Feeding/Eating Disorders

Definition
There are several categories of feeding disorders in infancy and early childhood, which is defined as a failure to eat adequately. Persistent eating of dirt or other nonnutritive substances may be diagnosed as pica. Repeated regurgitation and re-chewing of food may be diagnosed as rumination disorder.
Symptoms
Poor weight gain or an actual weight loss
Constipation
Excessive crying
Irritability
Apathy
Criteria for feeding disorder of infancy and early childhood include:
Lack of adequate eating with significant weight loss or failure to gain weight, lasting one month or longer
Behavior is not attributable to a gastrointestinal or other medical condition
Behavior is not better explained by lack of available food or another mental disorder
Onset is before age 6
Criteria for pica include:
Dirt or other nonnutritive substances are eaten for a month or longer
Behavior is not developmentally appropriate
Behavior is not acceptable within the child's culture
If behavior exists within sole context of a mental disorder such as mental retardation, a pervasive developmental disorder or schizophrenia, it warrants independent treatment.
Criteria for rumination disorder include:
After a period of normal eating, food is repeatedly regurgitated and re-chewed for a month or longer
Behavior is not attributable to a gastrointestinal or other medical condition
Behavior does not occur only during anorexia nervosa or bulimia
If behavior exists within sole context of a mental disorder such as mental retardation, or a pervasive developmental disorder, it warrants independent treatment.
Causes
Feeding disorders are diagnosed when the infant or young child does not eat adequately and the problem is not the result of a medical condition (such as a cleft palate) or a mental condition (such as any disorder that causes mental retardation). The cause of such disorders, while currently unknown, often results from a variety of factors such as poverty, parental misinformation and dysfunctional child-caregiver interactions.
Treatment
Depending on the severity of the condition, the number of calories and amount of fluid taken by the infant will be increased, any vitamin or mineral deficiencies will be corrected, and underlying physical illnesses or psychosocial problems will be uncovered and corrected. A short period of hospitalization is oftentimes required to accomplish these goals.
There is no quick cure for the majority of infants and children with a feeding disorder. Rather, a multidisciplinary approach is required with pediatricians, dieticians, social workers, outreach nurses, behavior specialists and parents collaborating to improve the child's well-being and nutritional status.
Treatment of pica and rumination disorder includes a variety of approaches such as psychotherapy for the parents and behavioral therapies for the child. One possibly effective tool is mild aversion therapy followed by positive reinforcement.
Sources:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders
National Institutes of Health - National Library of Medicine