Feeding & Eating in Pediatrics

Feeding

The act of bringing food to the mouth

Eating

Manipulating food in the mouth (chewing, tasting)

Swallowing

The complex action of moving food from the mouth to the stomach 

What are some components or systems of comprehensive feeding and eating assessment and intervention?

• Multidisciplinary: Often includes a PCP, nutrition/dietician, SLPs, OTs, Psychology, Child life (and radiology for swallow studies)

• Holistic and comprehensive 

• Safety and well-being of child 

• Various settings including inpatient (+NICU), outpatient, group, telehealth

What are the types of feeding difficulties in children? - Picky Eating

(50%): Typical and temporary phase. Developmentally normal (i.e., “I hate broccoli”) 

What are the types of feeding difficulties in children? - Selective Eating

Includes an ongoing pattern of restrictive eating where food range may be limited to under 25 foods. (May consider clinical evaluation if eating impacts wellbeing)

What are the types of feeding difficulties in children? - Pediatric Feeding Disorders

(3-4%): Considered a medical feeding disorder with difficulties in one or more domains (nutritional, medical, psychological, and feeding skill challenges)

What are the types of feeding difficulties in children? - Avoidant/Restrictive Feeding Intake Disorder (ARFID)

(0.5-5%): Considered a psychiatric eating disorder, characterized by a restrictive intake without body image concerns or underlying medical or skill issue (Restriction results from sensory sensitivities, fear of adverse consequences, or low interest in eating)

What are some sensory considerations when working on feeding and eating with children?

• Tactile Sensitivity 

• Oral Hypersensitivity 

  • Appearance, texture, taste, smell 

  • Gradual oral sensory exploration 

  • Use play and positive experiences to progress 

  • “School food”

  • S.O.S (Sequential oral sensory) approach 

• Calming Strategies (e.g., for infants, swaddling or pacifier 

• Food chaining

• Routines 

• Environmental adaptions 

What is food chaining?

A structured, step-by-step feeding strategy designed to expand a picky eater’s diet by introducing new foods that are similar in taste, texture, or temperature to foods they already accept

What are some red flags for feeding and eating issues?

1. Ongoing poor weight gain, weight loss 

2. Ongoing choking, gagging, coughing during means

3. Ongoing problems with vomiting 

4. More than one incident of gastronasal reflux 

5. History of traumatic choking incident 

6. History of eating + breathing problems, with ongoing respiratory issues 

7. Instability to transition to baby food purees by 10 months 

8. Inability to accept any table food solids by 12 months 

9. An infant who cries and or arches at most meals 

10. Family is fighting about food/feeding 

11. Parents repeatedly report the child as difficult for everyone to feed. 

12. Inability to transition to a cup by 16 months

13. Parent history of eating disorder + child with poor weight gain 

14. Has not weaned off most/all baby foods by 16 months 

15. Aversion/avoidance of all foods in specific texture group 

16. Food range <20 foods, especially if foods are being dropped.

What are the general categories for the steps to eating?

1. Tolerates 

2. Interacts with 

3. Smells 

4. Touch 

5. Taste

6. Eating

What is a food jag?

a common childhood eating behavior where a child demands to eat only one specific food, or a very small group of foods, prepared the same way for every meal, often daily or weekly