Feeding Disorders In Early Childhood

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Feeding Disorders In Early Childhood
Feeding Disorders In Early Childhood
Video: Feeding Disorders In Early Childhood
Video: Understanding Pediatric Feeding Disorders 2023, February
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Feeding & Eating Disorders in Early Childhood

At the beginning of life, babies have to learn to regulate themselves, in the second half of their life the little ones have to face further developmental tasks, e.g. eating with a spoon. When children begin to want to eat independently, new challenges arise again. "Power struggles" with parents at the dining table are possible.

In many cases, it is not easy to set the limits so that feeding is not too strict but also does not get out of control. If infants or small children repeatedly refuse to eat or show no desire to drink or eat, this is a warning signal.

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  • What is a feeding disorder?
  • What are the causes of feeding disorders?
  • How is the diagnosis of a feeding and / or eating disorder made?
  • How is feeding disorders treated?
  • Whom can I ask?
  • How are the costs going to be covered?

What is a feeding disorder?

Temporary problems with feeding or eating are normal and caused by adapting to new types of feeding or eating as development progresses. A feeding disorder is only present if it is difficult to feed several times a day - over a period of more than four weeks. If children can (partially) eat themselves, these symptoms are referred to as an eating disorder in early childhood. Meals last longer than average, various distraction maneuvers are necessary when feeding or an unusual feeding position must be maintained. Frequent choking or vomiting can also occur. The feeding problem is often the focus and dominates everyday life.

It is important to discuss short-term feeding difficulties with your pediatrician, as feeding and hydration are essential, especially for babies. In addition, the risk of further eating disorders in life is increased if there is a feeding disorder. This is another reason why it is important to clarify and treat quickly.

Types of food refusal

If infants or young children refuse to eat, this can be done in several ways, for example:

  • Spit,
  • Turn your head away
  • Push the spoon away,
  • vomit
  • choke or
  • Close your mouth.

The amount of food consumed also varies greatly. In these cases, it is usually more difficult for parents to distinguish between hunger and satiety in their children.

Observe failure to thrive

It is possible that in addition to the feeding disorder, there is also a failure to thrive. This manifests itself in a weight loss or a lack of weight gain. Temporary problems with feeding babies are common, but failure to thrive is less common. They can also occur independently of feeding disorders and then usually have physical causes. Your pediatrician can use a growth curve to determine whether your child is growing and thriving.

It can also be observed that the child's eating skills do not correspond to age.

Often there are also other problems such as frequent restlessness, sleep disorders or pronounced screaming phases.

What are the causes of feeding disorders?

Feeding disorders can have various causes - from physical illnesses or malformations to developmental delays to painful experiences and problems in the parent-child relationship. The causes include:

  • Physical / organic causes: e.g. disorders of gastrointestinal function, congenital malformations (e.g. malformation of the esophagus), hypersensitivity in the mouth area, underdeveloped chewing muscles or swallowing problems.
  • Regulatory problems: Over time, the baby learns to regulate his behavior and his feelings, for example, how to deal with not being entertained for a short time or to perceive and express his needs with the help of the other person. If so-called "regulation disorders" occur, this learning does not succeed or does not succeed well. This can have several reasons, for example a developmental delay or parent-child interaction problem. Screaming and sleeping problems can also be traced back to a regulatory disorder.
  • Traumatic experiences: The child has experienced that touching the face, mouth or throat area is threatening or painful. This can be caused, for example, by (operated) malformations in this area, diseases of the gastrointestinal tract (e.g. frequent vomiting due to heartburn) or through intensive medical treatment (e.g. through the long use of tubes).

The role of parent-child interaction

Parents and children are related and interacting with one another. Stresses during pregnancy (e.g. premature labor), birth complications (e.g. emergency caesarean section) or problems / illnesses in the first time after birth (e.g. infection of the child, depression of the mother) can leave traces that strain the parent-child relationship and affect child development.

In addition to the problematic food intake, there is usually a certain pattern of parent-child interaction. It is not uncommon for this to result in a "vicious circle" that pushes parents to their limits. Power games also find their place when eating, for example:

  • From an appropriate age, food is negotiated.
  • The person feeding is trying to make the child eat too much.
  • The child tries to distract and finds out that not eating is more fun than eating, etc.

However, this “vicious circle” can be broken through therapeutic measures and the parent-child relationship can improve.

How is the diagnosis of a feeding and / or eating disorder made?

According to ICD-10, the international classification of diseases, a feeding disorder is present under the following conditions: refusal to eat, extremely fussy eating behavior with an adequate food supply and a reasonably competent caregiver, no presence of an organic disease. At the same time, choking up food that has been swallowed can be a side effect (rumination). In the meantime, the current German guidelines recommend an orientation towards the recommendations of the American Child Psychiatric Association.

What types of feeding disorders are there?

Various problems and symptoms can arise with feeding disorders. Depending on this, different forms are distinguished in medicine:

  • Regulatory feeding disorder : There are mainly difficulties in behavioral and emotional regulation. The child rarely or not at all appears satisfied during the feeding process.
  • Feeding disorder of reciprocal interaction: Here the child's usual reactions during the feeding situation are missing. There is little or no eye contact, smiles or voices.
  • Early childhood anorexia: Refusal to eat (not due to a traumatic experience or a physical illness) and significant growth deficiencies occur. Little interest in food. Can occur from the sixth month of life.
  • Sensory food refusal: Avoidance of certain foods (not as a result of a traumatic experience or a physical illness). Often with the introduction of complementary foods (new taste, etc.).
  • Feeding disorders in connection with medical illnesses: Refusal to feed occurs during illness.
  • Feeding disorders in connection with unpleasant stimuli / experiences in relation to the upper digestive tract (post-traumatic feeding disorder): Refusal to eat after unpleasant experiences that have to do with irritations of the upper digestive tract (e.g. tube feeding, suction, gagging, etc.).

Detailed medical discussion and examination

At the beginning of the diagnosis of feeding disorders there is a detailed medical discussion and the medical history (anamnesis) is taken by the pediatrician. The following points are taken into account:

  • Breastfeeding
  • Feeding situation
  • Diet (complementary foods etc.)
  • Weight
  • Family eating habits
  • daily routine
  • other abnormalities or symptoms
  • Stressful situation of parents or family / couple situation

Diet logs can help track down your eating problem. There is also a physical examination and a precise recording of the child's current development. Laboratory tests and other clarifications can also be used. Organic causes must be ruled out.

Other diagnostic options

If there is a suspicion of a feeding disorder, a child psychiatric or clinical-psychological / psychotherapeutic diagnosis is useful in addition to the pediatrician.

Video-based behavior monitoring

If there are no organic causes, a psychotherapeutic or advisory discussion can also help. Video-supported behavior monitoring and analysis of the feeding situation are also used. The relationship between caregivers and children is also considered in order to provide helpful impulses for promoting them. Observing the parent-child interactions results in suggestions that are important for diagnosis and therapy. Feeding problems also manifest themselves in the form of attachment problems. For more information about attachment, see Parent-Child Attachment.

If the reference person (s) is under psychological stress, appropriate advice / treatment is recommended for them. Because one's own mental illnesses can not only have a negative effect on the adult caregiver, but also on the course of the child's eating disorder. Particular risk factors are parental depression and own eating disorders, but also anxiety, post-traumatic stress and personality disorders.

Note A pediatrician examination is essential in any case of feeding disorders in order to rule out organic causes or to diagnose them in good time!

How is feeding disorders treated?

The therapy of a feeding or eating disorder in early childhood consists of several pillars and requires a certain stamina. If the disorder is severe, hospital treatment may also be necessary. The treatment includes: nutritional advice, speech therapy of sensation and motor skills of the mouth, occupational therapy and accompanying psychosocial measures (e.g. support options for everyday life such as early help).

Depending on the type of feeding disorders, special aspects are included in the treatment, e.g. parent-child psychotherapy, psychoeducation (explaining the causes and options for treating the feeding disorder), medical treatment of underlying and / or concomitant diseases. During the course of therapy, physical examinations, weight checks and often follow-up visits to specialists are necessary.

Advice on eating rules

Advice should also be given in the case of conspicuous feeding symptoms without a clear diagnosis. During the consultation, eating rules can be explained - including:

  • Fixed meals,
  • Plan snacks,
  • Duration of meals a maximum of 30 minutes,
  • no food apart from water between meals,
  • no obligation to eat from outside,
  • no playing while eating,
  • Not eating as a gift or reward,
  • small portions,
  • first solid food, then liquid,
  • support active self-eating,
  • if the child doesn't eat anything - put away the food after about five to ten minutes,
  • if the child throws food around in anger, stops eating,
  • Do not wipe your mouth until you have finished your meal.

When working with videos, feeding scenes can be viewed together with the practitioner and people can work together on satisfactory types of feeding.

Help for the parent-child relationship

If the cause of the problem is found in the parent-child relationship, there are several options for clinical-psychological counseling or psychotherapy (including family therapy) - for example in an outpatient clinic for crying, sleeping and feeding problems. Among other things, behavior and interaction patterns are revealed and many a surging vicious circle is broken. The feeding situation can be improved by training the feeding person's attention and sensitivity to the child's signals.

Note It is important to treat feeding disorders in good time in order to promote child development as well as possible and to recognize diseases at an early stage.

Whom can I ask?

If your child suffers from feeding disorders, the first way is to see the pediatrician. He / she initiates appropriate further diagnostic and therapeutic measures.

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

  • Pediatrician visit
  • Health Professions AZ.

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