Feeding Disorders

What are feeding disorders?

 Feeding disorders are characterized by a persistent disturbance in eating or eating-related behavior that affects food consumption and gets in the way of daily functioning. Generally speaking, individuals with feeding disorders fail to eat a sufficient amount or variety of food to maintain a healthy nutritional status. While feeding disorders are most common among children and early adolescents, they can present in individuals across the lifespan.

Feeding disorders can take many forms, such as:

  • Refusing to eat certain food groups or new foods
  • Refusing to eat specific brands, textures, colors, or presentations of foods
  • Gagging or vomiting while eating
  • Tantruming during mealtimes
  • Difficulty gaining or maintaining a healthy weight
  • Dependence on nutritional supplements
  • Dependence on a gastronomy or nasogastric tube
  • Sensory problems

What diagnoses are included in the category of feeding disorders?

Feeding disorders include diagnoses of avoidant/restrictive food intake disorder (ARFID), pica, and rumination disorder.

  • ARFID can take many forms, but is often characterized by extreme picky eating, inappropriate behavior during mealtimes, difficulty gaining or maintaining weight, or dependence on nutritional supplements or feeding tubes. When children are experiencing one or more of these challenges, a diagnosis of ARFID is typically provided.
  • Pica is characterized by developmentally inappropriate consumption of nonnutritive or nonfood items (e.g. paint chips, soap, paper, hair). Although pica can occur at any point during the lifespan, it is most commonly diagnosed during childhood.
  • Rumination disorder is diagnosed when previously swallowed food is regurgitated, but is not due to an associated medical condition. Regurgitated food may be rechewed and re-swallowed or ejected from the mouth. Individuals often describe this behavior as out of their control.

What is the difference between feeding disorders and an eating disorders?

Although feeding and eating disorders often have overlapping symptoms (e.g. disordered eating in some way), individuals with feeding disorders do not have a fear of gaining weight and do not experience disturbances in how they perceive their body weight or shape.

When is it time to seek treatment?

Since picky eating can be part of normal development, it is often challenging for parents to determine if or when they should seek treatment for their child. Here are some common signs that it is time to seek treatment:

  • Your child has mostly or fully eliminated a food group (e.g. fruits, vegetables, starches, proteins) from their diet
  • Your child engages in inappropriate behavior during mealtimes (e.g. tantrums, vomiting, taking too long to eat or refusing to eat) that interferes with quality of life
  • You feel as though you are bending over backward to feed your child (e.g. buying only preferred brands of foods or having to present foods in a particular way)
  • Your child is losing weight or not gaining weight appropriately
  • Your child is reliant on nutritional supplements to meet their caloric needs

How does having a feeding disorder impact my child’s life?

Feeding disorders can impact both the child and the caregivers. In children, feeding disorders can lead to nutritional deficits or difficulty growing appropriately. Feeding disorders can interfere with being able to participate fully in events that involve eating (e.g. refusing to eat food served at a birthday party) or general mealtimes (e.g. tantruming any time a nonpreferred food is presented). Feeding disorders can impact caregivers too – caregivers of children with feeding disorders often report higher levels of stress and anxiety and lower levels of self-esteem and confidence in their parenting.

What is the best treatment option for feeding disorders?

Treatment using an applied behavior analysis (ABA) framework is the most research-supported approach to treating feeding disorders. This approach centers on determining the specific reason(s) as to why children are having difficulty with eating and changing their environment to better support appropriate mealtime behavior. Although the intervention will be individualized for your child, treatment often involves creating consistency with regards to demands during mealtimes, providing clear consequences for appropriate and inappropriate behavior, and techniques for managing challenging behavior during mealtimes.

Is it typical for children or adults with feeding disorders to be diagnosed with other conditions?

Yes – individuals with feeding disorders may have co-occurring neurodevelopmental disorders such as autism spectrum disorder, intellectual disability, or attention deficit hyperactivity disorder, or other psychological disorders such as obsessive compulsive disorder or anxiety disorders. Some individuals also have co-occurring medical diagnoses, such as food allergies, constipation, gastritis, failure to thrive, or gastroesophageal reflux.

As a parent of a child with a feeding disorder, where is the best place to start?

A good place to start with a child who is exhibiting difficulties during mealtimes is to get an evaluation with someone who has expertise in this area to determine what is going on. An evaluation will typically consist of an interview focusing on current and past eating practices, mealtime skills, behavioral challenges during mealtimes, changes in eating patterns, and relevant medical history. A strong evaluation will typically also include a structured meal observation.