Many young children are thought by their parents to eat poorly. Although the majority of these children are mildly affected, a small percentage have a serious feeding disorder. Nevertheless, even mildly affected children whose anxious parents adopt inappropriate feeding practices may experience consequences. Therefore, pediatricians must take all parental concerns seriously and offer appropriate guidance. This requires a workable classification of feeding problems and a systematic approach. The classification and approach we describe incorporate more recent considerations by specialists, both medical and psychological. In our model, children are categorized under the 3 principal eating behaviors that concern parents: limited appetite, selective intake, and fear of feeding. Each category includes a range from normal (misperceived) to severe (behavioral and organic). The feeding styles of caregivers (responsive, controlling, indulgent, and neglectful) are also incorporated. The objective is to allow the physician to efficiently sort out the wide variety of conditions, categorize them for therapy, and where necessary refer to specialists in the field.

https://pediatrics.aappublications.org/content/pediatrics/early/2015/01/01/peds.2014-1630.full.pdf

A Practical Approach to Classifying and Managing Feeding Difficulties

The motility of the colon

https://www.cidjournal.com/article/S0738-081X(14)00037-6/pdf

An update on diaper dermatitis

Background: 
Feeding problems are common in autism. Parents are frequently worried about the health status of their children, which may be threatened by some consequent nutritional deficiencies. Despite this, feeding behaviours remain little explored by clinicians working with children with autism spectrum disorders and researches are lacking especially in Tunisia.

Aims: 
To evaluate the frequency and the types of feeding problems in children with autism spectrum disorders.

Settings and Design: 
A comparison was made between 57 children with autism spectrum disorders and 57 control groups regarding the feeding problems. Parents completed the children’s eating behavior inventory (CEBI). Autism severity is evaluated using the Childhood Autism Rating Scale. The SPSS statistical package, version 20.0 was used.

Results: 
According to the CEBI, children with autism spectrum disorders showed more feeding problems than the control group (82.4% versus 56.1%, p=0.002). In fact, the parents of these children observed more pica habits on their children compared to the control group (p=0.000). They also observed more selectivity for starchy foods compared to the control group (p=0.000). The more the autistic symptoms were severe, the more children exhibited feeding problems (p=0.02).

Conclusions:
Our findings suggest that feeding problems are more common in children with autism. Clinical implications trigger the need for clinicians to provide the necessary assessment and treatment.

Feeding Problems in Children With Autism Spectrum Disorders

This review provides an approach for resolving a variety of feeding difficulties in children, ranging from normal eating behavior that is misperceived as a problem to substantial feeding disorders. Criteria to identify pediatric feeding disorders have been thoroughly addressed in the newly established designations of avoidant restrictive food intake disorder (ARFID) and pediatric feeding disorder (PFD). These diagnostic criteria improve the accuracy of identifying, classifying, and managing significant feeding disorders in young children. While recent definitions of feeding difficulties are particularly appropriate in multidisciplinary settings, in this paper, we advocate for a progressive approach of managing feeding problems in all clinical settings. It begins by identifying red flags indicative of serious threats to the child, screening for oral motor dysfunction, stabilizing nutrient intake, and eliminating aversive feeding practices. The next step, if eating behavior does not improve, involves strategies that target specific eating behaviors and parental feeding styles. In severe or resistant cases, referral to specialists or interdisciplinary feeding teams is advised.

A Functional Approach to Feeding Difficulties in Children.

The aim of this study was to determine the prevalence, characteristics, and factors related to feeding problems among normal children, and the differences in feeding practices between those with and without feeding problems. Caregivers of 402 healthy children aged between one and four years of age were interviewed by pediatricians involved in the research. Data included the child’s medical history, food intake within a day, and feeding behaviors and practices. Parental socio-economic and demographic information, as well as information on parental education and occupation, and their concerns about feeding their children, was collected. Physical examination and anthropometric measurements were taken. The percentage of children identified as having feeding problems was 26.9%. The first child of a family had an increased risk of having feeding problems [P=0.032, odds ratio 1.68, 95% confidence interval (95%CI) 1.04-2.71]. Children with feeding problems were fed less frequently, were less likely to be fed at their own table or at the family table, and had mealtimes longer than 30 min when compared with children without feeding problems (P=0.015, 0.004 and 0.025, respectively). The results highlight that feeding problems in normally developing children are common. During consultations about feeding issues, pediatricians should focus on families with a first child. Topics such as frequency of meals per day, duration of meal-times, and appropriate places for feeding should be discussed.

/pdf/feeding-problems-in-healthy-young-children-prevalence-19k5m769li.pdf

Feeding problems in healthy young children: prevalence, related factors and feeding practices

The aim of this study was to define the bowel movements of healthy Thai infants up to 12 months of age. Fifty infants were evaluated at 1, 2, 4, 6, 9 and 12 months of age. Data regarding bowel habits was recorded by parents daily for 2 days before coming to the hospital at each visit. The mean frequency of bowel movements per day was maximal (3.16 stools) during the newborn period and declined (1.59 stools) by the age of 12 months. At birth stool consistency was mostly runny, and became consistently more solid by 4 months of age. With increasing age, infants produced larger stools: mean volume of stool was 32.7 ml at 1 month of age and increased to 45.34 ml at 12 months. Infants started to have regular bowel movements at 4 months of age, most of them stopped having bowel movements at night by 3 months.

Bowel movements of normal Thai infants.

Objective: To study the age at which Thai infants start and achieve toilet training and its associated factors Material and Method: The parents of fifty infants in a research entitled “Bowel movements of normal Thai infants” were interviewed about age at which toilet training started, the process of toilet training and age at which infant successfully completed toilet training Results: Forty-seven infants from the 50 infants registered had data of the date of beginning toilet training Five of them (106%) started toilet training at 4 months and 38 (809%) by 12 months Most of the infants (737%) were initially trained when they showed urging signs Only 45 infants had complete data of successful toilet training Twenty-two cases (489%) were trained successfully by 12 months and most of them (16/22) succeeded within one month The infants, who were not the first child and were taken care of by a well-educated mother, were found to start toilet training late Conclusion: The youngest age at which normal Thai infants start to be toilet trained was 4 months About 50% of the infants aged 12 months had successful toilet training Being raised by a well-educated mother and a having a later birth order in a family were factors associated with late toilet training Keywords: Infant, Toilet training, Associated factors, Start, Achieve

Infant toilet training in Thailand: starting and completion age and factors determining them.

A 2-year-9-month-old boy presented with feeding disorder and poor growth. The clinicalpresentation was compatible with infantile anorexia, one of behavioral feeding disorders. The author proposed that the main cause of poor food acceptance and growth failure in this child was poor appetite. Treatments were composed of behavioral interventions, rescheduling meals and foods enrichment. Alternative managements by prescribing cyproheptadine as an appetite stimulant resulted in significant improvement of feeding behaviors and weight gain.

Banchaun Benjasuwantep

Papers

Feeding problems in healthy young children: prevalence, related factors and feeding practices

Bowel movements of normal Thai infants.

Infant toilet training in Thailand: starting and completion age and factors determining them.

Successful treatment in a child with feeding problems and growth failure.