This document discusses feeding problems in children and eating disorders. It defines feeding problems as difficulties consuming food due to physical, behavioral, or both issues. Feeding problems are classified as oral-motor, positioning, self-feeding, or behavioral. The document also lists common pediatric conditions associated with feeding problems. It provides examples of ways to modify foods and positioning to address different feeding problems in school settings. The document then defines eating disorders and describes the three most common types: anorexia nervosa, bulimia nervosa, and binge eating disorder. Finally, it discusses potential biological, psychological, and environmental causes of eating disorders.

1. Eating Problems
and Intervention

2. What Is a Feeding
Problem?
A feeding problem occurs when a child has difficulty consuming solid foods or
liquids due to a physical impairment, behavioral issue, or both. Some conditions
that may disrupt feeding include oral cavity, neuromuscular, or neurologic defects. If
special accommodations are not made for feeding, it can have a detrimental impact
on the nutritional status of these children.
Feeding problems are usually classified as oral-motor, positioning, self-feeding, or
behavioral. These issues may begin in infancy and can sometimes be treated
through early intervention. However, when such conditions are present in a school
setting, feeding these children will require understanding and cooperation between
parents, teachers, therapists, and school nutrition personnel.

3. Pediatric Conditions
Associated With Feeding
Problems and Feeding
Disorders• Temperamental traits that complicate feeding and overwhelm parents
• Prematurity (especially neonates who require prolonged respiratory
support or enteral feeds or with delayed introduction of oral feeds)
• Genetic or chromosomal abnormalities (eg, Down syndrome and inherited
neuromuscular disease)
• Craniofacial anomalies (eg, Pierre-Robin sequence and cleft palate)
• Acquired brain impairment (eg, cerebral palsy, stroke, and traumatic brain
injury)
• Gastrointestinal disorders (eg, gastroesophageal reflux disease and chronic
constipation)
• Neurodevelopmental disorders (eg, autism spectrum disorder, global
developmental delay, and intellectual disability)

4. Various feeding problems and
ways to address them

5. Children with oral-motor problems are unable to suck, swallow, or
chew their food properly. For these children, school nutrition staff
may need to provide foods that are modified in texture so that
children can meet their intake needs and avoid the risk of choking.
Some examples of modifications likely to be requested by a physician,
therapist, dietitian, or parent include the following:
• Chopped–Food needs to be chopped into bite-sized pieces using a
food chopper, knife, or food processor.
• Ground–Food should be soft or small enough to swallow with little
or no chewing. Food can be ground using a food processor or blender.
Oral-Motor
Problems

6. • Pureed–Food must have a smooth texture, similar to pudding, but
should not be runny. Food can
be pureed in a food processor or blender, sometimes adding a small
amount of liquid to make it
smooth.
• Thickened–Thickened beverages may be required for children
with difficulty swallowing. This can
be done using commercial thickeners or pre-thickened products.

7. Children with physical impairments or muscle control problems may be
unable to sit up or hold their head up to eat, or they may have difficulty
holding utensils and feeding themselves.
Children with positioning problems may need to lie down or stand up to eat,
which may require they be fed outside of the cafeteria. Some children may
have specially designed wheelchairs to position them for feeding, and
arrangements should be made to accommodate such chairs at a table in the
cafeteria.
For children who have difficulty with self-feeding, various devices and
adaptive utensils are available to aid them in feeding themselves. Children
must be taught how to use these items effectively. Typically, the washing and
sanitizing of the equipment is the responsibility of the school nutrition staff.
Positioning and Self-Feeding Problems

8. Behavioral Problems
Some children have behavioral issues that can
disrupt feeding, such as being easily distracted,
difficulty sitting through mealtimes, refusing to eat,
spitting out food, or knocking food and utensils on
the floor.
Although addressing these issues is the
responsibility of the child’s teacher or therapist,
school nutrition
staff can help by

9. • providing small, easy-to-eat servings;
• limiting the number of foods served;
• finding a place in the cafeteria where the child can eat
free from distractions; and
• attending Individualized Education Program meetings
held for the child. (This applies mainly to the
School Nutrition Director.)

10. What is an Eating
Disorder?
Eating Disorders describe illnesses that are characterized by irregular
eating habits and severe distress or concern about body weight or
shape. Eating disturbances may include inadequate or excessive
food intake which can ultimately damage an individual’s well-being.
The most common forms of eating disorders include Anorexia
Nervosa, Bulimia Nervosa, and Binge Eating Disorder and affect both
females and males.

11. Types of Eating
Disorders
The three most common types of Eating
Disorders are as follows:
Anorexia Nervosa-The male or female suffering from
anorexia nervosa will typically have an obsessive fear of
gaining weight, refusal to maintain a healthy body weight,
and an unrealistic perception of body image. Many people
with anorexia nervosa will fiercely limit the quantity of
food they consume and view themselves as overweight,
even when they are clearly underweight. Anorexia can
have damaging health effects, such as brain damage, multi-
organ failure, bone loss, heart difficulties, and infertility.
The risk of death is highest in individuals with this disease.

12. Bulimia Nervosa-This eating disorder is characterized by
repeated binge eating followed by behaviors that
compensate for the overeating, such as forced
vomiting, excessive exercise, or extreme use of laxatives
or diuretics. Men and women who suffer with Bulimia
may fear weight gain and feel severely unhappy with
their body size and shape. The binge-eating and purging
cycle is typically done in secret, creating feelings of
shame, guilt, and lack of control. Bulimia can have
injuring effects, such as gastrointestinal problems,
severe hydration, and heart difficulties resulting from
an electrolyte imbalance.

13. Binge Eating Disorder- Individuals who suffer from Binge
Eating Disorder will frequently lose control over his or
her eating. Different from bulimia nervosa however,
episodes of binge-eating are not followed by
compensatory behaviors, such as purging, fasting, or
excessive exercise. Because of this, many people
suffering with binge-eating disorder may be obese and
at an increased risk of developing other conditions, such
as cardiovascular disease. Men and women who struggle
with this disorder may also experience intense feelings
of guilt, distress, and embarrassment related to their
binge-eating, which could influence further progression
of the eating disorder.

14. Causes of Eating
Disorders
Eating Disorders are complex disorders, influenced by a facet of factors.
Though the exact cause of eating disorders is unknown, it is generally
believed that a combination of biological, psychological,and/or
environmental abnormalities contribute to the development of these
illnesses.
Examples of biological factors include:
• Irregular hormone functions
• Genetics (the tie between eating disorders and one’s genes
is still being heavily researched, but we know that genetics
is a part of the story).
• Nutritional deficiencies

15. Examples of psychological factors include:
• Negative body image
• Poor self-esteem
Examples of biological factors include:
• Irregular hormone functions
• Genetics (the tie between eating
disorders and one’s genes is still being
heavily researched, but we know that
genetics is a part of the story).
• Nutritional deficiencies

16. Examples of environmental factors that would contribute to the
occurrence of eating disorders are:
• Dysfunctional family dynamic
• Professions and careers that promote being thin and weight
loss, such as ballet and modeling
• Aesthetically oriented sports, where an emphasis is placed
on maintaining a lean body for enhanced performance.
Examples include: rowing, diving, ballet, gymnastics,
wrestling, long distance running.
• Family and childhood traumas: childhood sexual abuse,
severe trauma
• Cultural and/or peer pressure among friends and co-workers
• Stressful transitions or life changes