Overcoming Challenges: Addressing Feeding Difficulties in Young Children

Overcoming Challenges: Addressing Feeding Difficulties in Young Children

Prof. Dr. E. De Greef, Prof. Dr. Y. Vandenplas 

Feeding difficulties in young children is a frequent reason for a pediatric clinic visit. Prevalence is estimated at 5-20% (1) and even higher depending on the definition of 'feeding difficulties'.  

Pediatric feeding disorders (PFDs) are complex, multifactorial conditions characterized by a child’s inability or refusal to consume adequate nutrition to support appropriate growth, development, or psychosocial functioning.  

In 2019, Goday et al (2), proposed a consensus definition of feeding difficulties within the World Health Organization’s (WHO) International Classification of Functioning, Disability, and Health framework.  

‘Feeding difficulties are an impaired oral intake that is not age appropriate and is associated with medical, nutritional, feeding skills and/or psychosocial dysfunction. Excluding any body imaging issues. This definition covers the different important factors contributing to feeding difficulties in children and emphasizes the multi-disciplinary approach in diagnosis and treatment.  

Medical conditions can be inborn or acquired anomalies such as prematurity, short bowel, Hirschsprung's disease, oesophageal atresia, cardiopathy, genetic syndromes … These conditions will limit the development of normal feeding behaviour. 

Nutrition conditions fail to meet metabolic demands and include all types of malabsorption such as coeliac disease, severe allergies, but also dietary restrictions for other reasons.  

Feeding skill problems imply improper motor skills to obtain age appropriate feeding. This can be linked to insufficient muscle tone or strength, but also to neurological impairment, understimulation, anatomical anomalies.

Psychosocial dysfunction often coexists with previous dysfunctions, but can also be the main problem. It can be linked to the child, the caregiver or the environment comprising autism spectrum disorders, ARFID, trauma, psychiatric disorders in parents, attachment difficulties… 

A multi-disciplinary approach, engaging a pediatrician, a specialized speech therapist, a psychologist, a pediatric dietician and sometimes a social worker, physiotherapist or psychiatrist, starting early in life and including all care takers surrounding the child, warrants the best outcomes for these patients.  

References:

1. Benjasuwantep B., Chaithirayanon S., Eiamudomkan M. Feeding problems in healthy young children: Prevalence, related factors and feeding practices. Pediatr. Rep. 2013;5:38. doi: 10.4081/pr.2013.e10 

2. Goday PS, Huh SY, Silverman A, Lukens CT, Dodrill P, Cohen SS, Delaney AL, Feuling MB, Noel RJ, Gisel E, Kenzer A, Kessler DB, Kraus de Camargo O, Browne J, Phalen JA. Pediatric Feeding Disorder: Consensus Definition and Conceptual Framework. J Pediatr Gastroenterol Nutr. 2019 Jan;68(1):124-129.