Disorders of infant feeding

Feeding disorders are common in infants and, if the underlying cause is not addressed, may persist into childhood.

Aetiologies are usually multifactorial, and are best managed by a multidisciplinary team. Causes include prematurity; anatomical abnormalities; neuromuscular/neurodevelopmental conditions; gastrointestinal, genetic, cardiac, or respiratory conditions; and behavioural factors.

Diagnosis is usually clinical, with a consistent history supported by dietetic assessment. Complementary diagnostic tests and subsequent management are guided by physical findings and severity of symptoms.

Feeding disorders are usually subacute to chronic in nature. A sudden change in feeding habit may be associated with other conditions, notably infections, which need to be excluded.

Conditions in children <1 year of age that lead to impaired oral intake, and are associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction.[1]Goday PS, Huh SY, Silverman A, et al. Pediatric feeding disorder: consensus definition and conceptual framework. J Pediatr Gastroenterol Nutr. 2019 Jan;68(1):124-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314510 http://www.ncbi.nlm.nih.gov/pubmed/30358739?tool=bestpractice.com [2]Borowitz KC, Borowitz SM. Feeding problems in infants and children: assessment and etiology. Pediatr Clin North Am. 2018 Feb;65(1):59-72. http://www.ncbi.nlm.nih.gov/pubmed/29173720?tool=bestpractice.com

Feeding plays an important role in the life of infants. Early motor milestones are related to feeding, and feeding is an important time for infant-carer interaction. During the first year of life, infants' weights may be more closely monitored than at other times, and feeding and growth become an important component of medical review.[3]Rommel N, De Meyer AM, Feenstra L, et al. The complexity of feeding problems in 700 infants and young children presenting to a tertiary care institution. J Pediatr Gastroenterol Nutr. 2003 Jul;37(1):75-84. http://www.ncbi.nlm.nih.gov/pubmed/12827010?tool=bestpractice.com  

The focus of this topic is infants <1 year of age. One European study reported that, of 700 children referred for tertiary assessment of a severe feeding disorder, 50% presented at less than 1 year of age.[3]Rommel N, De Meyer AM, Feenstra L, et al. The complexity of feeding problems in 700 infants and young children presenting to a tertiary care institution. J Pediatr Gastroenterol Nutr. 2003 Jul;37(1):75-84. http://www.ncbi.nlm.nih.gov/pubmed/12827010?tool=bestpractice.com  Another study conducted in the US showed that 67% of patients were under 3 years of age at presentation, and many had symptoms beginning in the first year of life.[4]Burklow KA, Phelps AN, Schultz JR, et al. Classifying complex paediatric feeding disorders. J Pediatr Gastroenterol Nutr. 1998 Aug;27(2):143-7. http://www.ncbi.nlm.nih.gov/pubmed/9702643?tool=bestpractice.com