Assessment and Treatment of Childhood Problems: A Clinician's Guide

By Carolyn S. Schroeder; Betty N. Gordon | Go to book overview
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CHAPTER 3
Eating Problems

Almost all parents have difficulty feeding their children from time to time. Significant conflict between parents and children can develop around feeding, because parents are naturally very concerned about their children's well-being and want to ensure that they eat a healthy diet. At the same time, children have an uncanny sense that this is a battle parents cannot win, and as a result often assert their independence around mealtime issues. Thus feeding necessitates shared control between parents and children (Linscheid, Budd, & Rasnake, 1995). Parents control what food is served and when it will be served, whereas children control what and how much they will eat and how they will eat it. Given the extent to which children control eating, it is not surprising that difficulties in this area are relatively common during childhood. It is estimated that from 20% to 62% of children exhibit eating problems serious enough to come to the attention of a professional (Budd & Chugh, 1998; Linscheid & Rasnake, 2001). Persistent problems that compromise health and development are seen in 1–3% of children (Dahl & Sundelin, 1986; Lindberg, Bohlin, & Hagekull, 1991).

There is no reliable classification for early feeding difficulties (Linscheid & Rasnake, 2001), most likely because of the wide variety of problems seen in young children and the multiple causes for these problems. The Diagnostic and Statistical Manual of Mental Dis- orders, fourth edition (DSM-IV; American Psychiatric Association [APA], 1994) includes in the section on disorders of childhood only pica, rumination, and a very general category called “feeding disorder of infancy or early childhood,” which is defined as “persistent failure to eat adequately, as reflected in significant failure to gain weight or significant weight loss over at least 1 month” (p. 98). DSM-IV further specifies that this disorder cannot be attributed to any medical conditions or other mental disorders. Although this disorder is descriptive of failure to thrive (FTT), it does not include most of the eating problems likely to come to the child clinician's attention. As an alternative, Linscheid and his colleagues (Linscheid, Budd, & Rasnake, 1995; Linscheid & Rasnake, 2001) suggest classifying feeding problems by type and cause. Types include problems with (1) developmental appropriateness of foods eaten (e.g., eating only pureed foods); (2) quantity consumed (e.g., under- or overeating); (3) mealtime behaviors (e.g., tantrums, refusals, crying); and (4) delays in self-feeding. Causes include (1) medical or genetic conditions that interfere with eating or development of feeding behaviors; (2) neuromotor delay or dysfunction, especially oral–motor problems; (3) mechani

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