The history of PFD
Feeding Matters Strategy
Pediatric feeding disorders lacked a universally accepted definition. A unifying diagnostic term, “pediatric feeding disorder” encompassing medical, nutrition, feeding skill, and psychosocial domains was proposed in “Pediatric Feeding Disorder: Consensus Definition and Conceptual Framework”.
In 2014, Feeding Matters’ Founder and Emeritus board member, Shannon Goldwater, envisioned pediatric feeding disorder as a stand-alone diagnosis, recognizing that the absence of a universally accepted term was the root cause of the system issues that failed her children and many more. Because these children were seen as having symptoms instead of a disorder, there was no comprehensive system in place that included collaborative care, qualified providers, proper insurance coverage, or an educational path to become a qualified feeding therapist.
In 2015, Feeding Matters’ Council approved the initiative to create a definition and identity for pediatric feeding disorders. They began the work to convene a consensus meeting on the disorder, publish a consensus paper, advocate for a diagnostic code within the ICD, and disseminate the information to the healthcare community.
In March 2016, Feeding Matters gathered in Arizona with over 17 experts from around the world to determine a name, definition, and diagnostic criteria for pediatric feeding disorders. This pivotal meeting led to two years of collaborative work to write and publish the paper, “Pediatric Feeding Disorder: Consensus Definition and Conceptual Framework” in the January 2019 Journal of Pediatric Gastroenterology and Nutrition.
Feeding Matters continued to advocate for PFD as a stand-alone diagnosis by devising an advocacy campaign to secure an ICD code for the newly defined PFD. In September 2019 and March 2020, the American Academy of Pediatrics partnered with Feeding Matters’ lead authors and Feeding Matters past Medical Director, Dr. Phalen, to present a proposal to the Centers for Disease Control and Prevention (CDC) calling for an ICD code for PFD. On August 20th, 2020, Dr. Phalen contacted Feeding Matters to share that the ICD code for PFD was approved and was to be included in the United States-ICD-10-CM in October 2021.
Now that PFD has been defined and an ICD code for pediatric feeding disorder has been approved, Feeding Matters will leverage the advocacy agenda to promote accurate and efficacious use of the PFD code. By working closely with healthcare professionals and insurance companies, strategies will be developed to promote appropriate use of diagnostic and treatment codes and prevent over-utilization and over-spending. The recognition of PFD and related judicial reimbursement practices are instrumental for improving health outcomes in children with PFD.
- There is no universally accepted term or diagnostic criteria for pediatric feeding disorders
- The International Classification of Diseases (ICD) code for feeding difficulties (R63.3 in the ICD 10) is non-specific and poorly defined
- Feeding disorders are often treated as a symptom rather than a stand-alone condition
- PFD requires comprehensive assessment and treatment, but the lack of a universally accepted definition has hindered collaborative care
- Previous diagnostic paradigms define PFD through the lens of a single discipline, which fails to characterize associated functional limitations
- Feeding Matters facilitated the consensus project which gathered over 17 world thought-leaders from various disciplines in the field of pediatric feeding disorders to determine a name, definition, and diagnostic criteria for pediatric feeding disorder
- During the consensus conference, the group elected to use the framework of the World Health Organization (WHO) International Classification of Functioning, Disability, and Health (ICF)
- This conceptual framework goes beyond disease-oriented or unilateral diagnostic paradigms
- Adoption of PFD from all disciplines will establish a common definition and terminology to impact clinical practice, education, research, and advocacy
1. Goday PS, Huh SY, Silverman A, Lukens CT, Dodrill P, Cohen SS, Delaney AL, Feuling MB, Noel RJ, Gisel E, Kenzer A, Kessler DB, de Camargo OK, Browne J, Phalen JA. Pediatric feeding disorder: consensus definition and conceptual framework. JPGN 2019;68(1):124-129.