“Is my child just being picky?” This is a question that parents and caregivers may often ask themselves when mealtimes become a struggle. And indeed, there are times when an infant or child just finished a growth spurt and seems to be eating less. Or when a toddler refuses most foods except ones of a certain color or texture, which is called a “food jag”. A food jag is often a normal part of childhood development. But when does it become “not normal”?

A Pediatric feeding disorder (PFD) is defined as impaired oral intake that is not age appropriate, lasts at least 2 weeks, and is associated with medical, nutritional, feeding skill, and/or social-emotional challenges.1

There is often an underlying reason for the pediatric feeding disorder that needs to be uncovered. A registered dietitian who specializes in pediatrics is a qualified heath care provider to work with you and your child. They are a credentialed specialist who can assess your child’s growth and nutrition needs. A nutritional assessment may include several components:

• Medical history
• Diet history
• Medical tests or procedures
• Laboratory values
• Anthropometric measurements (weight, length, head circumference)
• Physical examination

A registered dietitian may also complete a behavioral and feeding disorders assessment that identifies:

• Limited food variety acceptance (color, texture, smell)
• Limited tolerance to enteral nutrition (vomiting, diarrhea, constipation)
• Aversion to foods/beverages
• Mechanical issues (gagging, choking, aspiration)
• Neurological (failed swallow study)
• Inadequate enteral intake (food refusal at meals, prolonged feeding times, muscle wasting)

A complete assessment is more critical in a pediatric patient versus an adult patient because children can become malnourished quicker than adults. Children have lower body fat, lower muscle mass, but high calorie requirements. Risk for inadequate nutrition increases when a child is not consuming sufficient key nutrients like protein, fat, iron, calcium, and Vitamin D. This is important because children, especially in the first 1000 days of life, are undergoing a period of rapid brain growth which is the foundation for optimal development, a key factor in long-term health.2

Registered Dietitians are a specialist that your doctor and/or insurance provider can refer you to. Registered dietitians may work in private practice, in hospitals and in specialized feeding team clinics. They may also be employed by companies that manufacture formula and food supplements. Early Intervention, Head Start, and the WIC program are government entities that may have registered dietitians as part of their staff. They are a valuable resource to support you and your family!

References
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, Kraus de Camargo O, Browne J, Phalen JA. Pediatric Feeding Disorder: Consensus Definition and Conceptual Framework. J Pediatr Gastroenterol Nutr. 2019 Jan;68(1):124-129. doi: 10.1097/MPG.0000000000002188. PMID: 30358739; PMCID: PMC6314510.

2. Schwarzenberg SJ, Georgieff MK; COMMITTEE ON NUTRITION. Advocacy for Improving Nutrition in the First 1000 Days to Support Childhood Development and Adult Health. Pediatrics. 2018 Feb;141(2):e20173716. doi: 10.1542/peds.2017-3716. Epub 2018 Jan 22. PMID: 29358479.