How to Address Feeding Difficulties in Infants and Toddlers?

How to Address Feeding Difficulties in Infants and Toddlers?

Feeding difficulties in infants and toddlers typically have multifactorial etiologies and heterogeneous behavioral presentations, including neurological impairments, behavioral abnormalities, or a combination of both. According to the accounts of caregivers, about 25% to 40% of infants and toddlers with feeding difficulties exhibit symptoms such as abdominal pain, vomiting, slow eating, and food refusal.

When evaluating feeding difficulties in infants and toddlers, five key factors should be considered: How do the feeding difficulties manifest? Are there any underlying illnesses? Is the child's weight and growth development affected? How is the atmosphere during mealtimes? Are there any familial stressors?

When an infant's growth and development are normal, early detection of feeding difficulties by pediatricians should prompt assistance to parents in identifying and understanding the reasons behind the feeding issues and providing practical guidance and initial treatment. While some feeding difficulties are temporary, others, like refusal to eat (which occurs in approximately 3% to 10% of children), can persist and severely impact a child's health, leading to parental anxiety and the need for pediatric intervention.

Research has shown that high-risk infants who experience excessive crying and feeding difficulties during the first three months after birth are at risk of developing cognitive impairments during childhood. Prematurity, neonatal neurological complications, and disharmonious mother-infant relationships increase the likelihood of such occurrences. Therefore, it is crucial to pay adequate attention to the potential impact of early excessive crying and feeding difficulties on a high-risk infant's cognitive development and to take early intervention measures to prevent and reduce adverse outcomes.

Feeding difficulties can be classified into three categories, although there is often overlap between them. The first category involves abnormalities in anatomical structures, affecting three areas: the nasopharynx, larynx and trachea, and esophagus. The second category relates to neurodevelopmental disabilities that interfere with the normal eating process, resulting in oral hypersensitivity and dysfunctional oral motor function. The third category encompasses behavioral feeding difficulties.

Medical history should include information about the prenatal and perinatal periods, family history of allergies or feeding difficulties, past medical history, and hospitalization history, as well as any records related to medical procedures involving the oral and pharyngeal regions or previous feeding difficulties. The postnatal diet, changes in diet, timing of solid food introduction, current diet structure, feeding methods, and schedules should all be documented. Information about disliked foods, food intake, duration of feedings, and the current approach to feeding should also be recorded.

When a child has swallowing difficulties, anatomical abnormalities should be suspected. A history of recurrent pneumonia should prompt consideration of chronic aspiration, as approximately 70% to 94% of aspirations are "silent." Feeding-related wheezing may be due to abnormalities at the glottis or subglottis, and discoordination of sucking, swallowing, and breathing can be caused by conditions such as cleft palate or posterior choanal atresia. Vomiting, diarrhea, or constipation, as well as abdominal spasms or pain, should raise the possibility of gastroesophageal reflux (GER) or milk allergy.

Physical and laboratory examinations are essential. The physical examination should begin with anthropometric measurements, including head circumference, and growth curves should be recorded from birth. Craniofacial deformities, signs of systemic diseases, and allergy history should be identified. A thorough neurological examination is indispensable, and clinical data should be carefully analyzed and studied. Routine laboratory tests include complete blood cell count, erythrocyte sedimentation rate, serum albumin, serum iron, iron-binding capacity, serum ferritin, liver and kidney function, etc.

During feeding, the relationship between parents and children should be evaluated. Positive signs of a good relationship include mutual eye contact and caring communication, while signs of discord include force-feeding, coaxing, threatening, and children displaying uncontrollable behavior (such as turning away from food, discarding, or spitting it out).

Preventing sensory food aversion involves introducing various foods from 4 to 6 months of age. New foods should be introduced individually, and parents should persistently offer new foods to children until they become accustomed to them. It is advisable not to introduce new foods while the child is sick (e.g., with a cold or diarrhea). Children are more likely to accept a new food if they see their parents eating it.

Children with traumatic feeding difficulties can generally accept tube feeding, but it interferes with their experience of hunger and affects the development of oral-pharyngeal coordination. However, this treatment is temporary and aims to remove tube feeding and overcome resistance to oral feeding through behavioral extinction or gradual desensitization, ultimately leading to the achievement of the targeted food intake.

Behavioral intervention is essential. Parents should first be informed of dietary rules applicable to all infants and toddlers, learning what and when to feed their child and adjusting the food intake based on the child's hunger. During feeding, if a child vomits, parents should soothe them, pat their back to burp them, and remove gas from the stomach. Mothers should be patient and overcome feelings of anxiety and impatience.

Preventing sensory food aversion involves introducing various foods from 4 to 6 months of age. New foods should be introduced individually, and parents should persistently offer new foods to children until they become accustomed to them. It is advisable not to introduce new foods while the child is sick (e.g., with a cold or diarrhea). Children are more likely to accept a new food if they see their parents eating it.

Children with traumatic feeding difficulties can generally accept tube feeding, but it interferes with their experience of hunger and affects the development of oral-pharyngeal coordination. However, this treatment is temporary and aims to remove tube feeding and overcome resistance to oral feeding through behavioral extinction or gradual desensitization, ultimately leading to the achievement of the targeted food intake.