Feeding problems of infants and toddlers

Background: Eating is a primary biological need. Feeding is of great importance for the development and consolidation of the social relationship between infant and the primary caretaker. A minority of children and their parents, however, have distressing experiences around feeding and eating that can lead to long-term problems in the parent-child relationship and the child's health. Objective: To provide a review of the prevalence, etiological factors and consequences of feeding problems, and to describe a behavioral approach to the treatment of feeding problems. Method: Literature review. Results: Major feeding problems in infancy are refusal to eat any food or solid food, very selective eating, lack of appetite and failure to thrive with feeding problems. The prevalence of severe feeding problems has been estimated to be around 6-10%, and of failure to thrive to be between 3 and 4% in the general infant population. Feeding problems often lead to impaired growth and as a consequence have been found to affect the cognitive, behavioral and social development of children. Disturbances of mother-infant interaction, both as an etiological factor and as a secondary problem, are often found. A developmental task-orientated biological-behavioral model of the etiology of feeding problems is introduced and an approach to treating food refusal and failure to thrive is described. Behavior modification techniques, modified for the treatment of feeding problems, are introduced. A multi-disciplinary behavioral treatment approach to feeding problems has been reported in case series to be highly successful for treating feeding problems. Conclusions: Feeding problems are frequent and, if untreated, can have adverse consequences on the child's development. There is evidence for the effectiveness of a multi-disciplinary behaviorally and developmentally orientated treatment approach in small case series. However, sufficiently large randomized controlled trials of the effectiveness of behavioral treatment approaches in clinical practice are lacking.