Paediatric Feeding Disorder

Ψ Anatomical or neuromuscular issues

A physical or movement issue within a child’s oral structures can hinder their ability to eat well, causing them to experience difficulties holding, chewing, or swallowing the food in their mouths. This can result in feeding avoidance that may persist after their physical issues have been resolved.

Potential signs: Choking or gagging while eating or drinking, having difficulties with breastfeeding, having food or liquid coming out of their mouths or noses when eating or drinking.

Ψ Gastrointestinal conditions

A medical condition within a child’s digestive system, such as the stomach or intestines, can cause the child to associate eating with unpleasant sensations such as pain, vomiting or diarrhoea. As a result, the child may avoid food to avoid these experiences.

Potential signs: Vomiting, diarrhoea, frequent complaints of pain or discomfort after eating.

Ψ Sensory aversion

A child may experience difficulties accepting food that has a certain texture, look, smell or taste. These may be caused by issues such as oral motor difficulties, sensory sensitivity and/or rigidity.

Potential signs: The child avoids foods of certain textures and may be known as a “picky eater”, taking only a restricted variety of food.

Ψ Environmental factors

Inconsistent mealtimes, replacement of refused food with highly desired food, and resorting to means such as distractions during meals can result in the unintentional reinforcement of inappropriate behaviours. For instance, behaviours such as spitting, crying or food refusal might be maintained through reinforcement such as receiving extra parental attention or bribery via tangible rewards (e.g. iPad or television shows).

Potential signs: Refusing to eat, disruptive behaviour at mealtimes, eating only with distractions present.

Ψ Psychosocial factors

Feeding is a shared experience between the child and caregiver, and any underlying mental or emotional challenges can affect the feeding experience. In a child, issues such as mood disorders, anxiety, emotional dysregulation and disordered thinking can give rise to feeding disorders. In a caregiver, increase in stress, controlling behaviour and/or other mental health conditions can affect their approach to feeding. This often results in unpleasant mealtime interactions which in turn affect a child’s feeding behaviour.

Potential signs: Disruptive mealtime behaviour, prolonged mealtimes, food selectivity, onset of problems after a major life change (e.g. divorce, loss of a loved one).

Ψ Speech Therapist

• Assess the child to determine the contributing causes to feeding issues and recommend therapy or other interventions to help the child enjoy eating.

• Assist with safe and adequate intake of nutrition and hydration.

• Provide strategies and exercises for improving muscle tone and/or oral motor control.

• Advice optimum feeding methods and techniques to maximize swallowing safety and reduce choking.

• Collaborate with family to incorporate dietary preferences.

• Reference a Feeding Progression Milestone Guide

Ψ Occupational Therapist

• Determine whether the child’s feeding behaviour is due to oral-motor and/or oral-sensory issues.

• Promote safe and efficient eating and drinking by improving the skilled movement of the mouth.

• Improve coordination and overall muscular tone with a child’s oral/facial muscles.

• Focus on fine motor skills to develop coordination of more precise movements between the eyes, shoulders, arms, and hands.

• Strengthen head and trunk control to build the foundation for breathing, eating, and swallowing.

• Provide strategies for improving sensory experiences of eating, such as incorporating all the child’s senses in an organized way during eating.

• Assist children in becoming more comfortable with a variety of diverse food textures.