Feeding disorder of infancy or early childhood 1

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Feeding disorder of infancy or early childhood 1

  1. 1. Feeding Disorder of Infancy or Early Childhood Nihar J. Patel
  2. 2. • Feeding disorder of infancy, a broadly defined maladaptive pattern of eating behaviors in infants, features the interactive process between caregiver and infant. • This disorder has variable components that range from food refusal, food selectivity, eating too little, food avoidance, and delayed self-feeding. • According to DSM-IV-TR, feeding disorder of infancy or early childhood is a persistent failure to eat adequately, reflected in significant failure to gain weight or in significant weight loss over 1 month. • The symptoms are not better accounted for by a medical condition or by another mental disorder and are not caused by lack of food (Table 45-3). The disorder has its onset before the age of 6 years.
  3. 3. Epidemiology • It is estimated that between 15 and 35 percent of infants and young children have transient feeding difficulties. • A recent survey of feeding problems in nursery school children revealed a prevalence of 4.8 percent with equal gender distribution. • Children with feeding problems exhibited more somatic complaints and mothers of affected infants exhibited increased risk of anxiety symptoms. • Data from community samples estimate a prevalence of failure to thrive syndromes in approximately 3 percent of infants with approximately half of those infants exhibiting feeding disorders
  4. 4. Differential Diagnosis • Feeding disorder of infancy must be differentiated from structural problems with the infants' gastrointestinal tract that may be contributing to discomfort during the feeding process. • Because feeding disorders and organic causes of swallowing difficulties often coexist, it is important to rule out medical reasons for feeding difficulties.
  5. 5. Course and Prognosis • Most infants with feeding disorders exhibit symptoms within the first year of life and, with appropriate recognition and intervention, do not go on to develop failure to thrive. • When feeding disorders have their onset later, in children 2 to 3 years of age, growth and development can be affected when the disorder lasts for several months. • It is estimated that about 70 percent of infants who persistently refuse food in the first year of life continue to have some feeding problems during childhood.
  6. 6. Table 45-4 ICD-10 Diagnostic Criteria for Feeding Disorder of Infancy and Childhood A. There is persistent failure to eat adequately, or persistent rumination or regurgitation of food. B. The child fails to gain weight, loses weight, or exhibits some other significant health problem over a period of at least 1 month. (In view of the frequency of transient eating difficulties, researchers may prefer a minimum duration of 3 months for some purposes.) C. Onset of the disorder is before the age of 6 years. D. The child exhibits no other mental or behavioral disorder in the ICD-10 classification (other than mental retardation). E. There is no evidence of organic disease sufficient to account for the failure to eat.
  7. 7. Treatment • Treatments for feeding disorders need to be individualized and include interventions aimed at the infant, the mother, and most often targeting the interactions between the infant and mother, or caregiver. • If an infant tires before ingesting an adequate amount of nutrition, it may be necessary to begin treatment with the placement of a nasogastric tube for supplemental oral feedings. • On the other hand, if the mother or caregiver is unable to participate in the intervention, it may be necessary to include additional caregivers to contribute to feeding the infant. In rare cases, an infant may require hospitalization until adequate nutrition on a daily basis is accomplished.
  8. 8. • Most interventions for feeding disorders are aimed at optimizing the interaction between the mother and infant during feedings, and identifying any factors that can be changed to promote greater ingestion. • The mother is helped to become more aware of the infant's stamina for length of individual feedings, the infant's biological regulation patterns, and when the infant is fatigued, with a goal of increasing the level of engagement between mother and infant during feeding.
  9. 9. Table 45-5 ICD-10 Diagnostic Criteria for Pica of Infancy and Childhood A.There is persistent or recurrent eating of nonnutritive substances, at least twice a week. B.Duration of the disorder is at least 1 month. (For some purposes, researchers may prefer a minimum period of 3 months.) C.The child exhibits no other mental or behavioral disorder in the ICD-10 classification (other than mental retardation). D.The child's chronological and mental age is at least 2 years. E.The eating behavior is not part of a culturally sanctioned practice.
  10. 10. • Thank you!!

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