develop an aversion to eating, especially if there’s a lack of structure in the child’s feeding environment.

Why are feeding disorders a concern?

Children with feeding disorders tend to consume fewer calories and have a less varied and nutritious diet, which can lead to failure to thrive, poor weight gain or weight loss. These children can have poor energy levels, behavioral problems and constipation (particularly if their fluid intake is also low). They may also be more susceptible to infections or other illnesses because of the toll that malnutrition takes on the immune system.

How are feeding disorders diagnosed?

The specialists within our Feeding Program will start by analyzing your child’s medical history and feeding patterns. Our Feeding team will also observe while your child eats to look for signs of choking, coughing or gagging during eating. The team may also use imaging tests to assess swallowing function. Those tests could include a barium swallow study, a videoflouroscopic swallow study, and/or an esophageal manometry test. If your child’s doctor suspects another underlying condition, such as eosinophilic esophagitis, the doctor might order an endoscopy or other additional tests.

What is the treatment for feeding disorders?

Because feeding disorders vary in type and severity, treatment is based on your child’s needs. Our Feeding team takes a highly interdisciplinary approach to address the complexity of feeding disorders. Pediatric specialists from gastroenterology, speech pathology, psychology and nutrition work together to assess each child and develop a customized treatment plan to address each child’s needs. We believe this is key to offering our families the most comprehensive and efficient care.

Learn more about what to expect from an appointment with our feeding, swallowing and nutrition team.

What happens after treatment?

Some children may need to see our feeding team regularly for many years, while others could be discharged after only a few visits. For the Feeding Program, the average duration of treatment for feeding disorders is about one year. If problems reemerge, your child may need to restart treatment.

When should you contact a physician?

If you have any concerns about your child’s eating habits, talk to your pediatrician. He or she may refer you to a feeding specialist if further evaluation is necessary.

What is the long-term outlook for feeding disorders?

Children with this condition generally have a good outcome. Outcomes are even better for cases that are more behavioral than physiological in nature. Children who have autism, seizures or severe developmental delays may continue to have difficulty eating and may need nutritional supplements to ensure adequate nutrition.

How do I live with this condition?

Parents are key to a child’s success in overcoming a feeding disorder, and our team will provide education and coaching on behavioral strategies that can be used at home. It may take some time, but in most cases, feeding disorders can be successfully managed.

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