Paeds · gastroenterology-hepatology-and-nutrition
Paediatric feeding disorder: nutritional and gastrointestinal management
Also known as Paediatric feeding disorder · PFD · Feeding disorder of childhood · Oral intake dysfunction in children · Food refusal and faltering growth · Feeding difficulty nutritional management
Fellowship guide to paediatric feeding disorder and its nutritional and gastrointestinal management: the child whose oral intake is impaired across the four domains of medical, nutritional, feeding skill and psychosocial dysfunction; the Goday consensus definition built on the WHO ICF framework; prevalence of around one in thirty-seven children under five; the PFD-versus-ARFID distinction between an organ-based feeding disorder and a DSM-5 psychiatric eating disorder; the gastrointestinal drivers of reflux, constipation and eosinophilic oesophagitis; the stepped multidisciplinary plan from medical optimisation and behavioural intervention to oral nutritional support and enteral feeding; the intensive multidisciplinary program evidence; tube dependency and weaning; and the ESPGHAN gastrostomy guidance.
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Red flags
- A child whose weight or length is falling across centiles while mealtimes are a battle has a paediatric feeding disorder with nutritional compromise until assessed across the four domains, not behavioural food refusal to be reassured about
- Faltering growth, dehydration or a micronutrient deficiency such as iron deficiency anaemia in a child who restricts intake is a red flag that the feeding disorder is causing medical and nutritional dysfunction and needs multidisciplinary assessment, not watchful waiting
- A child with food aversion after an allergic or eosinophilic oesophagitis flare, after nasogastric feeding, or after reflux has been poorly controlled has a conditioned feeding problem layered on a medical driver, and treating only the behaviour without addressing the gut will fail
- Coughing, choking, a wet voice or recurrent pneumonia in a child with feeding difficulty raises aspiration and places the problem in the feeding-skill domain, demanding instrumental swallow assessment before oral intake is pushed further
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Board mappings
- Feeding difficulties and faltering growth in children
- General Paediatrics: multidisciplinary assessment and nutritional and gastrointestinal management of paediatric feeding disorder across the four domains of medical, nutritional, feeding skill and psychosocial dysfunction
- The child with paediatric feeding disorder: the Goday consensus definition, the four domains, the PFD-versus-ARFID distinction, gastrointestinal drivers and the stepped multidisciplinary management plan
- Short case: the child with food refusal, faltering growth and reflux
- Long case: the neurologically impaired child with tube dependency and recurrent chest infections
- Nutrition and feeding disorders; gastrointestinal problems in children with feeding difficulty
- Paediatric feeding disorder: definition, four domains, PFD versus ARFID and nutritional management
- Gastroenterology and nutrition: the child with feeding disorder and faltering growth
- Gastroenterology: feeding disorders and nutritional management in children
- Patient Care: multidisciplinary management of paediatric feeding disorder
- Medical Expert: feeding disorders and nutritional management in children
Overview & Definition
Picture the two-year-old who screams and turns away at the sight of lumps, the former premature infant who never learned to feed by mouth and is still tube-dependent at eighteen months, and the child with cerebral palsy whose reflux was poorly controlled and who now refuses every food he once enjoyed. These children do not have separate problems; they have a paediatric feeding disorder, a condition in which oral intake is impaired in a way that harms nutrition, growth, safety or the mealtime relationship, and the clinician's job is to work out which of the four domains is driving the failure and to treat all of them together. [1] [4]
For decades, feeding problems in children were described through the lens of whichever professional saw the child, so a speech-language therapist, a dietitian and a psychologist each labelled a different slice of the same child. The 2019 consensus paper by Goday and colleagues fixed this by proposing a single unifying term, paediatric feeding disorder, built on the World Health Organization International Classification of Functioning, Disability and Health framework. The definition is precise: paediatric feeding disorder is impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill and/or psychosocial dysfunction. The word "and/or" is the key, because most real children have dysfunction in more than one domain, and a plan that treats only one is the commonest reason treatment fails. [1] [3]
This leaf owns the nutritional and gastrointestinal management of paediatric feeding disorder. It sits beside the dedicated leaf on feeding assessment and paediatric dysphagia, which owns the swallow study and the penetration-aspiration scale; here the focus is on the medical and nutritional drivers, the gastrointestinal conditions that trigger and sustain feeding difficulty, and the stepped multidisciplinary plan that runs from treating the gut through behavioural intervention to oral nutritional support and enteral feeding. The ARFID distinction runs through the whole topic, because every examiner wants to know whether the child in front of them has an organ-based feeding disorder or a psychiatric eating disorder. [1] [9]
References12ShowHide
- [1]Goday PS; Huh SY; Silverman A Pediatric Feeding Disorder: Consensus Definition and Conceptual Framework. J Pediatr Gastroenterol Nutr, 2019.PMID 30358739
- [2]Kovacic K; Rein LE; Szabo A Pediatric Feeding Disorder: A Nationwide Prevalence Study. J Pediatr, 2021.PMID 32702429
- [3]Sharp WG; Silverman A; Arvedson JC Toward Better Understanding of Pediatric Feeding Disorder: A Proposed Framework for Patient Characterization. J Pediatr Gastroenterol Nutr, 2022.PMID 35687655
- [4]Silverman A; Wall MA; Begotka A Feeding Disorders: Current State and Future Directions. Gastroenterol Clin North Am, 2025.PMID 41238275
- [5]Sharp WG; Volkert VM; Scahill L A Systematic Review and Meta-Analysis of Intensive Multidisciplinary Intervention for Pediatric Feeding Disorders: How Standard Is the Standard of Care? J Pediatr, 2017.PMID 27843007
- [6]Sharp WG Intensive Multidisciplinary Feeding Intervention for High-Risk Infants. Clin Perinatol, 2023.PMID 36868708
- [7]Peterson KM; Piazza CC; Volkert VM A comparison of a modified sequential oral sensory approach to an applied behavior-analytic approach in the treatment of food selectivity in children with autism spectrum disorder. J Appl Behav Anal, 2016.PMID 27449267
- [8]Harrison ME; Norris ML; Robinson A Use of cyproheptadine to stimulate appetite and body weight gain: A systematic review. Appetite, 2019.PMID 30825493
- [9]Katzman DK; Norris ML; Zucker N Avoidant Restrictive Food Intake Disorder. Psychiatr Clin North Am, 2019.PMID 30704639
- [10]Krom H; de Winter JP; Kindermann A Development, prevention, and treatment of feeding tube dependency. Eur J Pediatr, 2017.PMID 28409284
- [11]Taylor C; Badawi N; Novak I Caregivers' experiences of feeding children with cerebral palsy: a systematic review of qualitative evidence. JBI Evid Synth, 2025.PMID 40012369
- [12]Homan M; Hauser B; Romano C Percutaneous Endoscopic Gastrostomy in Children: An Update to the ESPGHAN Position Paper. J Pediatr Gastroenterol Nutr, 2021.PMID 34155150