What is a feeding disorder?

A pediatric feeding disorder refers to a condition in which an infant or child fails to consume enough nutrients to promote growth.

Twenty-five percent of all children experience some feeding difficulties. The child may have had limited experience with eating, have difficulty eating, or simply refuse to eat. This can be a fairly common problem in infants and toddlers. However, it is most common in children with developmental disabilities.

What causes a feeding disorder?

Feeding and swallowing problems are most often associated with complex medical diagnoses (such as prematurity, reflux, complications secondary to tube feeding for extended periods of time, and disorders of the digestive system), anatomical or structural abnormalities (such as congenital diaphragmatic hernia or tracheo-esophagael fistula), allergies, or oral-motor dysfunction.

Early or delayed introduction of solid foods and active food refusal may cause child and parental anxiety during meals.

Out-Patient Feeding Services

Evaluation

The mission of a Pediatric Feeding Evaluation at Duke University Medical Center is to provide diagnostic and treatment planning for children whose congenital or acquired medical and developmental needs and oral-motor, feeding, and behavioral difficulties have affected their feeding and growth.

The team, comprised of Speech Pathology and Occupational Therapy staff, works with each child and family to address the multiple factors involved with eating. Family education and training are provided. Consultative services are available with Nutrition, Nursing, Psychology, Social Work, and Medical within the Duke University Health System as necessary.

Therapy

The feeding program offers outpatient feeding services with Speech Pathology and/or Occupational Therapy, which usually involve weekly visits.

The goal of outpatient therapy is to meet children’s needs not only by addressing the oral-motor, sensory, and dietary needs, but also by helping caregivers develop and implement an effective home-based feeding program. The frequency of treatment and disciplines involved are based on the child’s specific needs.

Consultation

Consultative services may also be provided to families and therapists in outlying areas following an initial evaluation. These visits would be treated as a follow-up for additional therapeutic suggestions for those accessing local services and/or when therapy services cannot be obtained.

Symptoms Indicating When to See a Specialist

The following symptoms may indicate the presence of a feeding disorder:

• Growth issues such as failure to consume enough nutrients to promote growth. (Reflux is often associated with this.)
• Oral-motor concerns including abnormal suck-swallow-breathe synchrony, prolonged feeding time (over 30 minutes), and excessive fluid loss during feeding.
• Swallowing concerns such as frequent episodes of gagging, coughing, or choking while eating; difficulty managing saliva; noisy or gurgling respirations after eating; or a diagnosis of aspiration.
• Difficulty transitioning from breast to bottle, baby foods, and solids, as well as from tube feedings to oral feedings.
• Active food refusal with any consistency and disruptive mealtime behaviors.

What is the referral process?

To schedule an evaluation, contact the Division of Speech Pathology and Audiology at 919-684-3859 or the Department of Physical Therapy and Occupational Therapy at 919-684-3730.

After an appointment has been made, a questionnaire and food diary will be mailed to the family to be completed prior to the evaluation appointment. Caregivers and other professionals are welcome to attend the evaluation.