Root Causes of Feeding Difficulties and the Importance of Collaborative Care

By Argie Pitsakis CCC-SLP, CLC

Are you struggling to manage your child’s feeding difficulties? You are not alone– nearly 50% of parents report their children have feeding-related issues (3-6). Some feeding challenges are a product of the environment and can be improved with a few changes in strategy or routine, while others can be more complex and require the support and intervention of healthcare experts.

In this blog, we will:

1. Clarify the difference between feeding difficulties and feeding disorders

2. Unpack the two main causes of feeding disorders

3. Explain why collaborating with multiple healthcare providers is key for effective intervention and progress for your child 

Whether your child’s feeding difficulties stem from external circumstances, internal factors, or a combination of both, Kids Feeding Wellness has resources and strategies to help you tackle the journey with confidence.

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Feeding Difficulties vs Pediatric Feeding Disorders 

Feeding difficulty is a broad term covering all issues related to feeding in children, regardless of their cause, severity, or effects. It includes problems like meals taking too long, refusing food, stressful mealtimes, difficulty feeding independently, eating at night, using distractions to eat, prolonged breastfeeding or bottle-feeding, and not moving on to more advanced textures. 

A pediatric feeding disorder is identified when a child consistently struggles with eating which impacts their ability to eat according to their developmental age. This diagnosis is made if feeding challenges affect the child's:

• Medical well-being, resulting in difficulties like breathing problems or aspiration, where food or liquids enter the lungs.

• Nutritional health, making it hard for the child to get enough nutrients from their diet, often necessitating oral or tube supplementation.

• Feeding skills or oral motor development, requiring modifications to food or need for specialized equipment or strategies for eating.

• Emotional and social (psychosocial) wellness, causing food or mealtime avoidance and causing stress and strain on family relationships.

To learn more about Pediatric Feeding Disorders visit: https://www.feedingmatters.org/

Two Forms of Feeding Disorders 

Feeding disorders are commonly classified into two categories: "organic" and "non-organic," based on the underlying causes contributing to the disorder. 

Below are descriptions and examples of each type of disorder:

Organic Feeding Disorders

This refers to feeding difficulties that arise from identifiable medical or physiological conditions. These conditions could include structural issues, gastrointestinal problems, neurological disorders, or genetic conditions. Essentially, there's a clear physical or medical reason for the feeding difficulties.

Gastrointestinal diseases

Tongue tie

Cleft lip or palate

Conditions related to the esophagus (narrowing or underdeveloped)

Cardiorespiratory problems

Metabolic dysfunction

Neurological conditions

Traumatic brain injury (TBI)

Premature birth

Intrauterine growth restriction

Non-organic Feeding Disorders

Non-organic feeding disorders are characterized by feeding difficulties that do not have an apparent medical or physical cause. These disorders may be influenced by factors such as behavioral issues, feeding experiences, parent-feeding approaches, environmental factors, psychological factors, and/or social factors.

Typical childhood feeding behaviors misperceived as feeding problems by caregivers

Appropriate nutritional intake mistakenly perceived as too low or high by caregivers

Delayed introduction to solids

Oral motor difficulties

Sensory processing difficulties

Caregiver feeding practices that are either too controlling or too permissive

Negative mealtime experiences

Traumatic events during feeding transition (e.g., vomiting, gagging, or choking)

Past organic causes that created negative associations and food refusal

Identifying the underlying causes of feeding disorders is crucial, as they can stem from organic, non-organic, or a combination of both factors. These disorders often present with overlapping symptoms, making accurate diagnosis and effective management challenging without pinpointing the root causes.

Importance of Collaboration 

Due to the complexity of feeding disorders, it is critical to collaborate with healthcare providers who each provide a piece of the puzzle in identifying and managing the root cause of your child’s feeding difficulties. This collaborative effort ensures that all aspects of your child's feeding issues are thoroughly examined and addressed, leading to more effective intervention strategies and improved outcomes.

Free Resource!
Navigate feeding and oral function

challenges with confidence.

If your child is exhibiting signs or symptoms of feeding difficulties or an Orofacial Myofunctional Disorder (OMD), our guide 'Partnering for Progress' is an essential resource. Gain insights into the key healthcare providers who actively identify root causes and effectively communicate your concerns with your child’s doctor to address symptoms promptly.

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References

1. Delaney AL, Arvedson JC. Development of swallowing and feeding: prenatal through first year of life. Dev Disabil Res Rev (2008) 14(2):105–17. doi:10.1002/ ddrr.16 

2. Davies WH, Satter E, Berlin KS, Rudolph CD. Reconceptualizing feeding and feeding disorders in interpersonal context: the case for relational disorder. J Fam Psychol (2006) 20(3):409–17. doi:10.1037/0893-3200.20.3.409

3. Carruth BR, Ziegler PJ, Gordon A, Barr SI. Prevalence of picky eaters among infants and toddlers and their caregivers’ decisions about offering a new food. J Am Diet Assoc. 2004; 104(1 suppl 1):s57–s64 

4. Jacobi C, Agras WS, Bryson S, Hammer LD. Behavioral validation, precursors, and concomitants of picky eating in childhood. J Am Acad Child Adolesc Psychiatry. 2003;42(1):76–84 

5. Wright CM, Parkinson KN, Shipton D, Drewett RF. How do toddler eating problems relate to their eating behavior, food preferences, and growth? Pediatrics. 2007;120(4). Available at: www.pediatrics.org/cgi/content/full/120/ 4/e1069

6. Saarilehto S, Lapinleimu H, Keskinen S, Helenius H, Talvia S, Simell O. Growth, energy intake, and meal pattern in five-year-old children considered as poor eaters. J Pediatr. 2004;144(3):363–367

• Blog Post References

  Delaney AL, Arvedson JC. Development of swallowing and feeding: prenatal through first year of life. Dev Disabil Res Rev (2008) 14(2):105–17. doi:10.1002/ ddrr.16

  Davies WH, Satter E, Berlin KS, Rudolph CD. Reconceptualizing feeding and feeding disorders in interpersonal context: the case for relational disorder. J Fam Psychol (2006) 20(3):409–17. doi:10.1037/0893-3200.20.3.409

  Carruth BR, Ziegler PJ, Gordon A, Barr SI. Prevalence of picky eaters among infants and toddlers and their caregivers’ decisions about offering a new food. J Am Diet Assoc. 2004; 104(1 suppl 1):s57–s64

  Jacobi C, Agras WS, Bryson S, Hammer LD. Behavioral validation, precursors, and concomitants of picky eating in childhood. J Am Acad Child Adolesc Psychiatry. 2003;42(1):76–84

  Wright CM, Parkinson KN, Shipton D, Drewett RF. How do toddler eating problems relate to their eating behavior, food preferences, and growth? Pediatrics. 2007;120(4). Available at: www.pediatrics.org/cgi/content/full/120/ 4/e1069

  Saarilehto S, Lapinleimu H, Keskinen S, Helenius H, Talvia S, Simell O. Growth, energy intake, and meal pattern in five-year-old children considered as poor eaters. J Pediatr. 2004;144(3):363–367