Assessment of a Feeding Difficulties Diagnostic Tool Questionnaire For Children With Oral Feeding Resistance

Background:

Surveys conducted throughout the world repeatedly demonstrate that approximately 50% of mothers consider at least one of their children to have a feeding difficulty, meaning that they resist taking an appropriate amount of food. This implicates between 20% and 30% of all children. The milder cases are frequently considered "picky eaters" and although well nourished they are at significant risk for coercive feeding. This in turn has been associated with cognitive limitations and behavioral problems. Sub-groups do exhibit poor growth, and some have sub-optimal nutrient consumption relative to body size,while others have underlying or co-morbid organic disease. To help identify the relevant intervention for these children, whether it is reassurance for the parents, counseling to resolve behavioral problems (of both the child and the feeder), nutritional intervention and/or medical treatment, it is necessary to identify the separate conditions that contribute to the feeding difficulty and its complications so that appropriate treatment can then be tailored to the cause.

The task of categorizing children with feeding problems is frequently daunting for the pediatrician due to time constraints and lack of training in this field. In developed countries, physicians may refer a child with severe feeding difficulties to a specialist; however, in many parts of the world, these resources are limited or absent. Additionally, health care professionals have a narrow perspective based on their specialized training, whether that is general medical care, specialized care, nutrition, or oral motor therapy.

To overcome the limitations detailed above, a questionnaire was developed based on the work of the principal investigator, Dr. Kerzner and the co-investigator, Dr. Chatoor. This questionnaire is filled out by the parents and their responses prompt the physician to consider relevant diagnostic possibilities for the particular child's feeding difficulty. Once a diagnosis or set of diagnoses is established by utilization of the questionnaire, specific and appropriate therapy can then be provided.

The diagnostic categories that are captured by this tool are based on typical symptoms demonstrated by children with feeding difficulties and their basis has been published by the principal investigator (copy attached).1 Children over one year of age are divided into three groups based on their dominant symptoms: those with poor appetite; those with excessive selectivity; and those with fear of feeding. Children with a poor appetite are further categorized into four sub groups: those who have underlying organic or medical problems; those who are very active and playful but whose poor feeding leads to conflict with the mother; those who fail to-thrive based on poor economic circumstances or neglect; and, finally, those who are eating appropriate amounts of food but are misperceived by their caregivers to have a poor appetite. Each feeding difficulty category has different and unique approaches necessary for its resolution and it is possible for a child to fit into more than one diagnostic category