Pediatric Feeding Disorder - It’s Not “Picky Eating”

feedingdisorders
Written By Jeff Bohrer

May is Pediatric Feeding Disorders Awareness Month.

Are you concerned with the variety of food that your child consumes? Does your child demonstrate challenges with eating and/or drinking foods? Does your child present with difficult behaviors at mealtimes? These may be signs of Pediatric Feeding Disorder. 

At Aspire, our team of professionals are available to assist with diagnosing and treating pediatric feeding disorders. Please contact us if you have any questions or would like to schedule an evaluation.

Pediatric Feeding Disorder (PFD) is impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction. 

PFD is different from an eating disorder, such as anorexia or bulimia, which is primarily influenced by psychological factors and develops in adolescence and young adulthood.

PFD is also different from picky eating. Many toddlers experience a phase of picky eating when they need fewer calories than during months when they were growing faster. This decrease in appetite coupled with their curiosity about boundaries can lead to fussy eating. Picky eating (also known as fussy, faddy or choosy eating) is characterized by an individual’s unwillingness to eat familiar foods or to try new foods, as well as strong food preferences. The consequences may include poor dietary variety during early childhood. When picky eating persists or becomes more extreme, these behaviors could be a sign of another underlying condition, such as pediatric feeding disorder (PFD).

Signs & Symptoms of PFD: 

Medical 

  • labored breathing with and without feeding 

  • color changes in lips or face when eating or drinking 

  • sweating when eating or drinking 

  • gurgle or squeaking sounds with and without feeding 

  • recurrent upper respiratory infections 

  • crying, arching, coughing, grimacing when eating or drinking 

  • suspected food allergies 

  • multiple formula changes 

  • vomiting 

  • never seems hungry 

Nutrition 

  • unable to eat or drink enough to grow or stay hydrated 

  • insufficient or too rapid of a change in weight or height 

  • lack of a certain nutrient, i.e., iron, calcium 

  • need for nutritional supplements 

  • reliance on a particular food for nutrition 

  • need for enteral feeds for nutrition-NG, GT, TPN 

  • constipation 

  • limited dietary diversity for age 

    • too few fruits and/or vegetables 

    • limited or no protein source 

    • too few foods eaten on a regular basis

Feeding Skill (over 12 months of age) 

  • labored, noisy breathing or gasping 

  • coughing, choking, gagging or retching 

  • gurgles or wet breaths 

  • loud and/or hard swallows or gulping 

  • unable to eat or drink enough for optimal growth 

  • excessively short mealtimes (< 5 minutes) 

  • excessively long mealtimes (> 30 minutes) 

  • need for thickened liquids 

  • need for special food or modified food texture 

  • need for special strategies, positioning or equipment 

  • grazing between scheduled mealtimes 

  • refusal to eat, drink or swallow certain food textures 

  • needs distraction to eat such as screen time 

  • needs excessive praise/threats/bribes to eat 

  • difficulty chewing age-appropriate foods 

  • unable to eat in new or unfamiliar situations 

Psychosocial 

  • unable to come to or stay with the family at meals 

  • refusal to eat what is offered or to eat at all 

  • disruptive mealtime behaviors 

  • unable to eat with others present at mealtimes 

  • child stress, worry or fear during meals 

  • caregiver stress, worry or fear when feeding child 

  • presence of bribes, threats, yelling at mealtimes 

  • need for distraction and/or rewards for eating 

  • unpleasant mealtime interactions between caregiver and child


If you have concerns about your child’s feeding, know that you are not alone. Early detection and treatment of PFD is essential to the long-term health and well-being of affected children.

Who Can Help Me Understand How to Support My Child’s Feeding?

Pediatric feeding disorder is best diagnosed by a team of professionals including medical providers, occupational therapists, speech therapists, clinical dietitians, and pediatric psychologists. These people should all have special training in feeding disorders in children. Your pediatrician can make a referral to a feeding clinic specializing in feeding disorders.

Children who are picky eaters do not always need the support of a medical provider or dietitian. Some picky eaters may benefit from therapy with feeding therapists and/or psychologists if the problems are causing significant stress. Not all picky eaters need therapy. It’s best to start by talking to your pediatrician about your concerns.

Young adults with eating disorders may benefit from psychotherapy, medical care and monitoring, nutritional counseling, medications, or a combination of these approaches. Please speak with your pediatrician for a referral and/or more information if you suspect your child struggles with an eating disorder.

At Aspire, our team of professionals are available to assist with diagnosing and treating pediatric feeding disorders. Please contact us if you have any questions or would like to schedule an evaluation.

About the author: Alison Polzin, CCC-SLP, is a licensed speech-language pathologist and team lead at Aspire. She has both interest and experience diagnosing and treating feeding disorders within the pediatric population. Alison has participated in additional training to further her knowledge and skillset regarding pediatric feeding disorders and is committed to implementing both client-focused and evidence-based approaches when working with families. 

Jeff Bohrer
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