Pediatric feeding disorders are common: 25% of children are reported to present with some form of feeding disorder. This number increases to 80% in developmentally delayed children. Consequences of feeding disorders can be severe, including growth failure, susceptibility to chronic illness, and even death. Feeding disorders occur in children who are healthy, who have gastrointestinal disorders, and in those with special needs. Most feeding disorders have underlying organic causes. However, overwhelming evidence indicates that abnormal feeding patterns are not solely due to organic impairment. As such, feeding disorders should be conceptualized on a continuum between psycho-social and organic factors. Disordered feeding in a child is seldom limited to the child alone; it also is a family problem. Assessment and treatment are best conducted by an interdisciplinary team of professionals. At minimum, the team should include a gastroenterologist, nutritionist, behavioral psychologist, and occupational and/or speech therapist. Intervention should be comprehensive and include treatment of the medical condition, behavioral modification to alter the child's inappropriate learned feeding patterns, and parent education and training in appropriate parenting and feeding skills. A majority of feeding problems can be resolved or greatly improved through medical, oromotor, and behavioral therapy. Behavioral feeding strategies have been applied successfully even in organically mediated feeding disorders. To avoid iatrogenic feeding problems, initial attempts to achieve nutritional goals in malnourished children should be via the oral route. The need for exclusive tube feedings should be minimized.

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Two mentally retarded boys with autism and one mentally retarded girl with Down syndrome were taught to initiate and play a ball game with an adult confederate. The program targeted both nonverbal responses related to the actual execution of the ball game as well as verbal responses for play initiation and providing compliments for the confederate's behavior. Training sessions provided ample practice in all aspects of the game from initiation to termination through use of brief play cycles. Instruction was provided using a combination of physical and verbal prompts as well as reinforcement and time-out. All three children learned the game and by the study's completion executed multiple play cycles each session. The implications of combining play and social skills training in programming for developmentally handicapped children are discussed.