Assessment of pediatric feeding disorders

Eating is a genetically pr ogrammed behavior that is necessary for survival. But eating has a larger role in human behavior in that it forms the backdrop for many of the social interactions individuals have with one another. In fact, most of our major life events (e.g., birthdays, anniversaries, retirement) are marked in the context of food, and food often dominates our cultural (e.g., Thanksgiving) and religious (e.g., Christmas, Bar Mitzvah) celebrations (Ivanovic et al., 2004). But what happens when eating is dysfunctional? How does disordered eating affect both the physiological and socioemotional functioning of humans, particularly when those problems emerge in infancy? The purpose of this chapter is to describe the various eating problems that occur in children and discuss how eating problems are assessed in children. The term feeding disorder is used to describe dysfunctional eating that occurs in childhood. By contrast, eating disorder is the diagnostic label for dysfunctional eating in adolescents and young adults (which is covered elsewhere in this volume). The characteristics of a feeding disorder are heterogeneous, which has made the development of a diagnostic nosology difficult. That is, children with feeding disorders may display a wide variety of behaviors such as refusal to eat, refusal to eat certain types or textures of food, dependence on a limited or developmentally inappropriate source of nutrition (e.g., bottle dependence in a three-year-old), and skill deficits such as inability to self-feed. Problematic feeding behavior may occur in isolation or in combination with a variety of medical (gastroesophageal reflux disease), oral motor (apraxia), or behavioral (tantrums) issues.