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Pediatrics. 2015 Feb;135(2):344-53. doi: 10.1542/peds.2014-1630. Epub 2015 Jan 5.

A practical approach to classifying and managing feeding difficulties.

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Departments of Pediatric Gastroenterology, Hepatology, and Nutrition, and
Pediatric Nutritional Consultant, Geneva, Illinois;
FAAP Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, College of Medicine, The Ohio State University, Columbus, Ohio; and.
Department of Paediatrics, North York General Hospital, Department of Paediatrics and Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
Departments of Pediatric Gastroenterology, Hepatology, and Nutrition, and.
Psychiatry, Children's National Medical Center, The George Washington School of Medicine and Health Sciences, Washington, District of Columbia;


Many young children are thought by their parents to eat poorly. Although the majority of these children are mildly affected, a small percentage have a serious feeding disorder. Nevertheless, even mildly affected children whose anxious parents adopt inappropriate feeding practices may experience consequences. Therefore, pediatricians must take all parental concerns seriously and offer appropriate guidance. This requires a workable classification of feeding problems and a systematic approach. The classification and approach we describe incorporate more recent considerations by specialists, both medical and psychological. In our model, children are categorized under the 3 principal eating behaviors that concern parents: limited appetite, selective intake, and fear of feeding. Each category includes a range from normal (misperceived) to severe (behavioral and organic). The feeding styles of caregivers (responsive, controlling, indulgent, and neglectful) are also incorporated. The objective is to allow the physician to efficiently sort out the wide variety of conditions, categorize them for therapy, and where necessary refer to specialists in the field.


eating disorder; failure to thrive; fear of feeding; limited appetite; picky eater; selective intake

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