DSM-IV-TR › Disorders usually first diagnosed in infancy, childhood, or adolescence › Feeding and eating disorders of infancy or early childhood › Feeding disorder of infancy or early childhood 

307.59 Feeding Disorder of Infancy or Early Childhood

Diagnostic Features

The essential feature of Feeding Disorder of Infancy or Early Childhood is the persistent failure to eat adequately, as reflected in significant failure to gain weight or significant weight loss over at least 1 month (Criterion A). There is no gastrointestinal or other general medical condition (e.g., esophageal reflux) severe enough to account for the feeding disturbance (Criterion B). The feeding disturbance is also not better accounted for by another Mental Disorder (e.g., Rumination Disorder) or by lack of available food (Criterion C). The onset of the disorder must be before age 6 years (Criterion D).

Associated Features and Disorders

Associated descriptive features and mental disorders.

Infants with feeding disorders may be more irritable and difficult to console during feeding than infants without feeding disorders. They may appear apathetic and withdrawn and may also exhibit developmental delays. In some instances, parent-child interaction problems may contribute to or exacerbate the infant's feeding problem (e.g., presenting food inappropriately or responding to the infant's food refusal as if it were an act of aggression or rejection). Inadequate caloric intake may exacerbate the associated features (e.g., irritability, developmental lags) and further contribute to feeding difficulties. Factors in the infant that may be associated with the condition include temperamental characteristics or intrauterine growth retardation and preexisting developmental impairments that make the infant less responsive. Other factors that may be associated with the condition include parental psychopathology and child abuse or neglect.

Associated laboratory findings.

There may be nonspecific findings associated with the malnutrition that is sometimes seen with Feeding Disorder of Infancy or Early Childhood (e.g., anemia and low serum albumin and total protein).

Associated physical examination findings and general medical conditions.

There may be malnutrition that, in severe cases, can be life threatening in Feeding Disorder of Infancy or Early Childhood.

Specific Age and Gender Features

A later onset (e.g., age 2 or 3 years rather than infancy) is associated with lesser degrees of developmental delay and malnutrition, although growth retardation may be observed. Feeding Disorder of Infancy or Early Childhood is equally common in males and females.

Prevalence

Of all pediatric hospital admissions, 1%-5% are for failure to thrive, and up to one-half of these may reflect feeding disturbances without any apparent predisposing general medical condition. Data from community samples suggest a point prevalence of around 3% for failure to thrive.

Course

Feeding Disorder of Infancy or Early Childhood commonly has its onset in the first year of life, but may have an onset in children ages 2-3 years. The majority of children have improved growth after variable lengths of time, although they remain shorter and lighter up through adolescence compared with children who did not experience growth failure.

Differential Diagnosis

Minor problems in feeding are common in infancy. The diagnosis of Feeding Disorder of Infancy or Early Childhood should be made only if the eating problem results in significant failure to gain weight or loss of weight.

This disorder is not diagnosed if the feeding disturbances are fully explained by a gastrointestinal, endocrinological, or neurological condition. Children with an underlying general medical condition may be more difficult to feed, and the diagnosis of Feeding Disorder of Infancy or Early Childhood should not be made in such cases unless the degree of disturbance is of greater severity than would be expected on the basis of the general medical condition alone. The diagnosis is suggested if there is improvement in feeding and weight gain in response to changing caregivers.

Diagnostic criteria for 307.59 Feeding Disorder of Infancy or Early Childhood

1. Feeding disturbance as manifested by persistent failure to eat adequately with significant failure to gain weight or significant loss of weight over at least 1 month.
2. The disturbance is not due to an associated gastrointestinal or other general medical condition (e.g., esophageal reflux).
3. The disturbance is not better accounted for by another mental disorder (e.g., Rumination Disorder) or by lack of available food.
4. The onset is before age 6 years.

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision^TM. Copyright 2000 American Psychiatric Association. All Rights Reserved.