When Does Food Refusal Require Professional Intervention?

Abstract

Food refusal can have the potential to lead to nutritional deficiencies, which increases the risk of a variety of communicable and non-communicable diseases. Deciding when food refusal requires professional intervention is complicated by the fact that there is a natural and appropriate stage in a child's development that is characterised by increased levels of rejection of both previously accepted and novel food items. Therefore, choosing to intervene is difficult, which if handled badly can lead to further food refusal and an even more limited diet. Food refusal is often based on individual preferences; however, it can also be defined through pathological behaviours that require psychological intervention. This paper presents and discusses several different types of food refusal behaviours; these are learningdependent, those that are related to a medical complication, selective food refusal, fear-based food refusal and appetite-awareness-autonomy-based food refusal. This paper describes the behaviours and characteristics that are often associated with each; however, emphasis is placed on the possibility that these different types of food refusal can often be co-morbid. The decision to offer professional intervention to the child and their family should be a holistic process based on the level of medical or psychological distress resulting from the food refusal.

Feeding Issues Associated with the Autism Spectrum Disorders

“…Other diagnostic classifications and screening criteria appear promising. These are: Feeding Behavior Disorder [32,33], Avoidant/Restrictive Food Intake Disorder [34] and Feeding Disorder [35][36][37], the Wolfson Diagnostic Criteria [38] and the framework proposed by Davies et al [39]. …”

“…The central problem of infantile anorexia is a lack of appetite, as manifested by a lack of interest in eating and food refusal, and issues of control and autonomy that may exist between the parent and the child [33,35]. Parent recall indicates that the child will be easily distracted by environmental stimuli, which interfere with nursing from the bottle or breast from the very first weeks of life.…”

“…The classification by Dovey et al [35,36] is built on an older classification by Chatoor and Ganiban [45]. Of the five types of feeding disorder, which will be further described below, four are similar to the classifications mentioned above.…”

“…In their decision-making model [36,37], Autism-Related Food Refusal is mentioned as a distinct category, but not further elaborated. In an earlier paper Dovey et al [35] briefly describe feeding problems associated with ASD and touch upon the importance of the cognitive and social aspects of these problems. However, at that time, the authors seemed to include Autism-Related Food Refusal in their selective food refusal category.…”

“…If children have had oral feeding experience before intubation there will be a transition time where they will have 'to learn to eat' again, but the transition will be shorter than in infants who have not had any feeding experience [46]. Dovey et al [35] describe these children as not interested in eating but generally as happy to explore and play with food. Food refusal can also be present due to an association of food and/or eating with pain or discomfort.…”