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Information

An approach to identifying and managing feeding difficulties

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Presenting Features of Feeding Difficulties

Suggestive symptoms/signs

Prolonged mealtimes

Food refusal lasting < 1 mo

Disruptive and stressful mealtimes

Lack of appropriate independent feeding

Nocturnal eating in toddler

Distraction to increase intake

Prolonged breast- or bottle-feeding

Failure to advance textures

Organic red flagsa

Dysphagia

Aspiration

Apparent pain with feeding

Vomiting and diarrhea

Developmental delay

Chronic cardio-respiratory symptoms

Growth failure (failure to thrive)

Behavioral red flagsa

Food fixation (selective, extreme dietary limitations)

Noxious (forceful and/or persecutory) feeding

Abrupt cessation of feeding after a trigger event

Anticipatory gagging

Failure to thrive

a Red flags are signs/symptoms that require prompt attention and, in many instances, referral for in-depth investigation or specialized treatment.

Adapted from Kerzner B, Milano K, MacLean WC Jr, Berall G, Stuart S, Chatoor I. A practical approach to classifying and managing feeding difficulties. Pediatrics. 2015;135(2):346.

Criteria for an “ideal” classification of feeding difficulties


Feeding difficulties can be classified based on parents’ expressed concerns about their child’s feeding/eating behavior, which fall into 3 principal categories: those not eating enough (limited appetite); those eating an inadequate variety of foods (selective intake); and those afraid to eat (fear of feeding). Each category has subcategories to acknowledge that such concerns may be a misperception on the part of the parents or primarily behavioral or organic, both with a spectrum ranging from mild to severe.

The criteria for an “ideal” classification of feeding difficulties systematically categorize the following:

The criteria are used to separate misperceived, mild, and severe conditions.

Conditions can therefore be

  • Readily recognized
  • Identified by familiar and accurate terminology
  • Logically related to each other
  • Manageable in number

Specific treatment options are available for each condition.


Adapted from Kerzner B, Milano K, MacLean WC Jr, Berall G, Stuart S, Chatoor I. A practical approach to classifying and managing feeding difficulties. Pediatrics. 2015;135(2):347.

Feeding guidelines for all children


Reviewing the following basic feeding guidelines with parents can be useful when managing a child with a limited appetite:

Avoid distractions during mealtimes (television, cell phones, etc)

Maintain a pleasant neutral attitude throughout meal

Feed to encourage appetite

  • Limit meal duration (20-30 min)
  • 4-6 meals/snacks a day with only water in between

Serve age-appropriate foods

Systematically introduce new foods (up to 8-15 times)

Encourage self-feeding

Tolerate age-appropriate mess


Adapted from Kerzner B, Milano K, MacLean WC Jr, Berall G, Stuart S, Chatoor I. A practical approach to classifying and managing feeding difficulties. Pediatrics. 2015;135(2):347.