Feeding problems in infancy and early childhood: Identification and management
Debby Arts-Rodas, RD and Diane Benoit, MD FRCPC
The purpose of this paper is to present a structured method to assess and manage feeding problems in children under three years of age and a newly developed instrument to assist in the assessment and monitoring of these feeding problems. Simple management strategies and practical suggestions are described, derived from clinical experience and a pertinent review of the literature. Because feeding problems are so prevalent (affecting up to 35% of infants), the use of structured parent questionnaires, interviews and observation scales is important when assessing and managing these problems.
Keywords: Feedin?g assessment, Feeding problems, Food aversion, Food refusal, Infancy
Although feeding problems are estimated to affect one in three to four infants and young children, there are no universally accepted methods of management. This may reflect, in part, the heterogeneity of feeding problems and the lack of a unifying classification system. Yet the early recognition of feeding problems is important because it may prevent simple feeding problems from becoming pervasive or resistant to treatment. In this paper, a systematic approach to the assessment and management of feeding problems is proposed based on clinical experience and findings from the literature.
The use of parent questionnaires and observational rating scales, in addition to a structured clinical interview, is important when assessing infants and young children with feeding problems. Indeed, such instruments provide clinicians and researchers alike with structured ways to collect information, to compare individual children and larger groups, to identify the presence of feeding problems, to ‘quantify’ the severity of the feeding problems, and to measure the effectiveness of treatment. The failure to use structured assessment protocols and tools that permit comparison of subjects across studies has greatly impeded research in the
field. An important focus of future research is the validation of instruments such as the Infant Feeding Behaviours – Parent and Rater checklists, the Feeding History Questionnaire, and other parent questionnaires and observational measures that help to structure assessment and treatment protocols of young children with feeding problems.
Poor outcomes associated with feeding problems early in life have been documented, including detrimental effects on family life and behavioural problems and eating disorders such as anorexia nervosa and bulimia. These serious short term and long term sequelae emphasize the importance to treat feeding problems early. The question of when interventions such as behaviour therapy, multidisciplinary approach nutrition counselling and occupational therapy should be used to treat young children’s feeding problems needs to be examined formally. More research is clearly needed to understand which single or combined treatment methods are the best to treat which feeding problems.