Health Library

Pediatric Feeding Disorder

PFD is associated with one or more types of underlying dysfunctions, including medical, nutritional, feeding skill and/or psychosocial:

• Medical dysfunction includes health conditions that make feeding difficult. Medical causes of feeding issues may include aspiration (food or drink entering the lungs), breathing problems, gastrointestinal conditions (reflux, constipation), genetic conditions, neurodevelopmental disorders, or differences in anatomy.
• Nutritional dysfunction happens when a child isn’t getting the right nutrition or hydration. This could mean they’re not growing well, gaining weight too fast or missing important vitamins and minerals.
• Feeding skill dysfunction means a child has trouble with the sensory or motor functions needed for eating or drinking. They may need special equipment or feeding strategies.
• Psychosocial dysfunction includes behaviors and emotions that cause feeding difficulties. This could be fear of eating, refusal to eat or high stress during mealtimes.

How Common Is Pediatric Feeding Disorder?

Pediatric feeding disorder affects at least 1 in 37 children under age 5 in the United States.

What Causes Pediatric Feeding Disorder?

Pediatric feeding disorder in children may result from illness, injury, medical conditions, behavioral issues or developmental delays. The root cause is sometimes unknown.

How Can Pediatric Feeding Disorder Affect My Child?

A child with pediatric feeding disorder may not eat or drink enough to grow and stay healthy. They may avoid foods, have strong reactions to certain foods, or refuse to eat altogether. Pediatric feeding disorder can make mealtimes stressful for the child and their family.

What Are Signs of Pediatric Feeding Disorder?

Medical Dysfunction Signs

Symptoms of pediatric feeding disorder related to medical dysfunction may include:

• Crying, arching, coughing or grimacing when eating or drinking
• Food allergies
• The need for multiple changes in formula
• Noisy breathing or gurgling sounds
• Poor appetite
• Signs of discomfort while eating or drinking
• Color changes during feeding (bluish color around the mouth or lips)
• Repeated respiratory infections
• Vomiting
• Constipation

Nutritional Dysfunction Signs

Symptoms of pediatric feeding disorder related to nutritional dysfunction may include:

• Eating a very limited diet for their age
• Growing too little or too quickly for their age
• Needing supplements or tube feedings
• Experiencing poor weight gain or rapid weight gain
• Eating only one or two foods
• Vitamin or mineral deficiencies

Feeding Skill Dysfunction Signs

Symptoms of pediatric feeding disorder related to feeding skill dysfunction may include:

• Coughing, choking, gagging or retching
• Swallowing loudly or gulping
• Needing special strategies, positioning or tools during feeding
• Noisy or labored breathing while feeding
• Needing to use thickened liquids or modified food textures
• Very long or very short mealtimes

Psychosocial Dysfunction Signs

Symptoms of pediatric feeding disorder related to psychosocial dysfunction may include:

• Avoiding sitting at the table or eating with others
• Having caregivers who feel stressed or worried about feeding
• Having tantrums or disruptive behavior during meals
• Needing distractions, rewards or bribes to eat
• Refusing to eat foods offered
• Showing fear, stress or worry at mealtime

How Is Pediatric Feeding Disorder Diagnosed?

Pediatric feeding disorder is typically diagnosed when feeding problems last more than two weeks and affect one or more of the following areas of dysfunction: medical, nutrition, feeding skill or psychosocial. A team of specialists often helps make the diagnosis. Your child’s team may include:

• Medical providers including pediatricians, allergists/immunologists, gastroenterologists, neurologists, otolaryngologists (ENT), and pulmonologists
• Registered dietitians who assess nutritional needs and growth
• Speech-language pathologists and occupational therapists who observe how the child eats and drinks
• Psychologists, social workers or behavioral health professionals who explore emotional and social factors that may impact feeding or the child’s mealtime behavior

Your child’s team will work together to understand their needs and determine the best approach to care.

How Is Pediatric Feeding Disorder Treated?

Treatment for pediatric feeding disorder is specific to each child and their unique needs. For that reason, it may involve more than one type of therapy. Treatment generally focuses on helping your child eat and drink safely and appropriately, meet their nutritional needs, and reduce stress at mealtimes.

Your child’s treatment may include one or more of the following:

• Medical care for health conditions that impact feeding
• Nutritional support to improve growth and hydration, which may include meal plans, supplements or tube feeding
• Feeding therapy to improve feeding skill development through improving oral motor skills or developing comfort with foods and textures
• Behavioral therapy to ease mealtime stress and promote healthy eating behaviors
• Parent and caregiver coaching to support families in daily feeding routines

If your child’s feeding issues are complex, they may need coordinated care from a multidisciplinary team that includes experts from different specialties to create and monitor a comprehensive treatment plan.

Some examples of the care options at Cincinnati Children’s include:

• Interdisciplinary Feeding Team: This team provides evaluation and care planning for children with complex feeding needs. The team typically includes a doctor, nurse practitioner, nurse, dietitian, social worker, speech-language pathologist and occupational therapist.
• Aerodigestive Multidisciplinary Feeding Treatment Team: This team offers short-term feeding therapy. The team usually includes a speech-language pathologist, occupational therapist and/or social worker.
• Occupational Therapy: An occupational therapist supports self-feeding, oral motor skills, sensory needs, body positioning and routines for your child.
• Speech Therapy: A speech-language pathologist can help your child with swallowing, oral motor skills and eating safely.

What Is the Outlook for Pediatric Feeding Disorder?

Many children with pediatric feeding disorder improve over time with the right support. Some may need months or years of therapy, while others may improve quickly.

Early diagnosis and treatment can make a big difference in your child learning to eat and drink in a way that meets their needs. Children have the best prognosis with help from a team and support at home. Ongoing care can help families manage changes as their child grows.