Milmedika

Eating disorders in children are common, affecting 20–45% of developmentally healthy children and up to 80% of children with developmental difficulties. Although they are not always accompanied by weight loss or failure to thrive, they can present a significant challenge for the entire family.

Types of eating disorders

Childhood eating disorders can be divided into three main groups:

1. Children with structural anomalies of the oropharynx and esophagus – difficulties feeding due to anatomical issues.
2. Children with neurological and neurodevelopmental disorders – chewing and swallowing problems due to underlying conditions.
3. Behavioral feeding disorders – the most common group, including various forms of food refusal, sensory aversions, and post-traumatic issues related to feeding.

One of the leading experts in this field is Prof. Dr. Irena Chatoor, a psychiatrist and pediatrician. Her classification of behavioral feeding disorders is included in the revised psychiatric publication Zero to Three. This classification covers six different types of disorders, each with clear diagnostic criteria and requiring specific treatment approaches.

Types of behavioral feeding disorders

1. Feeding regulation disorders (state of regulation disorder)

At birth, a baby must develop rhythmic mechanisms for feeding, sleeping, and hunger. When these mechanisms are not properly established, feeding regulation disorders can occur. This is most common in premature babies, babies with heart defects, and those with gastroesophageal reflux (GER). Symptoms include irregular feeding and sleeping cycles – babies may be too sleepy to feed or too agitated during meals.

Recommendation for parents: A calm and quiet environment during feeding, a dark room without distracting noises, and sometimes a warm bath with a massage before meals can help.

2. Feeding reciprocity disorders

From the second month of life, an interaction develops between the baby and parent, including eye contact, vocalization, and touch. If this reciprocity is absent, feeding problems may arise. These babies typically show malnutrition, which is often discovered during a checkup for other health issues. They show delayed development and lack of smiles and eye contact.

Treatment: Hospitalization for feeding observation, potential enteral feeding via a tube, and involvement of a psychologist and social worker in the therapeutic process.

3. Infantile anorexia

This disorder typically occurs around six months of age, often when the child transitions to pureed foods and begins to feed independently. Children with infantile anorexia show little interest in food but are otherwise developmentally normal. They are often characterized by an intense temperament and a strong curiosity about the world, but not about food.

Advice for parents: Avoid forcing feeding, focus on calorie-dense meals, tailor the diet to the child’s preferences, and ensure a calm environment during meals.

4. Sensory food aversion

Children with this issue refuse certain foods due to taste, texture, or smell. This aversion may develop when transitioning to a new type of milk, mashed foods, or certain foods like fruits and vegetables.

Recommendation: Repeated exposure to the food without coercion. Parents can model eating the same food in front of the child and gradually introduce new flavors.

5. Post-traumatic feeding disorders

These disorders arise from a traumatic feeding experience – choking, vomiting, aggressive feeding, or tube placement. Older children may develop a “choking” phobia and fear of choking on food.

Treatment: Psychological support is crucial, along with detailed gastroenterological and otolaryngological diagnostics to rule out medical causes.

6. Food refusal with a medical condition

If a child shows signs of hunger but becomes irritable and refuses to eat after a few bites, an underlying medical condition may be the cause. The most common issues are cardiopulmonary diseases (where the baby lacks the strength to feed) and reflux (where food causes discomfort).

Approach: The underlying medical condition must first be properly treated, after which feeding regulation can be addressed.

Conclusion

Pediatric feeding disorders require early identification and appropriate treatment to prevent long-term effects on a child’s growth and development.

Dr. Dušanka Novosel, pediatric-gastroenterologist

Institute for Diseases of Children, Clinical Center of Montenegro