Understanding Pediatric Feeding Disorder (PFD) and Selective Eating in Autistic Children
What is Pediatric Feeding Disorder?
Pediatric Feeding Disorder (PFD) is a feeding disorder defined as impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction by Feeding Matters. It is estimated that more than 1 in 37 children under the age of 5 are affected by Pediatric Feeding Disorder each year in the United States [1].
PFD can put a child at risk for malnutrition or nutritional deficiency, so it’s important that the child receives the proper supports to get the nutrition their body needs. It’s important to note that a child can still have nutritional deficiency even if their BMI is normal or they are above the 50th percentile.
Prevalence of PFD in Autism
Autistic children are notably at a higher risk of developing PFD due to their unique sensory sensitivities and behavioral differences that affect eating habits. In typically-developing children, the prevalence of PFD is 2.7% [1]. While we don’t quite have the exact prevalence of PFD in autism, feeding problems are found in up to 76% of autistic children [2]. Identifying and addressing PFD in autistic kids is crucial for ensuring they receive adequate nutrition for healthy development.
Exploring the Four Domains of Pediatric Feeding Disorder
There are four important domains that are intertwined in PFD that signficantly impact a child’s lifelong well-being, as established by Feeding Matters. Impairment in one domain can lead to dysfunction in other domains and impact a child’s feeding and contribute to development of PFD.
Medical Domain
Eating is a complex task that involves the entire body including organs, muscles, and nerves. Certain medical conditions can impact a child’s ability to eat successfully and contribute to PFD. Examples of medical factors include: gastrointestinal (GI) tract dysfunction or disease, respiratory or airway anomaly, and neurological conditions. Examples can include gastroesophageal reflux, EoE, chronic lung diseases, congenital heart disease, motor and cognitive delays, and neurodevelopmental disorders such as autism.
Nutritional Domain
Due to a restricted diet due to limited variety, quality, and quantity of food and beverages, kids with PFD are at significantly higher risk for dehydration and both sides of the nutritional spectrum: nutritional deficiency & malnutrition or overnutrition & nutritional toxicity. It’s important to note that a child may have a normal BMI and still have nutritional insufficiency. While BMI and percentiles can be a helpful tool in some instances, they should not be used as a contraindicator for PFD.
Skill Deficit Domain
Feeding requires a variety of skills that may be impaired due to developmental delay, illness, or injury. These skills include chewing, swallowing, tongue movement and mobility, airway protection, pharyngeal motor functioning, and the ability to successfully maneuver food or beverage in the mouth. Oral sensory functioning can also impact a child’s ability to accept certain food characteristics including textures, temperatures, colors, bite size, or chewing requirement.
Lack of feeding skills may present as aspiration, choking, vomiting, gagging, food refusal, and even adverse cardiorespiratory events. Children with delayed feeding skills may need foods to be modified to be safely consumed (i.e. pureeing), need help with self-feeding, and may have prolonged mealtimes (greater than 30 minutes).
Psychosocial Domain
Feeding can also be impacted by the child’s environment and other psychosocial factors in both the child and caregiver. Stress and anxiety during mealtime, inappropriate management of mealtime-specific behavioral problems, inconsistent mealtime schedules, and mealtime distractions, among other factors, can all impact development of PFD. Signs of psychosocial dysfunction include feeding aversions due to physical or emotional discomfort and pain during eating, stress and negative associations with mealtime and food, food overselectivity, failure to advance to an age-appropriate diet despite adequate feeding skill, and grazing through out the day.
PFD vs. ARFID in Autistic Children
While PFD and Avoidant Restrictive Food Intake Disorder (ARFID) both involve restrictive eating behaviors, they differ in their underlying causes and treatment approaches. ARFID is primarily a mental health diagnosis identified by significant food avoidance that affects nutritional intake without the presence of body image concerns. Unlike PFD, ARFID does not usually include medical or skill-based challenges unless they contribute to the restrictive eating behavior.
Understanding the differences between PFD and ARFID is essential for providing effective care to autistic children facing feeding challenges. ARFID treatments might focus more on the behavioral aspects of food avoidance, while PFD treatments would address a broader range of issues including medical conditions and skill development. A child can have a co-diagnosis of PFD and ARFID.
By tackling the complexities of PFD and ARFID, caregivers and healthcare providers can better support autistic children’s nutritional needs and improve their overall quality of life.
For more detailed guidance on managing PFD and selective eating in autistic children, Feeding Matters offers valuable resources and community support tailored to address these intricate feeding issues.
Getting Support and Referrals for PFD Treatment
If you have concerns about your child’s feeding, you do not need to wait to bring it up with your doctor until their next wellness checkup. Make an appointment with your child’s pediatrician as soon as you have concerns. We suggest keeping a log of your child’s safe foods and eating behavior to discuss with your doctor and help aid in the correct referrals. We also recommend filling out the Feeding Matters Infant and Child Feeding Questionnaire® (ICFQ©) and bringing it with you to the appointment or emailing it to your doctor ahead of time.
You can find qualified feeding therapists via the Feeding Matters Provider Directory and the SOS Approach to Feeding Therapist Locator.
Possible Specialists for PFD
It’s ideal that you have a multidisciplinary team to support your child with PFD in a variety of settings including clinics, home- or school-based care, intensive therapy programs (both inpatient and outpatient), and even teletherapy. These specialists may include:
Registered Dietitian (RDN)
Speech Language Pathologist (SLP)
Occupational Therapist (OT)
Feeding Therapists (often SLPs or OTs)
Physical Therapist (PT)
Gastroenterologist (GI)
Child Psychologist
Developmental Pediatrician
Through a collaborative feeding support care team, children with PFD can be well supported and obtain the care they need to thrive.
