Kidmunicate Pediatric Feeding Disorders

PEDIATRIC FEEDING DISORDER

Find causes, signs/symptoms, diagnoses, treatment, and prognoses of pediatric feeding disorder. You will find easy-to-understand information to manage your child’s feeding issues.

Pediatric Feeding Disorder 

Has your child been diagnosed with a pediatric feeding disorder or do you suspect your child may have a feeding problem? If so, you may find our detailed feeding disorders section helpful. We outline the causes, signs/symptoms, diagnosis, treatment approaches, and prognosis for pediatric feeding disorders.

Some feeding disorders can be diagnosed and treated by a licensed and specialty trained Speech-Language Pathogist. Some disorders need to be diagnosed by a medical doctor or psychiatrist. If you have any questions please call our office at 484-367-7131.

Causes, Signs and Symptoms, Diagnosis, Treatment Approaches and Prognosis

Pediatric feeding disorder (PFD) represents a significant challenge for children and their families. It’s more than just picky eating; it involves persistent difficulties with eating or drinking that interfere with growth, development, or overall health. PFD can manifest in various ways, impacting oral intake, food variety, and mealtime behavior. It’s crucial to distinguish PFD from typical childhood eating patterns, which often involve some degree of pickiness or neophobia (fear of new foods) that resolves with age.

Speech-language pathologists (SLPs) play a crucial role on a feeding team, especially when there are concerns about a child’s ability to eat, swallow, or communicate during mealtimes. SLPs are typically recognized for their expertise in speech-language disorders, but they also possess specialized knowledge in feeding and swallowing, which are closely linked to speech and oral motor functions.

Pediatric Feeding Disorder Causes

The etiology of PFD is often multifactorial, requiring a comprehensive assessment to pinpoint the contributing factors. These can be broadly categorized as:

  • Medical Conditions: 
    • Gastrointestinal Issues: Gastroesophageal reflux (GERD), eosinophilic esophagitis, constipation, and other GI problems can cause discomfort or pain during feeding, leading to food aversion.
    • Food Allergies and Intolerances: Reactions to specific foods can trigger oral motor difficulties, pain, or other symptoms that negatively impact feeding.
    • Neurological Impairments: Cerebral palsy, developmental delays, and other neurological conditions can affect oral motor skills, coordination, and swallowing.
    • Anatomical Differences: Cleft palate, tethered tongue, or other structural differences can impair sucking, swallowing, and chewing.
    • Respiratory Issues: Chronic respiratory conditions can lead to fatigue during feeding and difficulty coordinating breathing with eating.
    • Cardiac Conditions: Congenital heart defects can impact energy levels and feeding ability.
  • Developmental Delays:
    • Oral Motor Delays: Difficulties with chewing, swallowing, and other oral motor skills can hinder a child’s ability to process different food textures.
    • Sensory Processing Issues: Children with sensory processing difficulties may be overly sensitive to certain tastes, textures, or smells, leading to food aversions.
    • Cognitive Delays: Cognitive impairments can affect a child’s understanding of mealtimes, feeding routines, and the process of eating.
  • Psychological Factors:
    • Anxiety and Fear: Past negative experiences with choking, gagging, or vomiting can lead to anxiety and fear around mealtimes.
    • Behavioral Issues: Challenging behaviors, such as tantrums or food refusal, can develop as a way for children to express their discomfort or exert control.
    • Feeding Aversions: Strong dislikes for certain foods can develop due to taste, texture, or past negative experiences.
  • Environmental Factors:
    • Inconsistent Feeding Practices: Lack of consistent routines, pressure to eat, or overly restrictive feeding practices can contribute to feeding problems.
    • Limited Food Exposure: Restricted exposure to a variety of foods can hinder the development of acceptance of different tastes and textures.
    • Family Stress and Dynamics: Stressful mealtimes or family dynamics can negatively impact a child’s eating behavior.

Pediatric Feeding Disorder Signs and Symptoms

The signs of pediatric feeding disorder are easy to identify by parents, however, some signs may not be recognized as a problem. Some parents believe that their children, especially toddlers, will just grow out of the issue. In many cases that is true, but not always. Early intervention is the key, so if you suspect an issue, get an evaluation. 

Here are other signs to look for if you suspect that your child has a pediatric feeding disorder.

  • Infants:
    • Difficulty latching onto the breast or bottle
    • Excessive spitting up or vomiting
    • Refusal to eat
    • Poor weight gain
    • Irritability or fussiness during feeding
  • Toddlers and Older Children:
    • Limited food variety (eating fewer than 20 different foods)
    • Refusal to try new foods
    • Difficulty chewing or swallowing
    • Coughing or choking during meals
    • Food hoarding or stuffing
    • Prolonged mealtimes (lasting longer than 30 minutes)
    • Mealtime tantrums or power struggles
    • Avoidance of mealtimes
    • Reliance on pureed or liquid foods beyond the expected age
    • Poor growth or weight faltering

Feeding Disorder Diagnosis

Speech-language pathologists (SLPs) use their specialized knowledge in feeding and swallowing to provide a thorough assessment which is crucial for accurate diagnosis and effective treatment planning. The process typically involves:

  • Detailed Medical History: Gathering information about the child’s medical history, developmental milestones, feeding history, and family dynamics.
  • Physical Examination: SLPs assess the structure and function of the oral cavity, including the lips, tongue, teeth, and soft palate, to determine how they contribute to feeding difficulties. They also assess the child’s growth, nutritional status, and physical health.
  • Oral-Motor Assessment: The SLP evaluates how these structures function while chewing, swallowing, and managing food.
  • Feeding and Swallowing Observation: The SLP observes how the child manages different textures and types of food, from liquids to solids, to identify potential issues such as choking, gagging, or difficulty swallowing.
  • Behavioral Observation: SLPs observe the child during mealtimes to assess their feeding behaviors and interactions with caregivers. 
  • Safety and Efficiency of Swallowing: SLPs assess signs of aspiration (food or liquid entering the airway), which could lead to aspiration pneumonia or other respiratory issues.

It Often Takes a Multidisciplinary Team

The assessment process often involves a team of professionals, including pediatricians, speech-language pathologists, occupational therapists, registered dietitians, psychologists, and feeding specialists.

    • Standardized Assessments: Utilizing standardized tools to evaluate oral motor function, sensory processing, and feeding skills.
    • Nutritional Assessment: Evaluating the child’s nutritional intake, growth patterns, and potential nutrient deficiencies.
    • Psychological Evaluation: Assessing for any underlying emotional or behavioral issues contributing to the feeding difficulties.

Feeding Disorder Treatment

Treatment plans are individualized based on the child’s specific needs and the underlying causes of the feeding disorder. Some children need a team of experts to treat the disorder. Common interventions include:

  • Nutritional Management: Ensuring adequate nutrition through oral feeding, supplemental nutrition (e.g., formula, feeding tubes), or a combination of both. A registered dietitian can provide guidance on appropriate calorie and nutrient intake.
  • Oral Motor Therapy: Exercises and activities to improve oral motor skills, such as chewing, swallowing, and tongue coordination. A speech-language pathologist specializes in this area.
  • Behavioral Therapy: Addressing mealtime anxiety, food refusal, and other behavioral challenges through positive reinforcement, desensitization techniques, and other behavioral strategies. A psychologist or behavioral therapist can provide support. 
  • Sensory Therapy: Helping children with sensory processing difficulties to become more comfortable with different tastes, textures, and smells of food. A speech-language pathologist or occupational therapist can be helpful.
  • Parent/Caregiver Education and Training: Providing parents with education and support on feeding strategies, creating positive mealtime environments, and managing feeding-related stress. Parent/ Caregiver Education and Training is provided by all the care providers mentioned above for their specialty. This is a crucial component of successful treatment.
  • Medical Management: Addressing any underlying medical conditions that may be contributing to the feeding disorder, such as GERD, food allergies, or anatomical differences.

Speech-language pathologists (SLPs) use their specialized therapy techniques and strategies to treat pediatric feeding disorders.

  • Therapeutic Techniques: SLPs use specific techniques to help individuals improve their feeding and swallowing skills, such as strengthening oral muscles, improving coordination, or modifying posture to make swallowing safer and more efficient.
  • Swallowing Rehabilitation: If there are issues with swallowing (dysphagia), SLPs can help manage or treat these issues through specific exercises, maneuvers, or diet modifications.

    •  Diet Modifications and Texture Recommendations. SLPs may recommend different food consistencies (pureed, soft, chopped, etc.) based on an individual’s swallowing ability. This ensures the person can safely and efficiently manage food without risk of choking or aspiration.

    • SLPs also help to increase the child’s repertoire of foods and textures they can safely tolerate.

    • The prevention of aspiration is important. A Modified Barium Swallow is always recommended before feeding therapy if aspiration is suspected.  During a Modified Barium Swallow study (conducted at a children’s hospital), SLPs work to prevent aspiration or choking incidents by recommending strategies to improve swallowing safety, such as changes in posture, modifying food textures, or recommending specific swallowing strategies.
  • Feeding Strategies: For individuals with feeding difficulties (e.g., picky eaters, or those with sensory processing issues), SLPs might use techniques to introduce new foods, improve oral intake, and reduce food aversions or sensitivities.
  • Supporting Children with Developmental Delays: For children with developmental disabilities, SLPs help promote appropriate oral and feeding skills that align with their growth and milestones and monitor for early signs of difficulty in these areas.

SOS (Sequential Oral Sensory) Feeding Approach

  • SOS (Sequential Oral Sensory) Feeding Approach is a therapeutic method designed to help children with feeding difficulties, including picky eating, food aversions, or feeding delays. It focuses on addressing sensory and motor challenges related to eating, designed to build a positive relationship with food, reduce anxiety around mealtime, and promote the development of healthy eating. It is especially helpful for children with sensory processing issues, autism, or other conditions that impact feeding. It should be noted that only an SOS-trained therapist can provide this approach. 
  • Key features of the SOS Feeding Approach include:
    1. Step-by-Step Sensory Exploration: The approach begins with sensory exploration of food (such as smelling, touching, or playing with food) before progressing to tasting and eating. The goal is to reduce anxiety and help children become more familiar with food through positive and enjoyable interactions.
    2. Focus on the Child’s Readiness: The SOS approach respects the child’s pace, allowing them to gradually advance through the stages of food exploration and consumption. This ensures that the process does not cause stress or resistance.
    3. Integration of Motor Skills: Since feeding involves both sensory and motor skills, the SOS approach emphasizes strengthening oral motor skills (such as chewing, biting, and swallowing) through various exercises and activities.
    4. Variety of Food Types: The approach introduces a variety of textures, tastes, and food types to encourage children to explore and expand their diet. It acknowledges that children may have a sensory preference for certain textures and works to address that through gradual exposure
    5. Positive Reinforcement: The method emphasizes using positive reinforcement and praise to build confidence in a child’s feeding abilities, rewarding progress even if it’s small.
    6. Family Involvement: The SOS approach encourages parents and caregivers to be involved in the process, helping to create a supportive and consistent feeding routine that

Feeding Disorder Prognosis

The prognosis for PFD varies depending on several factors, including:

  • Underlying Cause: Children with medical conditions may have a different prognosis than those with purely behavioral feeding difficulties. It is important to note that children are often diagnosed as having a behavioral feeding disorder, but it is often due to oral motor difficulties or an underlying medical condition. 
  • Severity of the Disorder: More severe feeding problems may require more intensive and long-term intervention.
  • Age at Intervention: Early intervention is often associated with better outcomes.
  • Consistency of Treatment: Consistent implementation of treatment recommendations at home and in other settings is essential for progress.
  • Family Involvement and Support: Active participation of the family in the treatment process is crucial.

While some children may experience rapid improvement, others may require ongoing support and intervention. It’s important to remember that progress can be gradual, and celebrating small victories is essential.