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Infant Toddler Development Training
Module 6, Lesson 2

Behaviorally Based Feeding Disorders

There are four general classifications of feeding disorders: neuro-muscular, behavioral, sensory, and mixed. Neuro-muscular disorders are those that have muscular or anatomic basis. Behavioral disorders are those that are more psychosocial or interactive in nature. Sensory disorders are those that are a response to specific tastes, textures or smells. Other disorders are considered mixed because they have aspects of more than one of the classifications.

There are several sub-classifications of behaviorally based feeding disorders provided by Chatoor (2002). The classification is based on the behavioral characteristics and the age at onset.

Condition Age at Onset Characteristics Management
Disorder of State Regulation Newborn period Infant has difficulty reaching and maintaining a state of calm alertness necessary for healthy feeding Modulation of stimulation
Alternative feeding route
Support and counseling for the parents/caregivers
Disorder of Reciprocity Early infancy Lack of social reciprocity: visual engagement, smiling, babbling during feeding
Failure to grow		 Multidisciplinary team approach to include physician
Home visits
Parent training and support
Hospitalization as needed
Infantile Anorexia Around time of the transition from liquids to solids and to self feeding with fingers and spoon Refusal to eat adequate foods for at least one month in duration
Does not communicate hunger
No interest in food but explores environment and interacts with caregivers at times other than mealtimes
Not related to trauma or illness		 Assess infant's temperament
Assess for an insecure attachment and parent vulnerability
Use a behavioral specialist to develop a behavioral plan that includes structured mealtime routines and to counsel the parents
Food Aversions Early toddler or preschool age Refusal to eat specific foods with certain tastes, smells, textures, or appearances
Occurs during the introduction of a new food
Eats better when given preferred food
May have nutritional deficiency and oral motor delay		 Prevention when possible by teaching parents about the early introduction of a variety of tastes and textures before the child reaches toddler age
Teaching caregivers to model the practice of eating healthy foods
Instruct caregivers to provide a neutral atmosphere for mealtimes
Nutritional supplements and vitamins
Disorder associated With Chronic Medical Condition Occurs when disorder is manifest from newborn period and thereafter Readily initiates feeding but shows distress over the course of feeding and refuses
Medical treatment can improve but not eliminate the problem
ails to gain weight or loses weight		 Team approach
Behavioral management specialist to assist in planning routines and calm atmosphere and to modulate the feeding schedule
Oral motor feeding specialist if oral motor dysfunction or aspiration
Post Traumatic Feeding Disorder May occur anytime as a result of a reaction to a traumatic event or anything that reminds the infant/child of the event May refuse food following a traumatic or related event such as the insertion of a naso-gastric tube, an episode of choking, severe vomiting or aspiration
May refuse food from one utensil, but accept it from another
May accept the bottle, but nothing else
May accept offending utensil if sleepy
Intense resistance if reminded of the traumatic event		 Behavioral management specialist to use extinction behavioral therapy
May require supplements to the feeding and may require use of gastrostomy tube feedings until proper nutrition can be managed

Behaviorally based feeding disorders are considered in the context of the antecedents or past history of behavior. The medical provider and the team, including the ITDS and parents, need to observe what is happening at the time of feeding or mealtimes in order to plan appropriate intervention strategies.

 

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