Most children, especially during their toddler years, will go through a phase of picky eating. But according to the National Institute of Health, more than 20% of children in the United States have some sort of pediatric feeding issue. That statistic is significantly higher in children who have some form of a developmental disability.

So how do you know if it’s just picky eating — or something more involved?

“We know you can become president and not like broccoli,” quipped Richard Katz, M.D., MBA, FAAP, the Chief Medical Officer and VP of Medical Affairs of Mt. Washington Pediatric Hospital (MWPH). (Not that eating broccoli would improve and inhibit presidential skills — but it is indisputable fact you can become president and not like the veggie). 

In all seriousness, Dr. Katz says a feeding disorder is characterized by a child passing on entire food groups (not just one or two foods) and missing an entire category of nutrients, to the point where it’s causing a tremendous amount of stress at mealtimes. Mealtimes that last more than an hour or involve regular tantrums are not typical of picky eating. It’s something more.

“I know parents who literally chase their children around trying to get them to eat — or solely fed their child in the bathtub because that’s where he would eat,” said Dr. Katz.

I winced at that comment. I’ve been one of those parents. Our Little Lion Man was entirely fed via feeding tube for the first year of his life. I remember the quiet desperation of doing anything to get him to take food by mouth as we started to introduce him to eating. I remember running around after him with a plate.  It was like a real-life version of Green Eggs and Hamwould you, could you, in a box? Would you, could you, with a fox? While we never fed him in a bathtub, I would have tried it had I thought of it. 

Is it picky eating? Or is it a feeding disorder? - (cool) progeny

It’s important to distinguish that feeding disorders are different from eating disorders, said Dr. Katz. Eating disorders like anorexia nervosa or bulimia are psychological disorders. The affected person is trying to control food intake to manipulate body image. A child or adult with a feeding disorder does not have body image distortion. They simply really never learned to eat.

“It was a huge surprise to me that there were all of these children who couldn’t eat,” saidDr. Katz. “As a provider, it was incredibly frustrating.”

He found that looking at the issues solely through a medical lens wasn’t working — which is why he truly believes in the multidisciplinary program MWPH has developed to treat pediatric feeding disorders. A team of pediatric gastroenterologists, nurse practitioners, nurses, psychologists, speech language pathologists, occupational therapists, physical therapists, dietitians and social workers develop personalized goals for each child in the program. Parents, siblings, and caregivers also play a pivotal role in treatment. {Check out Austin’s story here}.

Ellen Wingert, manager of MWPH’s Feeding Day Program, credits this approach to the successes their patients celebrate.

“As an occupational therapist, it’s frustrating when you have a patient struggling to make progress,” said Ellen. In a team environment, every specialist looks at the patient with a slightly different perspective. Collectively they can understand the bigger picture (are sensory issues involved? food allergies? a medical condition?) and put together a comprehensive, individualized treatment plan.

Is it picky eating? Or is it a feeding disorder? - (cool) progeny

Austin, a patient in the feeding program at Mt. Washington Pediatric Hospital, participates in a feeding session.

If you suspect your child may have a feeding disorder, your first step is to have a conversation with your pediatrician. Make it clear to your pediatrician that what you believe you’re seeing with your child is different than what he or she is hearing from parents of the other 25-40 patients they are seeing that day. Clearly outline the situation, your frustrations, and how your child is different from your friends’ children. 

Once you start the dialogue with your pediatrician, your next step is to work with your pediatrician to determine if there is an underlying medical condition and to work with a dietician to get a full understanding of your child’s eating habits. Oftentimes, an intensive feeding program may not be a logical first step in addressing a feeding disorder. Outpatient therapy services may work better. MWPH offers those as well.

Ellen reitereated that there isn’t a quick fix for a feeding disorder. It takes hard work, sticking to a plan, and a lot of patience.  

“But you will see success with a plan that works well for your child and your entire family,” said Ellen. 

As for those picky eaters that you parent? Dr. Katz has one word of advice…

Relax.

“Offer them the food they don’t want to eat,” said Dr. Katz. “But don’t make a big deal out of it when they refuse it.”

Your mealtimes will be better for it.

 

our sponsor: mt. washington pediatric hospital

This post is brought to you by Mt. Washington Pediatric Hospital

About Mt. Washington Pediatric Hospital: Where Children go to Heal and Grow
Mt. Washington Pediatric Hospital is a specialty children’s hospital that treats more than 8,000 patients each year on an inpatient and outpatient basis. The 102-bed post-acute hospital specializes in family-focused treatment of children with serious, chronic and/or complex medical needs. MWPH has renown in feeding and sleep disorders, brain injury and rehabilitation, behavioral health and autism, neonatal transition, newborns transitioning from heroin dependence, and childhood obesity, among other service lines. Founded in 1922 as a children’s convalescent home, MWPH is a jointly owned affiliate of The University of Maryland Medical System and The Johns Hopkins Health System. To learn more, visit www.mwph.org.

Images and video provided by Mt. Washington Pediatric Hospital.