Feeding disorder of infancy and early childhood is commonly diagnosed if your child meets the following diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR):
- He or she is six years old or younger.
- There is no gastrointestinal or other medical condition causing the eating problem.
- The problem is not caused by a mental disorder or the unavailability of food.
- The child is not eating an adequate amount of food, which means the child is not following the normal weight gain curve for his or her age, or he or she has lost a considerable amount of weight in one month or more (BC Medical Journal).
However, if your child is not eating adequately but is at a normal weight for his or her age, you should still make an appointment with your child’s pediatrician. Doctors in the medical community are currently discussing and revising some of these diagnostic criteria due to factors such as this one. In fact, recent statistics show that between 25 and 45 percent of otherwise normal-developing infants have feeding problems (Bryant-Waugh, Markham, Kreipe, & Walsh, 2010).
Sometimes feeding disorders continue from infancy into early childhood. This condition may be noticeable from birth, or it may appear suddenly, often in response to psychological or environmental triggers.
Many cases of poor weight gain (also called failure to thrive) and malnutrition are due to an underlying condition relating to your child’s stomach, metabolism, or other factors. Sometimes, no physical condition can be identified.
Nonmedical causes for a child’s inadequate eating habits may include the following:
- Your child is fearful or stressed about something.
- Your fear is afraid to eat due to a past traumatic incident, like choking.
- Your child is not receiving adequate or healthy emotional care from his or her parent or primary caregiver, due to caregiver alienation or aggression. For example, a child may feel afraid of his or her parent’s temper, or the parent may suffer from a deep depression and may withdraw from the child.
- Your child just doesn’t like foods of certain textures, tastes, or smells.
Many of the signs of this condition are similar to symptoms of other conditions that may cause your child to become malnourished. Regardless of how healthy you think your child is, you should seek medical attention if you notice that your child:
- appears underweight
- does not eat as frequently (or as much) as he or she should
- is often irritable and cries frequently
- seems mentally distressed or withdrawn
- struggles to pass bowel movements and/or seems to be in pain when doing so
- often seems tired and sluggish
- vomits frequently
- lacks age-appropriate social skills and tends to shy away from others
Seek emergency care any time your child is unresponsive or has a seizure.
Sometimes feeding disorder of infancy and early childhood is mild. Your child may not have many symptoms of malnourishment and may appear to simply be a picky eater. However, let your child’s pediatrician know about your child’s eating habits during your next checkup because the absence of certain foods and vitamins in your child’s diet can lead to more serious vitamin deficiencies or even decreased oral motor skills. Your child’s doctor may need to do a more detailed exam so he or she can figure out how to best help your child receive these important vitamins.
Your child will likely be diagnosed with feeding disorder if:
- he or she has not gained weight, or has actually lost weight, for at least one month
- he or she does not have an underlying medical or mental condition causing the disorder
- he or she is not lacking available food (i.e. food is readily available)
- This condition emerged before your child’s sixth birthday. Older children may be diagnosed with other conditions, such as anorexia (BC Medical Journal).
If your child appears to have this condition, have him or her checked by a doctor. This disorder may also be discovered at regular well-baby and well-child checkups. Your doctor will weigh and measure your child, and the figures will be plotted on a chart and compared with national averages. If your child weighs much less than most other children of the same age and gender, your doctor may do more testing. Testing may also be necessary if there is a sudden change in your child’s growth pattern.
If the doctor decides your child is underweight or malnourished, he or she will run blood and urine tests or do imaging to screen for conditions that may be restricting your child’s growth. If your doctor does not find an underlying condition, you may be asked about feeding habits, family environment, and your child’s behavior. Based upon this conversation, your doctor may refer you and your child to any of the following:
- a psychologist (to study family relationships and your child’s possible anxiety or depression)
- a dietitian (for nutritional counseling)
- a speech or occupational therapist (to learn if there is delayed oral motor skill development)
If it is believed that your child’s malnutrition is due to neglect, abuse, lack of nutritional knowledge, or poverty, a social worker and/or child protection official may be sent to work with you and your family.
In an emergency situation, hospitalization may be required. While there, your child may need a feeding tube to receive adequate nutrition.
Many cases of feeding disorders are addressed before hospitalization is necessary. Nutritional counseling and/or regular meetings with specialists are sometimes all that is needed to overcome your child’s feeding disorder. Treatment is often done in a team approach between you, other caregivers, your pediatrician, and professionals such as dietitians, therapists, and social workers.
Often, your child will be placed on a specific diet and/or prescribed nutritional supplements. This will help him or her catch up to a recommended weight while undergoing treatment. Once vitamin and mineral deficiencies are addressed, your child may become more alert, and regular feeding may become easier.
If feeding disorder of infancy and early childhood is addressed as soon as your child begins to lose weight or show symptoms of persistently inadequate eating, the condition is usually mild and resolved easily with minimal long-term impact. If left untreated, however, feeding disorders can lead to delayed physical and mental development that may stay with your child for life. For instance, when certain foods are not part of your child’s diet, nutrition and oral motor development can be affected. This can lead to speech delays or long-term problems with eating foods that have similar tastes or textures (BC Medical Journal).
In the most severe cases, feeding disorders can cause death from lack of nutrition.