A single underlying cause for why children refuse to eat enough to sustain normal growth is rarely
Table 2 Common feeding disorder symptoms
Liquid dependent Enteral tube dependent
Texture Type evident, and therefore this problem presents a significant diagnostic and therapeutic challenge to clinicians and parents. Given the complexity of this challenge, numerous attempts at classifying feeding disorders have been made based on the apparent etiology, physical condition, or associated behaviors. Because most feeding disorders are the result of multiple factors (i.e., physical, motivational, skill, and parent/child relationships), a more functional classification has been developed that allows differentiation of patient types by symptoms rather than an arbitrary disease-based diagnostic approach (Table 2).
Children with food refusal who require any kind of enteral tube feed would be categorized as 'food refusal—enteral tube dependent,' whereas a child who drinks more than 80% of his or her calorie requirement would be considered 'food refusal— liquid dependent.' Another feeding problem category is 'food selectivity—type.' In this category, children would eliminate 75% of the four basic food groups. Typically, a child with this categorization would have the skill to eat but would choose to only eat one or two different foods and restrict all other foods. The child may or may not be able to sustain normal growth with this kind of diet. 'Food selective—texture' describes a child who does not eat an age-appropriate texture of food due to lack of skill or oversensitivity to a particular food texture—for example, a 5-year-old child who only eats pureed foods when he or she should be able to handle regular textured food. Again, the child may or may not sustain normal growth.
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