Don't worry, he'll grow out of it. This Statement represents one of the most commonly delivered pieces of advice given to parents of young children who have difficulties at mealtime. As indicated in the chapter on the Assessment of Pediatric Feeding Disorders, the feeding difficulties of most children do, in fact, resolve over time. However, there are some children whose feeding problems will not resolve without intervention, and it is on these children that this chapter is focused. The data from our interdisciplinary Pediatric Feeding Disorders Program at the Munroe-Meyer Institute at the University of Nebraska Medical Center shows that the mean age of children referred for assessment and treatment of severe feeding problems is three. We think that it is about this time that parents and professionals realize that the child is not going to grow out of it and therefore, needs treatment. Eating is a complex process, consisting of a chain of behaviors that begins with accepting solids or liquids into the mouth, retaining solids or liquids in the mouth, forming a bolus of the solids and liquids, chewing solid food (when necessary), swallowing the solids or liquids, and retaining the solids and liquids in the gastrointestinal tract. Dysfunctional eating may be the result of difficulties anywhere along this chain of behaviors. Thus, an important first step in the successful treatment of children with feeding problems is to identify which specific behaviors are problematic for the child and then to set measurable goals for those individual behaviors. &$$$;Goals should be individualized for each child. Some examples of measurable goals might be to increase oral intake of solids and liquids to 100% of the child's caloric and nutritional needs. This might be an appropriate goal for a child who is failing to thrive due to insufficient intake. Another goal might be to increase acceptance of 16 new foods (four from each of the food groups: fruit, proteins, starches, vegetables) to greater than 90%. This might be an appropriate goal for a child who is a selective eater (e.g., a child who only eats French fries). Other goals might focus on decreasing inappropriate behavior, increasing levels of swallowing, and teaching chewing or self-feeding to name a few.
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