Oftentimes when children are experiencing difficulty eating, parents ask one of the following two questions: “What actually caused this?” OR “What can actually be done to determine what is going on? In this article, we will briefly look at the answers to these two questions to help clear up some of the muddy waters surrounding pediatric feeding difficulties!

So…why is my child having trouble eating? There are so many reasons that your child may be struggling with this super important life skill! And it is even more important to get to the root cause and determine the “why” as opposed to just delving in and trying to fix it. Trying to treat a child for feeding concerns without looking into what is causing them will never work! It is extremely crucial to figure out the cause of the problem before simply trying to implement a quick fix. Below, find a comprehensive but not exhaustive (that would be impossible!) list of common conditions that lead to a majority or feeding difficulties in children:

• Child temperament (slow to change, does not like new things, easily stimulated, over-stimulated)
• Pain or discomfort with feeding (from things such as reflux or allergy – some allergies are extremely difficult to diagnose such as EoE (Eosinophilic Esophagitis) and take special testing to examine and determine if they are present)
• Negative past experiences with feeding (pain, coughing, vomiting or gagging during feeding)
• Sudden scary choking event
• Negative experiences related to the mouth (history of NG tubes, oral procedures, being on a ventilator, surgeries)
• Time spent in the hospital as a baby, perhaps in the NICU
• Slow emptying of the stomach (gastroparesis)
• Chronic constipation, intermittent constipation – if food is not coming out, food will not go in!
• Poor oral motor skills (dysphagia)
• Low muscle tone/high muscle tone
• Developmental delays (wide variety)
• Certain developmental disabilities, such as autism spectrum disorder
• Anxiety (anxiety specifically around food is commonly referred to as ARFID)
• ADHD
• Sensory differences (hypersensitivity to taste, smell, texture)
• Chronic health problems (ear infections, frequent respiratory infections, dental problems, seizures)
• Parent-child conflict, parental anxiety

So now that we have some information and we know we need to get to the underlying cause of the problem before treatment begins, how exactly do we do that? See below to get a better understanding of some of the tests/procedures that may be included with your workup.  Many children have only one or two or these completed, while some need more. Your feeding therapist should be able to guide you through this complex journey as you navigate your way down this path.  

• Review of medical history, growth pattern, developmental history, and current symptoms
• Assessment of dietary intake (typically a 3-day diet review is very beneficial) – a dietary journal can help because it can be very hard to remember!
• Feeding evaluation to look at intake, setting, response to food presentation
• Evaluation of feeding behaviors 
• Evaluation of oral motor skills, chewing and swallowing
• Special tests to evaluate swallowing, such as a barium swallow or endoscopic assessment. 
• Evaluation by a pediatric gastroenterologist to determine if there are problems of the GI tract (reflux, constipation, or other GI disorders) that may be contributing to feeding problems
• Blood work to evaluate nutrition status or to screen for medical conditions that can contribute to feeding problems. This can often be performed by your pediatrician or your GI doctor if you already have an appointment. 

If you feel your child is having feeding difficulties, there are obviously a huge variety of factors that can contribute. Feeding challenges go far beyond simple “picky eating,” and it is crucial to figure out the cause of the problem and get to the right professional to help fix the issue.  Kelly is a feeding specialist and founder of pickyeatersonline.com treating children with feeding disorders in Lake Nona and beyond. If you would like to ask her any questions regarding feeding concerns for your child or if you have feeding questions in general, email her at kelly@pickyeatersonline.com and she will be covering topics you request in upcoming articles!