Feeding Disorders

What is a Pediatric Feeding Disorder?

refusing to eatA pediatric feeding disorder is a condition in which a child does not eat enough to provide adequate nutrition, calories, or hydration. Behavior deficits or excesses that inhibit the intake may result in an infant or child being characterized as failure to thrive (FTT). FTT itself is characterized by being under the third percentile for weight. Feeding problems are considered to be pediatric feeding disorders only if a child is safe to eat by mouth. If the child is experiencing physiological issues that make eating or drinking unsafe, the feeding problem is not considered to be a pediatric feeding disorder, but rather a medical issue.

A feeding disorder can be categorized as follows: complete food refusal, selective (picky) eating, or tube dependency. Each category can present different sets of symptoms or unique clusters of behavior.

Some children drink only water, others will not open their mouth at mealtimes, and some turn their heads when a spoon is presented at mealtime; other children gag, cry, and spit out food. Each children performs a unique combination of behaviors (such as those listed in the feeding disorders symptom checklist below).

This makes it crucial to treat each child with a feeding problem as a unique case. Approaching all feeding problems with one protocol is inefficient and ineffective.

Etiology of Pediatric Feeding Disorders

Pediatric feeding disorders originate from both organic and environmental variables, although in most occurrences the actual cause of the feeding disorder is unknown or undeterminable.

Medical Conditions

Food refusal may be caused by a prior medical condition that has, in the past or in the present, caused discomfort during eating. This makes the act of eating uncomfortable for a child, or the experience of discomfort in the past has been paired with eating in general.

Tube Dependence

Tube dependence can be the main reason for food refusal. Feeding tubes are in place for various reasons. Some children are unsafe to eat orally, while at other times, children are at an unsafe weight when a feeding tube is placed.

Attention Maintained

Sometimes, children are easily reinforced by attention to their eating behaviors. If a child is being coddled subsequent to a head turn after food is presented, it will be more likely that during the next meal, the presentation of food will result in head turns.

Food Refusal Treatment

The goal of using behavior analysis is to identify problematic behaviors during mealtimes and then to teach an appropriate set of behaviors that will yield a proper mealtime experience.

Types of Food-Refusal Related Conditions:

  1. Texture – Child accepts only certain textures
  2. Complete Food Refusal – Child will not accept any food
  3. Food Selectivity – Child only accepts a limited number of foods
  4. Low-Volume Acceptance – Child refuses to eat after a certain volume of food is consumed

Mealtime Behaviors

Every child exhibits a different set of behaviors during meals.


The extent to which behaviors are ingrained and exhibited also differs from child to child. This makes the number of distributions nearly infinite. The probability of two children (even identical twins) exhibiting the same distribution of behaviors is miniscule.

Children also respond differently to various forms of treatments used for each individual behavior, which adds another degree to the complexity of dealing with food refusal.

Severity of Food Refusal

Studies have shown that 25% of the pediatric population exhibits moderate to severe food refusal.


Not every child in the 25th percentile that exhibits “moderate” food refusal needs to seek treatment. Others may only need a few treatment sessions.

The criteria used for determining whether to proceed with treatment is the degree in which the food refusal is causing a child’s health to be affected.

Recent statistics reveal that one in four children have some sort of feeding disorder. This is reflective of a continuum of feeding problems. Not all problems are severe enough to warrant therapy. Some children will eat all kinds of food, but only three items from the vegetable group, while children on the other end of the spectrum will not consume any food at all.

Checklist of Pediatric Feeding Disorder Symptoms

  • Spitting food out
  • Not opening mouth during feedings
  • Gagging during mealtimes
  • Coughing during mealtimes
  • Retching during mealtimes
  • Vomiting during mealtimes
  • Rumination during mealtimes
  • Not acting hungry
  • Drinking only water
  • Baby refuses to take significant amounts of formula through the bottle
  • G-Tube dependency
  • NG-Tube dependency
  • Packing solids (keeping food in the mouth)
  • Pooling liquids (keeping liquids in the mouth)
  • Eating non-food items
  • Problems in eating chunkier textures
  • Refusal behaviors (turning the head, pushing away the spoon) during mealtimes
  • Throwing food, bowls, or spoons from a table or highchair tray
  • Crying during mealtimes
  • Child is unusually picky in what he/she will eat
  • Child not drinking or not drinking enough
  • Baby won’t drink from a bottle
  • Child only eats or drinks from a syringe
  • Baby won’t sit in high chair