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A Pediatric Perspective

Feeding Issues and the Possible Non-Medical Causes ...

Published February 28, 2011 2:04 AM by Wendy Hof

So, we've ruled out any possible medical reasons that may cause a child not to eat.  What we have to do now is go back to our list we made when we began playing detective and see what else could be going on.  A few possibilities to keep in mind are:

  • Sensory Issues: This is one of the most common reasons a child who has no medical issues may not want to eat. This is especially true if the child was born prematurely or had any extended hospital stay. A child who does not want anything to come near their face or into their mouths or who gets upset when any unfamiliar or new texture is introduced could be showing sensory defensive behaviors. A child who stuffs it's mouth with food or mouths everything they can fit into their mouths could be showing sensory seeking behaviors. In many cases filling out a Sensory Profile could help to see if the cause is sensory related. If you don't have access to a Sensory Profile, basic observation of what the child is doing when it is offered food and what happens when you try to offer appropriate sensory input could yield the same answers to whether it may be sensory related or not.

  • Environmental: When you work with the child in their natural environment it is much easier to see if the reason they are not eating has to do with what is going on in their environment than it is if they are coming into a clinic and you have to rely on family reporting. There are times when a child may be allowed to graze throughout the day and not have set meal times. A child may be drinking more fluids (milk, juice, water) than is usually recommended in one day causing them not to be hungry for food. A child may not have good positioning during meals (highchair or booster seat) and may not be able to either use their utensils or even their fingers properly or comfortably and thus give up on eating because it's too much effort.

  • Behavioral: Children will often go through food jags where they only want to eat one type of food for a week and then not want to eat it again for several weeks. This is very typical behavior for toddlers but in some cases the food jags go on too long and the jag turns into a habit and the picky eater becomes a problem eater. A parent may just have so much going on that they are too tired by meal time to argue or fight with their child over what they will or won't eat and without meaning to the parent feeds into the child's behavior to keep peace. Some children just don't want to try new things or use their utensils or switch to a sippy cup and will cry and fuss and be stubborn. Many new parent don't want to see their child upset and will give in, again, to keep the peace.

These are the main non-medical reasons a child may not want to eat.  It can be difficult at times to figure out just what is going on that is causing a child to not eat at an age appropriate skill level.  There are even times when it may be a combination of a medical issue and a non-medical issue or even two non-medical issues combined.  In these cases it becomes a matter of trial and error and lots of observing and questioning to try and figure out what is going on and what we can do to help out.

I know I had said that I was going to go into strategies to help with these feeding concerns but I feel I would be amiss if I did not do post on GERD and acid reflux.  Working with little ones I find this condition to be very challenging and sometimes even frustrating when I can see what is going on but the pediatrician feels we should "wait and see".  There are a few things I would like to share about this condition before we move on to strategies.

So for now, thank you, as always, for stopping by.  I hope to see you back again soon.



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