Diagnosis
Common presentation: Frustrated mother brings her infant or toddler to PCP complaining about his eating habits. Mother says when she puts the patient on her high chair to eat, she throws tantrums + pushes the food to the floor and won’t eat. Mother has been giving her cookies, crackers, and juice, which she says are the only things the patient would it. PE and growth charts are normal. I’ve had a few patients exactly like that, mothers are very frustrated with the patient.
H&P:
Red flags: Look for organic and behavioral red flags.
Classify the feeding difficulty according to 3 principal eating behaviors: limited appetite vs. selective intake vs. fear of feeding.
Classify the feeder (parent) into 4 feeding styles: Responsive vs. controlling vs. indulgent vs. neglectful.
DDx and Causes.
Diagnostic studies:
Treatment
Counsel mother to create a and follow a consistent schedule and serve only healthy foods for meals and snacks, and stop the meal if the patient won’t eat.
-Unhealthy foods should not be an option. The only option is healthy.
-Don’t offer any food or drinks (except for water) between scheduled meals and snacks.
-And don’t use food as a reward or present.
-The feeder/parent should control what, when, and where the child should eat and the child should control how much he/she eats at each meal time.
Reassure the parent that if done consistently, a normal child will readjust to the new system and would learn to eat enough to prevent starvation.
F/u frequently to reevaluate and if malnutrition occurs, evaluate the patient for a physical or mental abnormality.
Background
About 3%–10% of infants and toddlers have feeding problems.
Note, a Feeding problem (difficulty) is NOT a feeding disorder. See DSM-V for feeding disorders.
References
Pediatrics 2015;135(2):344-353. A practical approach to classifying and managing feeding difficulties. http://pediatrics.aappublications.org/content/135/2/344
Can Fam Physician. 2006 Oct 10; 52(10): 1247–1251. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1783606/