Feeding problems of infants and toddlers.

OBJECTIVE To propose a diagnostic and therapeutic approach to feeding problems in early childhood. QUALITY OF EVIDENCE Articles were retrieved through a MEDLINE search from January 1990 to December 2005 using the MeSH terms eating disorders, infant, and child. Recommended practice is based mainly on levels II and III evidence. MAIN MESSAGE Feeding problems are classified under structural abnormalities, neurodevelopmental disabilities, and behavioural disorders, with overlap between categories. A medical approach also needs an evaluation of diet and an assessment of the interaction between parent and child. Treating medical or surgical conditions, increasing caloric intake, and counseling about general nutrition can alleviate mild to moderate problems. More complicated cases should be referred to multidisciplinary teams. Behavioural therapy aims to foster appropriate behaviour and discourage maladaptive behaviour. CONCLUSION Feeding problems in early childhood often have multifactorial causes and a substantial behavioural component. Family physicians have a key role in detecting problems, offering advice, managing mildly to moderately severe cases, and referring more complicated cases to multidisciplinary teams.

[1]  T. A. Hoch,et al.  Behavioral Assessment and Treatment of Pediatric Feeding Disorders , 1994, Journal of developmental and behavioral pediatrics : JDBP.

[2]  S. Salvatore,et al.  Gastroesophageal reflux and cow milk allergy: is there a link? , 2002, Pediatrics.

[3]  M. Dahl.  Early Feeding Problems in an Affluent Society , 1987, Acta paediatrica Scandinavica.

[4]  Michelle M. Garrison,et al.  A systematic review of treatments for infant colic. , 2001, Pediatrics.

[5]  K. Christoffel,et al.  One-Year Follow-up of Symptoms of Gastroesophageal Reflux During Infancy , 1998 .

[6]  E. Wang,et al.  Discontinuation of enterostomy tube feeding by behavioral treatment in early childhood: a randomized controlled trial. , 2000, The Journal of pediatrics.

[7]  S. Powers,et al.  Family Functioning in Young Children with Cystic Fibrosis: Observations of Interactions at Mealtime , 2004, Journal of developmental and behavioral pediatrics : JDBP.

[8]  K. Christoffel,et al.  Infant and Toddler Feeding Patterns and Problems: Normative Data and a New Direction , 1996, Journal of developmental and behavioral pediatrics : JDBP.

[9]  M. Dahl,et al.  Feeding problems in an affluent society. Follow‐up at four years of age in children with early refusal to eat , 1992, Acta paediatrica.

[10]  I. Chatoor,et al.  A Developmental Classification of Feeding Disorders Associated with Failure to Thrive: Diagnosis and Treatment , 1985 .

[11]  S. Bahna.  Cow's milk allergy versus cow milk intolerance. , 2002, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[12]  L. Worrall,et al.  Feeding problems in infants with gastro‐oesophageal reflux disease: A controlled study , 1999, Journal of paediatrics and child health.

[13]  L. Birch.  Development of food preferences. , 1999, Annual review of nutrition.

[14]  J. Arvedson.  Management of pediatric dysphagia. , 1998, Otolaryngologic clinics of North America.

[15]  A. Rydell,et al.  Children with early refusal to eat: follow‐up during primary school , 1994, Acta paediatrica.

[16]  E. Satter.  The feeding relationship: problems and interventions. , 1990, The Journal of pediatrics.

[17]  Feeding and Eating Disorders of Infancy and Early Childhood , 2004 .

[18]  S. Powers,et al.  Randomized Clinical Trial of Behavioral and Nutrition Treatment to Improve Energy Intake and Growth in Toddlers and Preschoolers With Cystic Fibrosis , 2005, Pediatrics.