A Functional Approach to Feeding Difficulties in Children

  • Kim Milano
  • Irene Chatoor
  • Benny KerznerEmail author
Pediatric Gastroenterology (S Orenstein and S Khan, Sectior Editor)
Part of the following topical collections:
  1. Topical Collection on Pediatric Gastroenterology


Purpose of Review

This review provides an approach for resolving a variety of feeding difficulties in children, ranging from normal eating behavior that is misperceived as a problem to substantial feeding disorders.

Recent Findings

Criteria to identify pediatric feeding disorders have been thoroughly addressed in the newly established designations of avoidant restrictive food intake disorder (ARFID) and pediatric feeding disorder (PFD). These diagnostic criteria improve the accuracy of identifying, classifying, and managing significant feeding disorders in young children.


While recent definitions of feeding difficulties are particularly appropriate in multidisciplinary settings, in this paper, we advocate for a progressive approach of managing feeding problems in all clinical settings. It begins by identifying red flags indicative of serious threats to the child, screening for oral motor dysfunction, stabilizing nutrient intake, and eliminating aversive feeding practices. The next step, if eating behavior does not improve, involves strategies that target specific eating behaviors and parental feeding styles. In severe or resistant cases, referral to specialists or interdisciplinary feeding teams is advised.


Feeding disorder Food selectivity Poor appetite Fear of feeding Picky eating 


Compliance with Ethical Standards

Conflict of Interest

Kim Milano and Irene Chatoor report receiving honoraria from Abbott Laboratories for speaking at conferences related to feeding difficulties and disorders. The other author declares that there is no conflict of interest. Benny Kerzner carried out a clinical study 5 years ago to assess the ability of pediatricians to correctly classify young children with feeding problems in the office setting. The study was funded by Abbott Laboratories.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.College of Health & Human SciencesNorthern Illinois UniversityDeKalbUSA
  2. 2.Department of Psychiatry, Children’s National Medical Health System, The George Washington School of Medicine and Health SciencesWashingtonUSA
  3. 3.Department of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s National Medical Health System, Professor of Pediatrics, The George Washington School of Medicine and Health SciencesWashingtonUSA

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