What is Feeding Disability in Children?
Feeding disability in children refers to a child’s inability to eat properly. This issue can cause delays in development, insufficient weight gain, and failure to grow as expected. A feeding disorder can manifest in various ways, such as a child refusing to eat certain foods or showing signs of distress like crying, vomiting, choking, or spitting up during meals. Figuring out what’s causing these problems necessitates a complete evaluation of the child’s health, social environment, feeding abilities, and any related nutritional complications.
In children with neurological disabilities like cerebral palsy, troubles with eating can also arise. This is due to the interaction between the brain and the gut’s nervous system. This interaction must be examined thoroughly to better understand the child’s health condition. Depending on how long it lasts, a feeding disability can be classified as acute (less than three months) or chronic (more than three months).
What Causes Feeding Disability in Children?
Pediatric feeding disorder, a problem where a child has difficulty eating, can be caused by many different factors. These factors can include medical conditions, changes in feeding habits, and mental health issues.
Some of the medical conditions related to pediatric feeding disorder can include problems with the muscles used for eating, a cleft lip or palate, conditions that change the shape of the face like Down syndrome, or blockages in the nasal airways. Other causes can include problems with gastrointestinal movement, acid reflux, reliance on a feeding tube, allergies, failure to gain enough weight, issues with processing sensory inputs, cerebral palsy, stroke, intellectual disability, or a short gut. Conditions such as inflammation in the esophagus or intestines can also lead to pediatric feeding disorder.
Mental health disorders can also cause a pediatric feeding disorder. These can include issues such as anorexia nervosa, binge eating disorder, bulimia nervosa, avoidant/restrictive food intake disorder, or autism.
Psychosocial-related causes are also important to consider. A child might develop aversions to certain foods, experience stress, exhibit disruptive behaviour, become overly selective with food, or graze on food throughout the day. Issues might arise if the parent or caregiver uses inappropriate feeding techniques, or if a child isn’t exposed to a variety of foods early on.
Risk Factors and Frequency for Feeding Disability in Children
In the US, between 5% to 20% of kids are diagnosed with a feeding disorder. A small fraction, 1% to 5%, of these children have what’s known as ‘failure to thrive’. This basically means they aren’t growing as they should because of their feeding problems. Kids with nerve-related disabilities, like cerebral palsy, often have stomach problems. This shows there’s a connection between the brain and the digestive system. The prevalence of these nerve-related disabilities underlines the importance of a detailed medical history.
Signs and Symptoms of Feeding Disability in Children
When a child is having trouble with eating, the first steps are to take a full medical history and perform a physical exam. This information can often lead towards a provisional diagnosis, which can be confirmed with further testing.
For a newborn with eating problems, doctors will look at details from the birth, including any delivery complications, labor length, and any abnormal ultrasound findings. They will examine the placenta, which can provide clues to potential issues like cerebral palsy or chromosomal syndromes. They also work to rule out non-chromosomal genetic syndromes with the help of genetic experts.
If the child is experiencing reflux, doctors will ask about the amount and frequency of the reflux. They will also look for signs of anatomical blockages or abnormalities in the stomach’s ability to move food properly if the child is vomiting, choking, or can’t keep down food. They will consider the age of the child for potential premature birth impact. They will also check for food allergies and unusual sensory reactions to food.
For children from the first grade up to twelfth grade, doctor’s consider their performance at school and home, and consider Autism Spectrum Disorders as a possible cause. They also look for signs of emotional stress, fussiness about food, and changes in eating habits reported by caregivers. In adolescents, they will explore potential connections to psychiatric disorders, body image issues, and eating disorders. The doctor will also ask the caregiver about how the child is fed, such as the techniques and positions used for feeding.
Common signs and symptoms of a pediatric feeding disorder can include:
- Vomiting, gagging, or choking while eating
- Refusing to eat certain types of food
- Throwing tantrums during mealtime
- Difficulty swallowing
- Reacting negatively to food, such as by turning the head away or crying
During the physical examination, the doctor will look at the child’s entire body. Specific areas of focus include the face for any unusual features, the nostrils for any blockages, and the mouth and throat for abnormalities. They will also assess the child’s tongue. An examination of the abdomen might reveal tenderness, unusual gut noises, or a palpable mass that might indicate a bowel obstruction. They will also check the child’s development and growth, and conduct a full neurologic examination to look for conditions such as cerebral palsy or stroke.
Testing for Feeding Disability in Children
If your child is having difficulty eating, doctors may recommend several tests to understand why this is happening.
One of these tests is called a barium swallow test, which involves giving your child food containing a special substance called barium. This substance shows up on X-rays or a CT scan. The test allows doctors to see if there is any physical blockage in your child’s digestive system that could be causing difficulties with eating.
Another test is a videofluoroscopic swallowing study, which allows doctors to see how your child’s throat and esophagus are functioning while he or she eats. This can help identify any problems with the mechanics of swallowing.
Esophageal manometry is another test that can help doctors understand whether the issue with swallowing is primarily due to a problem in the esophagus itself,
or due to other factors.
Endoscopic procedures, on the other hand, allow doctors to have a closer look at the throat and voice box area while your child is awake and swallowing food.
If a food allergy is suspected as the cause of your child’s feeding difficulties, doctors may recommend a food allergen test. This test can help identify specific foods that your child might be allergic to.
In some cases, a CT scan of the head might be recommended, especially if a stroke is considered a potential cause of the feeding problem.
Lastly, doctors might conduct a laboratory workup, which involves taking blood samples and other tests to understand your child’s nutritional status and check for signs of malnutrition.
Treatment Options for Feeding Disability in Children
When it comes to treating a child’s eating disorder, the main approach depends on the root cause. A team of different medical professionals is essential to properly evaluate and manage the condition. This team usually includes a doctor who specializes in the digestive system (gastroenterologist), a mental health professional (psychiatrist), a diet expert (nutritionist), a specialist who studies human behavior (behavioral analyst), a therapist who focuses on everyday activities (occupational therapist), and a therapist who helps with speech (speech therapist).
For children who display difficult behaviors, rewards (positive reinforcement) are often useful. This kind of reinforcement encourages the child to develop good eating habits. Food should be provided to the child at regular intervals and should be presented in ways that the child can easily manage. For example, if a child has reflux – a condition where stomach acid comes back up into the esophagus – proper positioning before and after meals can be beneficial. If this doesn’t work, a type of medication called proton pump inhibitors might be used.
If a child has a physical problem like a cleft lip and palate, which might interfere with eating, surgical correction could be needed. While this surgery is being planned, a feeding tube might be put in place to ensure the child is getting enough nutrients. When a child has trouble swallowing (dysfunction), the treatment might also involve surgery, depending on what’s causing the swallowing problem.
For eating disorders related to the child’s mental health (psychiatric eating disorders), therapy that involves talking about thoughts and feelings (psychotherapy) can often be the most effective method to manage the condition.
What else can Feeding Disability in Children be?
Avoidant restrictive food intake disorder (ARFID) is a condition where a person avoids certain foods or doesn’t eat enough. This could be because they don’t like the texture or taste of some foods, aren’t very interested in eating, or are worried about what might happen when they eat.
ARFID and anorexia nervosa are different in that people with ARFID don’t have a mistaken belief that they are overweight. Also, people with ARFID might be of average weight, below average, or above average, unlike other eating disorders in children where not gaining enough weight is a key sign.
What to expect with Feeding Disability in Children
The chances of improvement heavily rely on the reason behind feeding difficulties. When the root cause is conditions like GERD (a gastroesophageal reflux disease that causes heartburn), constipation, delays in food emptying from the stomach, premature birth, or any physical blockages in the body, the overall chances of getting better are usually high.
However, addressing behaviors and feeding skills can take a longer time for a child to get used to normal, healthy eating patterns.
Possible Complications When Diagnosed with Feeding Disability in Children
If a child’s feeding disorder is not addressed quickly, it can lead to several problems:
- Failure to thrive – this is when a child does not grow or develop properly.
- Poor weight gain – not putting on weight as expected.
- Scurvy – a disease caused by a lack of vitamin C.
- Malnutrition – not getting enough nutrients.
- Cognitive impairment – problems with thinking, learning, and memory.
- Choking – when food or a foreign object blocks the airway.
- Aspiration – where food or liquid goes into the airways or lungs instead of the stomach.
- Bradycardia – a slower than normal heart rate.
- Apnea – periods when breathing stops during sleep.
- Dependence on a feeding tube – needing a tube to get nutrients and fluids.
- Aversion to social gatherings involving food – not wanting to take part in social events where food is involved.
Preventing Feeding Disability in Children
The parents or caregivers of a child play a critical role in managing their health. They are informed about how to recognize feeding difficulty in their child, which may present as vomiting, gagging, or food coming back up. They are also taught the correct way to position their child during feedings to prevent these issues.
Additionally, they are educated on the right way to feed a child. Parents and caregivers are also briefed on indications of potentially dangerous situations like aspiration, which is when food or liquid enters the airways, or sudden trouble breathing. They are advised to immediately take the child to the hospital’s emergency department if these symptoms are observed.
Furthermore, parents and caregivers are given information about the likely reasons for these symptoms and the treatment plans that may be used. They are also provided guidance on managing the stress they may experience during the child’s treatment journey.