Feeding disorder of infancy o... Health Article

Definition

Feeding disorder of infancy or early childhood is characterized by the failure of an infant or child under six years of age to eat enough food to gain weight and grow normally over a period of one month or more. The disorder can also be characterized by the loss of a significant amount of weight over one month. Feeding disorder is similar to failure to thrive, except that no medical or physiological condition can explain the low food intake or lack of growth.

Description

Infants and children with a feeding disorder fail to grow adequately, or even lose weight with no underlying medical explanation. They do not eat enough energy or nutrients to support growth and may be irritable or apathetic. Factors that contribute to development of a feeding disorder include lack of nurturing, failure to read the child's hunger and satiety cues accurately, poverty, or parental mental illness. Successful treatment involves dietary, behavioral, social, and psychological intervention by a multidisciplinary team of health professionals.

Causes

Feeding disorder of infancy or early childhood can occur with inappropriate parent-child interactions, such as failure to read the child's hunger cues or forcing food when the child is not hungry. Lack of nurturing and/or parental aggression, anger, or apathycan make eating a negative experience for the child, increasing the risk of feeding disorders.

Feeding disorders are more common in infants and children who are born prematurely, had a low birth weight, or who are developmentally delayed. Many medical (or physiological) causes can contribute to eating difficulties, eating aversions, or failure to thrive, including:

• diseases of the central nervous system
• metabolic diseases
• sensory defects
• anatomical abnormalities, such as cleft palate
• muscular disorders, such as cerebral palsy
• heart disease
• gastrointestinal diseases, such as Crohn's disease

To meet criteria for a true feeding disorder of infancy or childhood, these medical conditions must be ruled out.

Symptoms

Because the child or infant with a feeding disorder is not consuming enough energy, vitamins, or minerals to support normal growth, symptoms resemble those seen in malnourished or starving children. The infant or child may be irritable, difficult to console, apathetic, withdrawn, and unresponsive.

Delays in development, as well as growth, can occur. In general, the younger the child, the greater the risk of developmental delays associated with the feeding disorder.

Laboratory abnormalities may also be associated with the disorder. Blood tests may reveal a low level of protein or hemoglobin in the blood. Hemoglobin is an iron-containing substance in blood that carries oxygen to body cells.

Demographics

Although minor feeding problems are common in infancy and childhood, true feeding disorder of infancy or early childhood is estimated to occur in 1% to 3% of infants and children. Children separated from their families or living in conditions of poverty or stressare at greater risk. Mental illness in a parent, or child abuse or neglect, may also increase the risk of the child developing a feeding disorder.

Diagnosis

Between 25% and 35% of normal children experience minor feeding problems. In infants born prematurely, 40% to 70% experience some type of feeding problem. For a child to be diagnosed with feeding disorder of infancy or early childhood, the disorder must be severe enough to affect growth for a significant period of time. Generally, growth failure is considered to be below the fifth percentile of weight and height.

Feeding disorder of infancy or early childhood is diagnosed if all four of the following criteria are present:

• Failure to eat adequately over one month or more, with resultant weight loss or failure to gain weight.
• Inadequate eating and lack of growth not explained by any general medical or physiological condition, such as gastrointestinal problems, nervous system abnormalities, or anatomical deformations.
• The feeding disorder cannot be better explained by lack of food or by another mental disorder, such as rumination disorder.
• The inadequate eating and weight loss or failure to gain weight occurs before the age of six years. If feeding behavior or weight gain improves when another person feeds and cares for the child, the existence of a true feeding disorder, rather than some underlying medical condition, is more likely.