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What is Feeding Difficulty?

Feeding difficulty is the inability of your child to consume enough quantity or variety of foods. This is a disorder where the child refuses to eat or drink sufficiently to maintain adequate nutritional status and stay healthy.

Who is at Risk of Feeding Difficulty?

Children of all backgrounds can have feeding difficulty. However, the condition is more common among premature infants and children who have: 

  • Developmental delays 
  • Failure to thrive or grow
  • Behavioural issues (autism)
  • Genetic syndromes
  • Chronic illness

What if Feeding Difficulty is not Treated?

If not treated, the condition can impact your child’s health and result in substantial consequences such as:

  • Nutritional imbalance or deficiency
  • Emotional dysfunction
  • Poor or impaired growth
  • Neurocognitive dysfunction
  • Dislike or fear for some or all foods 
  • Cognitive impairment 

Causes of Feeding Difficulties

Many factors may contribute to your child’s feeding problems. They can be medical, developmental, behavioural or social.  Some of the common causes include but are not limited to:

  • Illness such as nausea or constipation 
  • Heart, coronary or lung problems
  • Nervous or sensory system issues
  • Stomach or intestine problems
  • Breathing problems like asthma 
  • Premature birth or low birth weight
  • Factors like altered diet or forced diet
  • Mouth abnormalities such as cleft lip or palate
  • Poor oral motor skills or face, mouth muscle problems
  • Difficulty chewing and swallowing

Signs and Symptoms 

Feeding difficulty is typically characterised by extreme food selectivity by type, texture, colour, etc. Your child will exhibit several symptoms of feeding difficulties, the most common being:

  • Food refusal or eating very little food 
  • Picky eating (avoiding certain foods)
  • Reduced, excessive or variable appetite
  • Significant dislike and/or distress during eating
  • Frequent food spitting, prolonged mealtimes
  • Disruptive and stressful mealtimes behaviour
  • Aversion for independent or self-feeding 


Diagnosis of feeding difficulties usually starts with your child’s thorough history taking. It may comprise the child’s feeding-related behaviours and parental reporting on dietary, developmental (growth), medical and social history. Feeding or mealtime observation and dietary assessment too can be part of the initial diagnosis. 

This will be followed by physical examination and anthropometric measurements (body weight, height and head circumference). Depending on the severity of the symptoms, the following tests may be ordered. 

  • Full blood count (blood test)
  • Urea and electrolytes (urine test)
  • Liver function tests (blood test)

Your paediatrician may also involve other healthcare professionals like GI physician, occupational therapists and clinical dieticians depending on the need.

Treatment of Feeding Difficulties

Treatment of feeding difficulties normally entails the formulation of age-appropriate feeding strategies coupled with proper nutritional support.

Your paediatrician will begin the treatment by assessing your child’s feeding requirements. Subsequently, the child will be referred to an occupational therapist and then to a dietician. 

During the referral, your child will be subjected to feeding therapy which includes tolerating, interacting, touching, smelling, tasting and swallowing non-preferred foods. This will be followed by a patient-specific nutritional programme. 

Nutritional counselling can also be an alternative form of treatment. However, this requires your child to go on a specific diet and take prescribed nutritional supplements. 

Both treatments can help your child catch up to a recommended weight and nutritional level. 

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