93 Feeding Disorder of Infancy or Early Childhood (307.59)

DSM-IV-TR criteria

• A. Feeding disturbance as manifested by persistent failure to eat adequately with significant failure to gain weight or significant loss of weight over at least one month.
• B. The disturbance is not due to an associated gastrointestinal or other general medical condition (e.g., esophageal reflux).
• C. The disturbance is not better accounted for by another mental disorder (e.g., Rumination Disorder) or by lack of available food.
• D. The onset is before the age of 6.

Associated features

Infants with feeding disorders can be more irritable and difficult to console when feeding then others of their age. They appear withdrawn and apathetic and may also show developmental delays. Sometimes parent-child interaction problems may add to or exacerbate the infant’s feeding problems. Inadequate caloric intake can make associated features worse and further impact to feeding difficulties. Factors that may be associated with Feeding Disorder of Infancy or Early Childhood include temperamental characteristics or intrauterine growth retardation. Preexisting developmental impairments that make the child less responsive could also be factors. Some other associated factors include parental psychopathology and child abuse or neglect.

Child vs. adult presentation

• Due to the nature of the disorder, adults cannot present with feeding disorders. This disorder is primarily focused on the presentation in children from infants to early childhood.
• A later onset, during toddler years, is associated with developmental delay and malnutrition. Growth retardation may be observed.

Gender and cultural presentation

Feeding Disorder of Infancy or Early Childhood seems to be equally common in both males and females.

Epidemiology

Of all pediatric hospital admissions, 1%-5% are for failure to thrive, and up to one-half of these may reflect feeding disturbances without any apparent predisposing general medical condition. Data from community samples suggest a point prevalence of around 3% for failure to thrive.

Etiology

• Feeding problems often occur in infant and children who are tube fed for extended periods of time due to some other illness or disability. In premature infants, the underdeveloped sphincter muscle, between the stomach and esophagus, can cause the infant to spit up frequently during feedings. Because this is uncomfortable for the child, he or she may not want to eat.
• Disorders of the digestive system can also cause feeding problems, and include abnormalities of the throat and esophagus that cause pain during swallowing, inhaling food into the lungs, constipation, and celiac disease, a hereditary disorder in which a cereal protein called gluten, which is found in wheat, causes an allergic reaction that results in poor absorption of fats from the diet.
• Other digestive-type disorders that can cause feeding problems include necrotizing entercolitis, a condition seen mainly in premature newborns where the inner surface of the intestine becomes injured and inflamed; Hirschprung disease, in which a section of the large intestine is abnormally developed; short bowel syndrome; pyloric stenosis, caused by a narrowing or blockage at the stomach outlet; and gastroesophageal reflux (GER), which occurs when the acid contents of the stomach flow back, or reflux, into the esophagus.
• Feeding disorders can be caused by food allergies, by difficulty with the movement of the mouth or tongue (oromotor), or may be a cry for attention by a neglected child or a child with a behavioral disorder. Some other factors include poverty, dysfunctional caregiver child-caregiver interactions, and parental misinformation.

Empirically supported treatments

• Depending on the severity of the condition of the infant the amount of calories and intake of fluids should be increased. You should also correct any vitamin or mineral deficiencies that the child may have. It is also very important to identify any physical problem that may be causing the disorder.
• To be able to effectively accomplish these goals, a brief hospital stay may be necessary. Isolating the child in the constant care of the hospital for a short time will make sure all the proper procedures are taken. Also, gastroenterologists, behavioral psychologists, and occupational and/or speech therapists.