Pediatric Nutrition in Practice

3 Nutritional Challenges in Special Conditions and Diseases

Key Words

Feeding problems · Food refusal · Pickiness ·

Responsive feeding

Key Messages

• Children acquire independence in feeding skills
  during the first 2 years of life and can start to self-
  feed within the first year


• Feeding problems (food refusal, pickiness, and dis-
  ruptive mealtime behavior) are common and part
  of the normal development of children


• Feeding problems can lead to family stress with
  long-term negative consequences on children’s
  growth, nutrition, and behavior


• Caregivers can promote healthy feeding behavior
  and prevent feeding problems by establishing
  healthy mealtime structure routines and respond-
  ing to their child’s signals of hunger and satiety,
  adopting principles of responsive feeding


• Feeding guidelines to caregivers should extend be-
  yond ‘what’ and ‘when’ to feed. Guidelines to pro-
  mote healthy feeding behaviors can be effective in
  preventing feeding problems
  © 2015 S. Karger AG, Basel

Introduction

Feeding problems are a major concern among
typically developing infants and toddlers through-
out the world, with prevalence estimates that

range up to 45% in the USA [1]. Observational

data on infants and toddlers from Bangladesh

have shown that not only are rates of food refusal

relatively high (mean of 6–7 refusals/meal), but

fewer than 20% of mouthfuls are self-fed. Feeding

problems tend to peak at around 2 years of age

and often include food refusals, pickiness, and

disruptive mealtime behavior [2]. Food refusal is

a major concern because it may be both a sign of

satiety [3] and a sign of feeding problems. In

many cases, early feeding problems resolve over

time, particularly when caregivers are sensitive to

their child’s signals of satiety and emerging au-

tonomy. However, feeding problems often in-

crease family stress [2] and can result in weight-

related problems (either underweight or over-

weight) [4] , nutrition-related health conditions,

and long-term behavioral problems [5]. Devia-

tions in children’s growth during the first 2 years

of life can have long-term health and develop-

mental consequences. Early stunting has been as-

sociated with poor academic performance during

schooling [6] , and early obesity increases the risk

for adult obesity and associated problems [7].

There is a dramatic evolution of feeding be-

havior over the first 2 years of life as infants ac-

quire the oral motor, physical, digestive, and so-

cial skills to progress from a liquid diet of breast

milk/formula to the texture and variety of the

family diet. Based on a national sample of over

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 209–213
DOI: 10.1159/000367875

3.13 Childhood Feeding Problems

Maureen M. Black

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