Feeding Difficulties

From conception to birth and beyond, babies need nutrients to develop and grow. A broad spectrum of nutrients is necessary for their health and wellbeing. However, some babies and children develop feeding difficulties that may affect their health and quality of life. In this post, you’re going to learn more about feeding difficulties in pediatrics.

What are feeding difficulties?

The term feeding difficulty refers to all feeding problems regardless of their severity, etiology, and consequences. More precisely, pediatric feeding disorder is an impaired oral intake that is not age-appropriate and is linked to nutritional, medical, psychosocial, and feeding skills and functions. 

The feeding difficulties can be acute or chronic. Acute feeding difficulties last less than three months, whereas chronic pediatric feeding disorder is over three months in duration.

How common are feeding difficulties?

The numbers show that 20% to 50% of normally developing children and 70% to 89% of children with developmental disabilities struggle with some form of feeding difficulty. In most cases, the onset of pediatric feeding disorder occurs from six months to four years of age.

Other reports reveal that one in four children develop some form of feeding disorder. Additionally, eight to 10 children with disability have feeding difficulties.

Considering that feeding difficulties are associated with growth faltering and nutritional deficiency, the prevalence of this disorder could be higher in children with failure to thrive than their healthy counterparts.

What causes feeding difficulties?

Feeding difficulties result from several reasons, including:

● Anatomical or structural abnormalities such as cleft palate, head and neck problems, muscle weakness in the head and neck

● Nervous system disorders such as cerebral palsy, sensory issues

● Medical conditions, e.g., food allergies, reflux, and other stomach problems, heart disease, breathing problems such as asthma, 

● Reinforcement of inappropriate behavior

In many cases, no single factor causes feeding difficulties. A combination of different causes plays a role in developing these problems. Medical aspects of pediatric feeding disorder involve a wide range of problems such as upper gastrointestinal (GI) tract dysfunction and inflammatory diseases that impair feeding.

Nutritional factors also play a role in feeding difficulties. Unfortunately, many children with pediatric feeding disorders have a restricted diet quality and quantity that places them at high malnutrition risk. 

The development of feeding difficulties also has a lot to do with feeding skill factors. For example, injuries, illnesses, and developmental delays can impair feeding skills. At the same time, feeding behavior is also influenced by a child’s environment, including caregiver-child interaction and cultural expectations within a mealtime context.

Symptoms of feeding difficulties

Feeding difficulties manifest themselves through different symptoms. The exact signs and symptoms vary from one child to another since they depend on their age and the underlying cause of the problem. In most cases, the symptoms include:

● Throwing tantrums at mealtimes

● Difficulty accepting and swallowing foods of different textures

● Sensory or oral motor problems

● Refusing to eat liquids or solids

● Refusing to eat specific food groups

● Gagging, vomiting, or choking when eating

● Dependence on gastrostomy tube or nasogastric tube

● Arching back or stiffing when feeding

● Spitting up and/or vomiting a lot

● Problems with breastfeeding

● Difficulty breathing when drinking/eating

● Holding food in the mouth too long

● Coughing or gagging during the meals

Besides the abovementioned symptoms, children with feeding difficulties don’t gain weight or grow properly. Parents or caregivers who notice these symptoms should schedule an appointment and take the child to a healthcare provider.

Types of feeding difficulties

A pediatric feeding disorder is usually a manageable problem, but it’s necessary to pinpoint the type of feeding behavior to tackle these difficulties adequately. Not all children with feeding difficulties have an underlying medical condition. Feeding difficulties can also involve:

● Refusing food in general

● Refusing to eat certain textures only 

● Picky eating

● Low volume acceptance, i.e., a child eats food but stops at a specific point at which insufficient nutrition is taken

Due to feeding difficulties, a child doesn’t consume enough nutrients, calories, and hydration vital for their bodies to grow and thrive.

How are feeding difficulties treated?

A single treatment option for pediatric feeding disorders doesn’t exist. There is no “one size fits all” rule here. The exact treatment depends on the child’s age and the cause of the problem.

The basic principles for children with feeding difficulties include:

● Maintaining appropriate boundaries

● Eliminating distractions such as TV, games, toys, phones

● Feeding the child at intervals of 3-4 hours to maximize and encourage appetite 

● Avoiding snacks and beverages between the meals

● Maintaining a pleasant and neutral attitude when feeding a child without demonstrating anger and nervousness

● Limiting the duration of mealtime to no longer than 20 to 30 minutes

● Serving age-appropriate food based on the child’s oral motor development 

● Introducing new food systematically step by step, one at a time

● Encouraging toddlers to feed independently by allowing them to have their own spoon

● Allowing age-appropriate messes during mealtime, e.g., avoiding wiping the child’s mouth every time they eat or drink and making sure toddlers use a bib

The healthcare provider recommends an adequate strategy based on the cause of the feeding difficulty. For instance, feeding difficulties caused by medical problems could resolve by treating or managing the underlying cause.

In children with infantile anorexia type indicated by lack of interest in food, a valid approach enhances hunger and increases appetite and satiety. This is achieved by limiting mealtime and having a specific number of meals during the day. Self-feeding is encouraged.

Children who eat specific textures only and picky eaters require a slightly different approach. For picky eaters, it could be helpful to hide food in sauces or use appealing designs. These simple techniques could correct picky eating behaviors. Children that eat specific textures only may benefit from long-lasting, intense systematic, and stepwise approaches such as offering particular food on the progressive acceptance of less desired food options. It also helps to replace one food with a similar choice.

Children whose feeding difficulties result from neurological impairment or oral motor delays can benefit from oromotor therapy by a language and speech specialist.

In other words, children with pediatric feeding disorders need consistency, boundaries, and encouragement. Parents and caregivers should work together with healthcare providers to address these problems.


Feeding difficulties are common in children. They appear in many forms and result from a wide range of causes. In most cases, a combination of different factors leads to feeding difficulties. Some problems occur due to diseases and developmental issues, whereas others can be due to unhealthy eating behaviors. Treatment of feeding difficulties depends on the cause of the issue. A proactive approach is vital because feeding difficulties could affect a child’s growth and development.