What are the causes of Feeding Problems?
There are many factors which can contribute to problems feeding. They can be medical, environmental, behavioral, nutritional, sensory related, oral-motor related, or due to a child’s particular diagnosis which may encompass a few of the previously mentioned.
Some Medical Causes of Feeding Problems Are:
- Gastroesophageal reflux disease (GERD): A condition often caused when the muscle at the bottom of the esophagus is weak, which allows stomach contents to drift back up into the esophagus. It can come from delayed gastric emptying or constipation or even muscle spasticity. The acid that comes up into the esophagus causes the esophagus to become inflamed which in turn makes swallowing painful and difficult. The condition is often seen in premature infants and children with neuromotor problems. Many children outgrow GERD, but some do not. Most children are treated with medication. It is one of the most common causes of feeding problems in children.
- Chronic Constipation: This is common in many children with special needs. It can be caused by a lack of fiber in the diet, or low/high muscle tone or motility problems (inability to move food through the digestive tract). Some children have pain when having bowel movements and therefore stop trying to go, leading to abdominal pain and refusal to eat.
- Food allergies: Can cause rashes, vomiting, abdominal pain and nausea which in turn can lead to a refusal to eat. Some children outgrow food allergies, but others do not.
- Dysphagia: This is a difficulty with swallowing foods, where swallowing is often painful. These children can be at risk for aspiration (inhaling food into their trachea or lungs).These children may gag or choke when eating and be prone to respiratory problems and pneumonia. These children should be evaluated by a physician.
- Motilty Problems/Delayed Gastric Emptying: This is a problem with food being emptied from the stomach or problems with food moving through the gastrointestinal tract. These children may have a lack of appetite and constipation or vomiting.
These are just a few of the most common medical reasons related to problem feeding, but there are many more.
A child should always be evaluated by medical professionals before starting a feeding program. Some medical tests that may be ordered by a physician include:
- Allergy Testing: A doctor may perform either a blood test or skin test to determine food allergies
- Upper GI/Modified Barium Swallow/Cookie Swallow: This is an X-ray of the esophagus, stomach and duodenum. If the pharynx and esophagus are evaluated this is called a barium swallow (also known as a cookie swallow) since a child drinks barium to coat the structures so they can be seen on film.
- Gastric Emptying Study: This study evaluates the speed at which food empties from the stomach into the small intestine. This involves the child eating a meal which includes a small amount of radioactive material so the doctor can see the rate of emptying that occurs.
- Upper Endoscopy: This involves using a flexible tube with a light that is inserted to examine the esophagus, stomach and duodenum.
- pH Probe: This is the test used to diagnose GERD (reflux). A tube is inserted in the child’s nose into the esophagus. This allows the doctor to assess the pH level of the esophagus over a period of 12-24 hours. When the child has reflux and food backs up into the esophagus, the probe records this.
Additional Issues Related to Feeding Problems
Behavioral Feeding Problems: Some children may have aggressive or self-injurious behaviors related to feeding, which may require professional intervention before the core issue of feeding can be dealt with so that the child is safe. Some children may react differently to different caregivers and may not eat for mom at home, but will eat for the day care staff. Some children may have learned behaviors over time, such as if they cry, vomit or gag, they will not have to eat. Sometimes there are even parent-child issues such as maternal depression, a parent being anorexic or other mental health issues of the caregivers which can impact feeding.
Environmental Issues Related to Feeding: Sometimes changes in the child’s environment will enhance his ability to eat. A child may need a special chair in order to be properly positioned in order to chew and swallow with ease. Some children will require special spoons or utensils, cups or plates to eat with success. Some children may need less distractions during mealtimes, such as turning off the TV or dimming the lights. There are also many children for whom a lack of sleep or lack of a stable mealtime schedule and daily routine affects their feeding skills/ability.
Oral Motor Problems: These problems are related to difficulty with tongue, lip or jaw movement that make eating difficult. These children may have trouble chewing, will take longer to eat, may tire easily during feeding and may show a refusal to eat.
Sensory Related Problems: These problems can involve the taste, texture, smell, appearance, type or temperature of foods. These children may have difficulty accepting new foods due to the appearance (may gag on sight of a certain food or due to smell of a food), may only accept hot or cold foods, may only accept foods of one texture (ie smooth, pureed). They may not like to touch foods with their hands or resist having their faces wiped after meals.
Sources include: Autism and Feeding Problems by Elizabeth Strickland, RD, LD; Pediatric Feeding Disorders by Kyong-Mee Chung and Sung Woo Khang; Treating Eating Problems of Children with Autism Spectrum Disorders and Developmental Delays by Keith E. Williams and Richard M. Foxx