Feeding disorders, characterized by suboptimal intake and/or lack of age-appropriate eating habits, are common and may be seen in up to 45% of children. Feeding disorders are a significant concern to both the affected families and to the providers who treat them. Fortunately, there are well-established behavioral treatments which have been shown to be highly efficacious. This article provides an overview of behavioral assessment and treatment of pediatric feeding disorders, provides guidance in treatment planning, and provides information which may be useful in considering if additional psychological consultation may be beneficial.

Journal Section:
Feeding Disorders in Infants and Children
Keywords:
Feeding disorder, Pediatrics, Assessment, Behavioral therapy, Parent training
1.
Drotar D, Sturm L: Prediction of intellectual development in young children with early histories of failure to thrive. J Pediatr Psychol 1988;13:281-295.
[PubMed]
https://doi.org/10.1093/jpepsy/13.2.281
2.
Galler JR, Ramsey F, Solimano G, et al: The influence of early malnutrition on subsequent behavioral development: I. Degree of impairment in intellectual performance. J Am Acad Child Psychiatry 1983;22:8-15.
[PubMed]
https://doi.org/10.1097/00004583-198301000-00002
3.
Polan HJ, Leon A, Kaplan MD, et al: Disturbances of affect expression in failure-to-thrive. J Am Acad Child Adolesc Psychiatry 1991;30:897-903.
[PubMed]
https://doi.org/10.1097/00004583-199111000-00006
4.
Wolke D, Skuse D, Mathisen B: Behavioral style in failure-to-thrive infants: a preliminary communication. J Pediatr Psychol 1989;15:237-254.
[PubMed]
https://doi.org/10.1093/jpepsy/15.2.237
5.
Bentovim A: The clinical approach to feeding disorders of childhood. J Psychosom Res 1970;14:267-276.
[PubMed]
https://doi.org/10.1016/0022-3999(70)90053-X
6.
Forsyth BWC, Leventhal JM, McCarthy PL: Mothers' perceptions of problems of feeding and crying behaviors: a prospective study. Am J Dis Child 1985;139:269-272.
[PubMed]
https://doi.org/10.1001/archpedi.1985.02140050063023
7.
Gouge AL, Ekvall SW: Diets of handicapped children: physical, psychological, and socioeconomic correlations. Am J Ment Defic 1975;80:149-157.
[PubMed]
8.
Manikam R, Perman JA: Pediatric feeding disorders. J Clin Gastroenterol 2000;30:34-46.
[PubMed]
https://doi.org/10.1097/00004836-200001000-00007
9.
Perske R, Clifton A, McLean B, et al (eds): Mealtimes for Severely and Profoundly Handicapped Persons: New Concepts and Attitudes. Baltimore, University Park Press, 1977.
10.
Babbitt RL, Hoch TA, Coe DA: Behavioral feeding disorders; in Tuchman DN, Walters RS (eds): Disorders of Feeding and Swallowing in Infants and Children. San Diego, Singular, 1994, pp 77-95.
11.
Dahl M, Sundelin C: Feeding problems in an affluent society. Follow-up at four years of age in children with early refusal to eat. Acta Paediatr 1992;81:575-579.
[PubMed]
https://doi.org/10.1111/j.1651-2227.1992.tb12303.x
12.
Marchi M, Cohen P: Early childhood eating behaviors and adolescent eating disorders. J Am Acad Child Adolesc Psychiatry 1990;29:112-117.
[PubMed]
https://doi.org/10.1097/00004583-199001000-00017
13.
Silverman AH, Tarbell S: Feeding and vomiting problems in pediatric populations; in Roberts MC, Steele RG (eds): Handbook of Pediatric Psychology. New York, Guilford Press, 2009, pp 429-445.
14.
Burklow KA, Phelps AN, Schultz JR, et al: Classifying complex pediatric feeding disorders. J Pediatr Gastroenterol Nutr 1998;27:143-147.
[PubMed]
https://doi.org/10.1097/00005176-199808000-00003
15.
Fischer EA, Silverman AH: Behavioral conceptualization, assessment, and treatment of pediatric feeding disorders. Semin Speech Lang 2007;28:223-231.
[PubMed]
https://doi.org/10.1055/s-2007-984728
16.
Silverman AH: Interdisciplinary care for feeding problems in children. Nutr Clin Pract 2010;25:160-165.
[PubMed]
https://doi.org/10.1177/0884533610361609
17.
Berlin KS, Davies WH, Silverman AH, et al: Assessing children's mealtime problems with the Mealtime Behavior Questionnaire. Child Health Care 2010;39:142-156.
https://doi.org/10.1080/02739611003679956
18.
Archer LA, Rosenbaum PL, Streiner DL: The children's eating behavior inventory: reliability and validity results. J Pediatr Psychol 1991;16:629-642.
[PubMed]
https://doi.org/10.1093/jpepsy/16.5.629
19.
Davies WH, Ackerman LK, Davies CM, et al: About Your Child's Eating: factor structure and psychometric properties of a feeding relationship measure. Eat Behav 2007;8:457-463.
[PubMed]
https://doi.org/10.1016/j.eatbeh.2007.01.001
20.
Musher-Eizenman D, Holub S: Comprehensive feeding practices questionnaire: validation of a new measure of parental feeding practices. J Pediatr Psychol 2007;32:960-972.
[PubMed]
https://doi.org/10.1093/jpepsy/jsm037
21.
Johnson SL, Birch LL: Parents' and children's adiposity and eating style. Pediatrics 1994;94:653-661.
[PubMed]
22.
Ramsay M, Martel C, Porporino M, Zygmuntowicz C: The Montreal Children's Hospital Feeding Scale: a brief bilingual screening tool for identifying feeding problems. Paediatr Child Health 2011;16:147-e17.
[PubMed]
23.
Lukens CT, Linscheid TR: Development and validation of an inventory to assess mealtime behavior problems in children with autism. J Autism Dev Disord 2008;38:342-352.
[PubMed]
https://doi.org/10.1007/s10803-007-0401-5
24.
Derogatis LR: Symptom Checklist-90-Revised (SCL-90-R): Administration, Scoring, and Interpretation Manual. Towson, Clinical Psychometric Research, 1983.
25.
Abidin R: Parenting Stress Index - Short Form. Odessa, Psychological Assessment Resources, 1995.
26.
Budd KS, McGraw TE, Farbisz R, et al: Psychosocial concomitants of children's feeding disorders. J Pediatr Psychol 1992;17:81-94.
[PubMed]
https://doi.org/10.1093/jpepsy/17.1.81
27.
Linscheid TJ, Budd KS, Rasnake LK: Pediatric feeding problems; in Roberts MC (ed): Handbook of Pediatric Psychology. New York, Gilford Press, 2003, pp 481-498.
28.
Barnard KE, et al: Measurement and meaning of parent-child interaction; in Morrison F, Lord C, Keating D (eds): Applied Developmental Psychology. New York, Academic Press, 1989, pp 40-76.
29.
Mathisen B, Skuse D, Wolke D, et al: Oral-motor dysfunction and failure to thrive among inner-city infants. Dev Med Child Neurol 1989;31:293-302.
[PubMed]
https://doi.org/10.1111/j.1469-8749.1989.tb03998.x
30.
Sanders MR, Patel RK, Le Grice B, et al: Children with persistent feeding difficulties: an observational analysis of the feeding interactions of problem and non-problem eaters. Health Psychol 1993;12:64-73.
[PubMed]
https://doi.org/10.1037//0278-6133.12.1.64
31.
Kerwin ME: Empirically supported treatments in pediatric psychology: severe feeding problems. J Pediatr Psychol 1999;24:193-214.
[PubMed]
https://doi.org/10.1093/jpepsy/24.3.193
32.
Palmer S, Thompson RJ Jr, Linscheid TR: Applied behavior analysis in the treatment of childhood feeding problems. Dev Med Child Neurol 1975;17:333-339.
[PubMed]
https://doi.org/10.1111/j.1469-8749.1975.tb04671.x
33.
Linscheid TR: Behavioral treatments for pediatric feeding disorders. Behav Modif 2006;30:6-23.
[PubMed]
https://doi.org/10.1177/0145445505282165
34.
Lukens CT, Silverman AH: Systematic review of psychological interventions for pediatric feeding problems. J Pediatr Psychol 2014;39:903-917.
[PubMed]
https://doi.org/10.1093/jpepsy/jsu040
35.
American Academy of Pediatrics, Committee on Nutrition, Kleinman RE: Pediatric Nutrition: Policy of the American Academy of Pediatrics, ed 7. Elk Grove Village, American Academy of Pediatrics, 2014, pp xxvi, 1477.
36.
Birch LL, Fisher JA: Appetite and eating behavior in children. Pediatr Clin North Am 1995;42:931-953.
[PubMed]
37.
Trahms CM, Pipes PL: Nutrition in Infancy and Childhood, ed 6. New York, WCB/McGraw-Hill, 1997, pp xv, 458.
38.
Handen BL, Mandell F, Russo DC: Feeding induction in children who refuse to eat. Am J Dis Child 1986;140:52-54.
[PubMed]
https://doi.org/10.1001/archpedi.1986.02140150054033
39.
O'Brien S, Repp AC, Williams GE, et al: Pediatric feeding disorders. Behav Modif 1991;15:394-418.
[PubMed]
https://doi.org/10.1177/01454455910153007
40.
Sisson LA, Dixon MJ: Improving mealtime behaviors through token reinforcement. A study with mentally retarded behaviorally disordered children. Behav Modif 1986;10:333-354.
[PubMed]
https://doi.org/10.1177/01454455860103005
41.
Riordan MM, Iwata BA, Finney JW, et al: Behavioral assessment and treatment of chronic food refusal in handicapped children. J Appl Behav Anal 1984;17:327-341.
[PubMed]
https://doi.org/10.1901/jaba.1984.17-327
42.
Hoch T, Babbitt RL, Coe DA, et al: Contingency contacting: combining positive reinforcement and escape extinction procedures to treat persistent food refusal. Behav Modif 1994;18:106-128.
[PubMed]
https://doi.org/10.1177/01454455940181007
43.
Ahearn WH, Kerwin ML, Eicher PS, et al: An alternating treatments comparison of two intensive interventions for food refusal. J Appl Behav Anal 1996;29:321-332.
[PubMed]
https://doi.org/10.1901/jaba.1996.29-321
44.
Coe DA, Babbitt RL, Williams KE, et al: Use of extinction and reinforcement to increase food consumption and reduce expulsion. J Appl Behav Anal 1997;30:581-583.
[PubMed]
https://doi.org/10.1901/jaba.1997.30-581
45.
Dahlquist LM: The treatment of persistent vomiting through shaping and contingency management. J Behav Ther Exp Psychiatry 1990;21:77-80.
[PubMed]
https://doi.org/10.1016/0005-7916(90)90052-M
46.
Greer RD, Dorow L, Williams G, et al: Peer-mediated procedures to induce swallowing and food acceptance in young children. J Appl Behav Anal 1991;24:783-790.
[PubMed]
https://doi.org/10.1901/jaba.1991.24-783
47.
Shore BA, Babbitt RL, Williams KE, et al: Use of texture fading in the treatment of food selectivity. J Appl Behav Anal 1998;31:621-633.
[PubMed]
https://doi.org/10.1901/jaba.1998.31-621
48.
Stimbert VE, Minor JW, McCoy JF: Intensive feeding training with retarded children. Behav Modif 1977;1:517-530.
https://doi.org/10.1177/014544557714005
49.
Piazza CC, Anderson C, Fisher W: Teaching self-feeding skills to patients with Rett syndrome. Dev Med Child Neurol 1993;35:991-996.
[PubMed]
https://doi.org/10.1111/j.1469-8749.1993.tb11581.x
50.
Stark LJ, Powers SW, Jelalian E, et al: Modifying problematic mealtime interactions of children with cystic fibrosis and their parents via behavioral parent training. J Pediatr Psychol 1994;19:751-768.
[PubMed]
https://doi.org/10.1093/jpepsy/19.6.751
51.
MacArthur J, Ballard KD, Artinian M: Teaching independent eating to a developmentally handicapped child showing chronic food refusal and disruption at mealtimes. Aust NZ J Dev Disabil 1986;12:203-210.
https://doi.org/10.3109/13668258609084083
52.
Larson KL, Ayllon T, Barrett DH: A behavioral feeding program for failure-to-thrive infants. Behav Res Ther 1987;25:39-47.
[PubMed]
https://doi.org/10.1016/0005-7967(87)90113-6
53.
Kahng S, Tarbox J, Wilke AE: Use of a multicomponent treatment for food refusal. J Appl Behav Anal 2001;34:93-96.
[PubMed]
https://doi.org/10.1901/jaba.2001.34-93
54.
Duker PC: Treatment of food refusal by the overcorrective functional movement training method. J Behav Ther Exp Psychiatry 1981;12:337-340.
[PubMed]
https://doi.org/10.1016/0005-7916(81)90075-6
55.
Lamm N, Greer RD: Induction and maintenance of swallowing responses in infants with dysphagia. J Appl Behav Anal 1988;21:143-156.
[PubMed]
https://doi.org/10.1901/jaba.1988.21-143
56.
Siegel LJ: Classical and operant procedures in the treatment of a case of food aversion in a young child. J Clin Child Psychology 1982;11:167-172.
https://doi.org/10.1080/15374418209533082
© 2015 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2015
You do not currently have access to this content.