Stay informed with the latest updates on coronavirus (COVID-19). Find out more >>

Feeding Development and Difficulties

What are the key elements in assessing a feeding difficulty?

  • Parental reporting

    Family beliefs and cultural feeding practices, parental knowledge in diet and nutrition, food availability that may impact both the perception of the problem for the child and family and management strategies should be explored [9].

    Discussions with parents should also aim to identify any discrepancies between the health professional’s perception of problematic behaviours and those of the parents as these may impact future management strategies. Behaviours that parents do not consider problematic may go unreported. (For example cooking of separate meals for child may be considered problematic by health professional but not the parents.)

    In clinical practice a semi structured interview is recommended for guiding discussions with parents. [2]. Discussion should cover all domains of the Feeding Development Framework.

    Developmental, Medical, Growth and Social history

    Developmental history: to provide insights into when the feeding difficulties began and possible contributing factors. Learning to eat typically parallels the achievement of developmental milestones, hence a developmental history considering the three areas of feeding based upon development (Social and Emotional development, Physical, Sensory and Oral Motor development and Communication and Cognitive development).

    Medical history: to identify any developmental delays and their possible causes or medical conditions that may be contributing to the problem. It is important to identify children with swallowing dysfunction for whom feeding may be unsafe.

    Growth history: to determine the extent to which feeding difficulties may or may not be resulting in altered growth patterns. The relationship between the presence of feeding difficulties and poor growth is variable. For information on the use of growth charts and the interpretation of child growth click here.

    Social history: to identify the capacity and availability of parents and other carers to meet the child’s social, emotional and other developmental needs as well as to provide a supportive mealtime environment.

    Dietary assessment

    A diet history or preferably a 3 day food diary to determine nutritional adequacy of the diet should be obtained. While a nutritionally adequate diet does not exclude the presence of feeding issues that impact on the child and family, assessment will help in prioritising goals for management.

    Information regarding the mealtime environment including presence of distractions and who else is present at mealtimes, type of food, texture, amount eaten and duration of the meal should all be included in the assessment. Gathering this information helps determine the child’s strengths as well as factors that are potentially influencing negative feeding behaviours.

    Feeding or Mealtime observation

    Mealtime observations are essential and should consider[10]:

    • Child-parent interactions
    • Parental awareness of a child’s feeding cues
    • Child’s oral motor skills
    • Feeding position
    • Mealtime behaviours and parental response
    • Mealtime experience from the child’s point of view

    Observations conducted in the child’s natural eating environment can provide valuable information that may not be apparent in the clinical setting [9] and can help complement parental reporting. Where direct observation is not possible a video of mealtimes may provide valuable insights.

    Consideration of the findings from the clinical assessment in terms of the Feeding Development Framework is useful in identifying the child and family’s strengths as well as factors contributing to the development of feeding difficulties. Examples of this are provided in the included case scenarios.