Virtually all children go through some stage of “picky eating,” and it may be both temporary and harmless. However, when it persists and a child fails to grow and thrive alongside their peers, they may be diagnosed with pediatric feeding disorder – a new diagnosis that Fort Myers feeding therapy can help to treat.

The condition was formally recognized last October, as explained by the American Academy of Pediatrics.

Pediatric feeding disorder (PFD) is understood to involve impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, or psychosocial dysfunction. It lasts more than two weeks, and is associated with 1 or more of the following:

• Medical dysfunction (cardiorespiratory compromise during oral feeding or aspiration/recurrent aspiration pneumonitis).
• Nutritional dysfunction (as evidenced by malnutrition, specific nutrient deficiency/significantly restricted intake of one or more nutrients resulting from restricted dietary diversity, or reliance on enteral feeds/oral supplements for hydration and/or nutrition).
• Feeding skill dysfunction (need for texture modification of liquid or food, use of modified feeding position/equipment, or modified feeding strategies).
• Psychosocial dysfunction (active/passive avoidance of child when being fed, inappropriate caregiver management of child’s feeding needs, disruption of social functioning in a feeding context, or disruption of caregiver-child relationship associated with feeding).

The full diagnostic criteria is spelled out by the Journal of Pediatric Gastroenterology and Nutrition.

The AAP noted that feeding is a complex process that involves the caregiver-child relationship, numerous body systems, and multiple developmental processes. This is why pediatricians need to ask pretty specific questions when they’re trying to determine whether a child has PFD.

As our Southwest Florida feeding therapists can explain, PFD is different than avoidant/restrictive food intake disorder. PFD includes older kids and those with comorbid diagnoses and dysphagia. It’s also not not the same as an eating disorder (such as anorexia nervosa) because it excludes adults, as well as the fear of gaining weight/disturbance of body image. And it’s also fairly common, with the AAP reporting it affects 20 percent of neurotypical kids and 80 percent of those with developmental disabilities. It’s even more prevalent than autism spectrum disorder.

How Fort Myers Feeding Therapy Can Help

The first step in making pediatric feeding therapy accessible was getting the PFD codified, as codes are used worldwide for medical tracking and recording of disease statistics, as well as for insurance companies to qualify the condition for coverage.

A few years ago, a non-profit organization called Feeding Matters collaborated with physicians across the world – including those at the American Academy of Pediatrics – to develop research that ultimately led to a new insurance code for the disorder.

This was so important because 63 percent of families with a child who has a “failure to thrive” diagnosis (before pediatric feeding disorder was formally recognized) reported the financial burdens were significant – with parents often compelled to stay home and care for their sick child, not to mention prescription formulas and out-of-pocket payments for therapy (because insurance would not cover).

Now, with this new coded diagnosis, there is a better chance of having treatment covered by insurance.

Feeding Matters developed a toolkit for doctors treating pediatric patients with PFD.

Meanwhile, the American Speech-Language Hearing Association set forth guidelines for speech therapists, who are generally tasked with treating children who suffer from feeding and swallowing disorders or difficulties. Depending on the specifics of the child’s condition, treatment options may include:

• Postural and positioning techniques. This is where we would adjust the child’s posture or position to create central alignment & stability so the child can feed safely.
• Diet modifications. This involves altering the texture, temperature, portion size, viscosity, or taste of food/liquid to help the child eat more easily – and safely.
• Providing adaptive equipment and utensils. The goal here is independence and safety in eating. That could mean cut-out cups, modified nipples, weighted spoons and forks, angled spoons and forks, non-tip bowls, sectioned plates, etc.
• Exercises and maneuvers. If the difficulty with feeding has to do with certain cognitive or muscle impairments, there are exercises we can do to help the child develop the strength, timing, or movements of swallowing.
• Feeding strategies. These might include pacing (moderating the rate of intake), cue-based feeding (relying on cues from the child), and responsive feeding (focuses on the child-caregiver dynamic).
• Sensory stimulation techniques. This might include thermal-tactile stimulation (ice or heat), tactile stimulation (using a NUK brush, etc.) that may allow the child to reduce their sensitivity and increase tolerance for the whole process of feeding.
• Behavioral interventions. These we can collaborate on with our ABA therapy team, and may include antecedent manipulation, shaping, prompting, modeling, stimulus fading, etc.

In some cases, tube feeding may be necessary, but typically as a last resort, and only for a short window, if possible. Depending on the child’s condition, feeding therapy may also involve professionals from other disciplines, including occupational therapists, ABA therapists, and physical therapists.

Whatever the treatment, the good news is that with this new diagnosis of PFD, more children may have access to Fort Myers feeding therapy services – and sooner.

FOCUS offers pediatric feeding therapy in Fort Myers and throughout Southwest Florida. Call (239) 313.5049 or Contact Us online.

Additional Resources:

SOS Approach to Feeding, 2017, Toomey & Associates

More Blog Entries:

What to Expect in a Feeding Therapy Evaluation, July 21, 2021, Fort Myers Feeding Therapy Blog