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FeedingFeedingDisorderDisorder

by:by:Alvarez, AnthonyAlvarez, Anthony

BSN 3BSN 3--D SSCTD SSCT

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Feeding DisordersFeeding Disorders

What is it?What is it?The term "feeding disorder" refers to a condition in which anThe term "feeding disorder" refers to a condition in which aninfant or child is unable or refuses to eat, or has difficultyinfant or child is unable or refuses to eat, or has difficultyeating, which can result in frequent illnesses, failure to groweating, which can result in frequent illnesses, failure to grownormally, and even death.normally, and even death.

Feeding disorders should not be confused with eatingFeeding disorders should not be confused with eatingdisorders, such as anorexia, which are more common indisorders, such as anorexia, which are more common inadolescence and adulthood.adolescence and adulthood.Some common types of feeding disorders in children includeSome common types of feeding disorders in children includeadipsiaadipsia ,, which is the absence of thirst or the desire to drink;which is the absence of thirst or the desire to drink;dysphagiadysphagia, , a real or imagined difficulty in swallowing; fooda real or imagined difficulty in swallowing; foodrefusal; inability to self refusal; inability to self- -feed; taking too long to eat; choking,feed; taking too long to eat; choking,gagging, or vomiting when eating; inappropriate mealtimegagging, or vomiting when eating; inappropriate mealtimebehavior; and picky eating according to food type and texture.behavior; and picky eating according to food type and texture.

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Who gets it?Who gets it?

ApproximatelyApproximately25% of all25% of allchildrenchildrenexperienceexperiencefeedingfeedingdisorders.disorders. HowevHowever, they are most er, they are most common incommon inchildren withchildren withdevelopmentaldevelopmentaldisabilities.disabilities.

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What causes it?There are many medical conditions that cancause feeding problems. Feeding problems often

occur in infant and children who are tube fed for extended periods of time due to some other illnessor disability.In premature infants, the underdevelopedsphincter muscle, between the stomach andesophagus, can cause the infant to spit upfrequently during feedings. Because this isuncomfortable for the child, he or she may notwant to eat.Disorders of the digestive system can also causefeeding problems, and include abnormalities of the

throat and esophagus that cause pain duringswallowing, inhaling food into the lungs(aspiration), constipation, and celiac disease, ahereditary disorder in which a cereal protein calledgluten, which is found in wheat, causes anallergic reaction that results in poor absorption of

fats from the diet.

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O ther digestiveO ther digestive- -type disorders that can causetype disorders that can causefeeding problems includefeeding problems include necrotizingnecrotizingentercolitisentercolitis ,, a condition seen mainly ina condition seen mainly inpremature newborns where the inner surface of premature newborns where the inner surface of the intestine becomes injured and inflamed;the intestine becomes injured and inflamed;HirschprungHirschprung disease,disease, in which a section of thein which a section of thelarge intestine is abnormally developed;large intestine is abnormally developed; shortshortbowel syndromebowel syndrome ;; pyloricpyloric stenosisstenosis , caused by, caused bya narrowing or blockage at the stomach outlet;a narrowing or blockage at the stomach outlet;andand gastroesophagealgastroesophageal reflux (GER),reflux (GER), whichwhichoccurs when the acid contents of the stomach flowoccurs when the acid contents of the stomach flowback, or reflux, into the esophagus.back, or reflux, into the esophagus.Feeding disorders can be caused by foodFeeding disorders can be caused by food

allergies,allergies, by difficulty with the movement of theby difficulty with the movement of themouth or tongue (mouth or tongue (oromotororomotor), or may be a cry for), or may be a cry forattention by a neglected child or a child with aattention by a neglected child or a child with a

behavioral disorder.behavioral disorder.

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W hat are the symptoms?A child with a feeding disorder may refuse to

eat or drink at all; seem to have difficulty

swallowing; be unable to feed him or herself atan appropriate age; take an abnormally longamount of time to eat; choke, gag, or vomitwhen eating; behave inappropriately atmealtime; or choose only to eat foods of acertain type, color, or texture.

Because the feeding problems occur for aprolonged period of time, the child will notgrow according to normal growth rates and

may suffer from frequent illnesses. In severecases, feeding disorders can result in death .A feeding disorder may include behavioral

problems such as hitting, biting, kicking, and vomiting at mealtime as an attention-getting

strategy .

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How is it diagnosed?How is it diagnosed?A feeding disorder is diagnosed when anA feeding disorder is diagnosed when aninfant's or child's continuing failure to eatinfant's or child's continuing failure to eatcauses inadequate weight gain or significantcauses inadequate weight gain or significantweight loss over at least a oneweight loss over at least a one- -month periodmonth periodand there is no known medical condition orand there is no known medical condition orwithholding of food that would cause thewithholding of food that would cause thefailure to eat.failure to eat.The first step is to determine if the feedingThe first step is to determine if the feedingproblems are caused by any underlyingproblems are caused by any underlyingmedical condition.medical condition. To do this, the doctor willTo do this, the doctor willcheck for disorders of the child's digestivecheck for disorders of the child's digestive

and neurological systems; for anyand neurological systems; for anyabnormalities of the ear, nose, or throat; forabnormalities of the ear, nose, or throat; forproblems with respiratory control; forproblems with respiratory control; fororomotororomotor difficulties, which relate to thedifficulties, which relate to themovement of the mouth and tongue; and formovement of the mouth and tongue; and for

any swallowing disorders.any swallowing disorders.

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T he most common test performed for children with swallowingdifficulties is called a video swallow or videofluoroscopy. In thistest, the child is given a barium solution of different consistenciesto drink. X-rays show whether the barium is swallowed or aspirated(inhaled into the lungs).

A speech pathologist usually assists with this test so he or shecan detect any swallowing abnormalities. If these tests are normaland your doctor suspects a feeding disorder, he or she will carefullystudy the child's developmental history, and perform an evaluationof the child's feeding patterns.

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What is the treatment?What is the treatment?Treatment for feeding disorders can involve a teamTreatment for feeding disorders can involve a teamincludingincluding gastroenterologistsgastroenterologists , which are doctors who, which are doctors whospecialize in the treatment of disorders affecting thespecialize in the treatment of disorders affecting thestomach and intestines;stomach and intestines; nutritionistsnutritionists , who specialize in, who specialize infood and nourishment;food and nourishment; behavioral psychologistsbehavioral psychologists , who, whohelp the parent and child with behavioral issues related tohelp the parent and child with behavioral issues related tofeeding;feeding; occupational and speech therapists,occupational and speech therapists, who canwho canevaluate and treat problems with food aversions,evaluate and treat problems with food aversions, oromotororomotor(mouth and tongue), and fine motor skills that might (mouth and tongue), and fine motor skills that might interfere with proper eating; andinterfere with proper eating; and social workerssocial workers totoprovide families with support and resources for childrenprovide families with support and resources for childrenwith these types of disorders.with these types of disorders.The first step is to treat any underlying medical conditionThe first step is to treat any underlying medical condition

that is causing a feeding problem.that is causing a feeding problem. If an infant has beenIf an infant has beentube fed for a prolonged period of time, it is unrealistic totube fed for a prolonged period of time, it is unrealistic toexpect the child to begin to feed normally soon after theexpect the child to begin to feed normally soon after thetube is removed.tube is removed. These children frequently miss aThese children frequently miss adevelopmental period in which they are ready to accept developmental period in which they are ready to accept changes in feeding methods, tastes, and textures.changes in feeding methods, tastes, and textures. They Theyalso may not recognize feelings of hunger.also may not recognize feelings of hunger.

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In these children, it is extremely important to receiveIn these children, it is extremely important to receivetherapy from an occupational, speech, or physicaltherapy from an occupational, speech, or physicaltherapist who specializes in infant feeding.therapist who specializes in infant feeding. Infants andInfants andchildren are also naturally afraid of new tastes andchildren are also naturally afraid of new tastes andtextures, calledtextures, called neophobianeophobia.. It is important to be patient It is important to be patient and continue to offer new foods in a nonand continue to offer new foods in a non- -threatening,threatening,positive manner.positive manner.O ffering infants and children new foods in a positive wayO ffering infants and children new foods in a positive way

can also help avoid picky eating later in life.can also help avoid picky eating later in life. TreatmentsTreatmentsfor children withfor children with oromotororomotor difficulties can include changingdifficulties can include changingthe position the child is in when he or she feeds.the position the child is in when he or she feeds. Food Foodaversions are treated by positively offering foods withaversions are treated by positively offering foods withdifferent consistencies.different consistencies. If your child is extremely sensitiveIf your child is extremely sensitiveto having things in his or her mouth, the speechto having things in his or her mouth, the speech

pathologist will work with the child to overcome thispathologist will work with the child to overcome thissensitivity.sensitivity.This treatment may include some type of special adaptiveThis treatment may include some type of special adaptivefeeding device.feeding device. Force feeding or coaxing a child to eat Force feeding or coaxing a child to eat with games or rewards are not recommended treatmentswith games or rewards are not recommended treatmentsfor feeding disorders and can lead to eating disorders laterfor feeding disorders and can lead to eating disorders laterin life.in life.

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S elf-care tipsP arents can help prevent feeding disorders with

no underlying medical cause by feeding their children a wide range of foods before they reachthe age of 15 to 18 months; being positive rolemodels by eating a variety of healthy foodsthemselves; making sure more healthy thanunhealthy foods are readily available to eat athome; making mealtime a relaxing, enjoyable

occasion that is free of distractions such astelevision; and emphasizing good mealtimebehaviors.

D o not provide small children with an unending supply of juice to drink throughout the day.

C hildren who take in large amounts of sugaryliquids will be less likely to have a good appetite for a variety of foods. It is also important to recognizethat a child's growth slows between the ages of oneand around four. During this time, the child maynaturally eat less.

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ENJOY EATING! =)

THANK YOU FOR LISTENING!