Feeding Disorder of Infancy or
Nihar J. Patel
• Feeding disorder of infancy, a broadly defined
maladaptive pattern of eating behaviors in infants,
features the interactive process between caregiver and
• 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.
• It is estimated that between 15 and 35 percent of
infants and young children have transient feeding
• 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
• Feeding disorder of infancy must be
differentiated from structural problems with
the infants' gastrointestinal tract that may be
contributing to discomfort during the feeding
• Because feeding disorders and organic causes
of swallowing difficulties often coexist, it is
important to rule out medical reasons for
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
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
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
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.
• 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
• 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
• 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.
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
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.