Pediatric Feeding Disorder (PFD) refers to impaired oral intake that is not age-appropriate and is associated with dysfunction in one or more of four domains: medical, nutritional, feeding skill, and psychosocial. PFD may manifest as food refusal, extreme selectivity, delayed self-feeding skills, or disruptive mealtime behaviors, often affecting nutritional status and growth. Unlike dysphagia, which focuses on the mechanics of swallowing, PFD encompasses a broader array of issues related to the act of eating and mealtime engagement. This condition often involves complex interactions between sensory sensitivities, developmental delays, behavioral responses, and caregiver-child dynamics.
Clinical subtypes of PFD are typically categorized by the domains involved:
1. Feeding skill dysfunction, such as poor oral-motor coordination or delayed transition to textured foods.
2. Nutritional dysfunction, including failure to thrive or dependence on nutritional supplements due to inadequate intake.
3. Medical dysfunction, where underlying conditions (e.g., gastrointestinal, neurological, or cardiopulmonary) affect appetite or tolerance.
4. Psychosocial dysfunction, involving anxiety around food, caregiver stress, or disrupted mealtime routines.
Children with PFD may present with limited food variety, refusal of entire food groups, or distress during meals. The prevalence is estimated at 25–45% in typically developing children and up to 80% in those with developmental disabilities.
PFD has far-reaching implications for child development, family functioning, and healthcare utilization. Nutritionally, children may experience deficits in calories, protein, vitamins, and minerals, which can impair physical and cognitive growth. The emotional toll on families is often high, as mealtimes become prolonged, stressful events filled with negotiation, pressure, or avoidance. Children may develop anxiety or behavioral patterns that worsen the feeding problem, while caregivers may experience guilt, frustration, and social isolation.
PFD also has implications for later development, as oral-motor feeding challenges in infancy can affect speech clarity and coordination. Families often require support not only in managing the child’s intake but also in restructuring mealtime environments and routines. Without intervention, these disorders may persist, limiting participation in school and social activities and impacting long-term quality of life.
Treatment for PFD is individualized and ideally delivered through a multidisciplinary approach involving speech-language pathologists, occupational therapists, dietitians, psychologists, and physicians. Feeding therapy focuses on improving oral-motor skills, sensory tolerance, and self-feeding abilities through structured exposure and skill-building exercises. Strategies may include food chaining, responsive feeding techniques, caregiver coaching, and environmental modifications to reduce mealtime stress. The goals are to promote nutritional adequacy, expand food variety, and foster positive feeding relationships in a trauma-informed and developmentally appropriate way.
Goday, P. S., et al. Pediatric feeding disorder: Consensus definition and conceptual framework. Journal of Pediatric Gastroenterology and Nutrition 68, no. 1 (2019).
Clawson, E. P., et al. Pediatric dysphagia: Physiology, assessment, and management. Seminars in Speech and Language 43, no. 4 (2022).
Silverman, A. H., & Tarbell, S. Treatment of severe pediatric feeding disorders: Combining medical and behavioral approaches. Infants & Young Children 22, no. 1 (2009).
