A Practical Approach to Classifying and Managing Feeding Difficulties

Abstract

Many young children are thought by their parents to eat poorly. Although the majority of these children are mildly affected, a small percentage have a serious feeding disorder. Nevertheless, even mildly affected children whose anxious parents adopt inappropriate feeding practices may experience consequences. Therefore, pediatricians must take all parental concerns seriously and offer appropriate guidance. This requires a workable classification of feeding problems and a systematic approach. The classification and approach we describe incorporate more recent considerations by specialists, both medical and psychological. In our model, children are categorized under the 3 principal eating behaviors that concern parents: limited appetite, selective intake, and fear of feeding. Each category includes a range from normal (misperceived) to severe (behavioral and organic). The feeding styles of caregivers (responsive, controlling, indulgent, and neglectful) are also incorporated. The objective is to allow the physician to efficiently sort out the wide variety of conditions, categorize them for therapy, and where necessary refer to specialists in the field.Parents of young children worldwide are concerned about feeding difficulties. When asked, more than 50% of mothers claim that at least 1 of their children eats poorly; this implicates ∼20% to 30% of children.

What’s the fuss about? Parent presentations of fussy eating to a parenting support helpline

“…Conversely, qualitative studies provide a contextual, first-hand account of how parents describe specific feeding concerns that can capture emotional content (14) . Parental feeding concerns can manifest in anxiety that adversely impacts the child-parent relationship (15) . For example, mothers of children who are difficult to feed experience more negative emotions and use 'nonresponsive' feeding practices, such as using liked food as a reward, pressuring and offering alternatives (16) .…”

Dificuldades na introdução de alimentos complementares ao aleitamento materno em bebês não disfágicos: efeitos da atuação fonoaudiológica

“…Porém, tais informações não lhes possibilitavam considerar aspectos relacionados à dinâmica de interação mãe/ bebê durante a cena alimentar cotidiana, como sugere a literatura 11,12,13 . Vale ressaltar que, exceto o Caso III, todas as mães relataram alguma questão relacionada à alimentação de seu filho primogênito.…”

“…Quando o bebê é inserido num ambiente em que não promove oportunidades de novas vivências, o processo de integração sensorial pode ser prejudicado 7,8,9,10 . Seguindo essa perspectiva que este estudo foi desenvolvido, a saber: na consideração de fatores biopsíquicos presentes na cena de alimentação 11,12,13 . Podemos destacar os casos de bebês que se recusam ao desmame, não necessariamente o problema se limita aos aspectos orgânicos (bio), mas envolve a interação estabelecida entre mãe e bebê (psíquicos).…”

Feeding difficulties are not associated with higher rates of iron deficiency anemia in Brazilian children and adolescents—cross-sectional study

“…Parallel to anemia, feeding difficulties (FD), a group of several eating complaints common during early childhood [7,8], affect approximately 25% of healthy children and up to 80% of children with gastrointestinal and developmental issues [9,10]. According to Kerzner et al [7], FD can be divided into groups of similar behaviors, such as: "Children with limited appetite": ranges from children who eat appropriately but appear to eat too little (misperception), to those with overt organic disease that impact on appetite.…”

“…According to Kerzner et al [7], FD can be divided into groups of similar behaviors, such as: "Children with limited appetite": ranges from children who eat appropriately but appear to eat too little (misperception), to those with overt organic disease that impact on appetite. "Agitated children": children with limited appetite or food refusal, generally caused by lack of interest in food, and more on environmental stimuli.…”