Understanding Pediatric Feeding and Nutrition Disorders: When Picky Eating Becomes a Health Concern

For many Wisconsin families, mealtime can feel like a battle. While most children go through phases of picky eating, some face more serious challenges that go beyond typical childhood selectiveness. Pediatric feeding and nutrition disorders represent a significant health concern that affects children across all populations and communities, with particularly elevated rates among children with medical diagnoses and developmental conditions like autism.

In a recent episode of the Advancing a Healthier Wisconsin Endowment's (AHW's) monthly livestream, Coffee Conversations with Scientists, Alan Silverman, PhD, professor of pediatrics and director of pediatric psychology training at the Medical College of Wisconsin (MCW), discussed the complex nature of pediatric feeding disorders and how families can recognize when their child may need specialized support.

Key takeaways:

• Pediatric feeding disorders go beyond picky eating when a child's nutrition is compromised or eating skill development is disrupted.
• Red flags include missed developmental feeding milestones, meals consistently taking less than five or more than 30 minutes, and missing entire food groups from a child's diet.
• Poor nutrition affects both physical development (growth stunting) and psychological functioning (increased rates of ADHD, behavioral problems, and sleep disruption).
• Children with medical diagnoses and developmental conditions like autism have significantly higher rates of feeding disorders.
• Early intervention with an interdisciplinary approach, including medical, nutritional, speech/language, and psychological perspectives, provides the best outcomes for children with feeding disorders.

What Are Pediatric Feeding and Nutrition Disorders?

Understanding the difference between typical picky eating and a feeding disorder can be challenging for parents. Dr. Silverman explained that while picky eating is very common, feeding disorders are identified by their impact on a child's nutrition and development.

"What I would say is everybody knows a picky eater. Picky eating is an exceptionally common thing, especially in children between the ages of about two and six, but what differentiates the disorder piece is when we start to become concerned about a child's nutrition," Dr. Silverman said.

According to Dr. Silverman, pediatric feeding disorders affect children who "have struggled to achieve normal eating habits either because of a medical condition, developmental condition, or something traumatic that has happened… that has halted the development and interfered with the normal eating habits that we would expect to see with most kids."

During the first two years of life, children typically progress through predictable feeding stages—from breastfeeding or bottle feeding to pureed foods, soft solids, and eventually table food by age two. When this natural progression is disrupted or delayed, it can be a signal of a feeding disorder that requires professional intervention.

Recognizing the Warning Signs

For parents concerned about their child's eating habits, Dr. Silverman shared several important red flags that can help differentiate normal developmental patterns from potential feeding disorders.

"If a child is missing entire food groups, so they won't eat any fruits or vegetables or they take no dairy or they won't eat any meat, that's another important red flag," Dr. Silverman explained.

Additional warning signs include:

• Meals that consistently take less than five minutes or more than 30 minutes
• Children who don't progress through normal feeding developmental milestones
• Strong aversive responses to certain foods, such as gagging, retching, or even fleeing from the table when specific foods are presented

Growth patterns also provide important clues. When children fall off their established growth curves or show flattening growth patterns, it may indicate that their nutritional needs aren't being met, even if they appear to be eating regularly.

The Health Impact Beyond Mealtime

The consequences of pediatric feeding disorders extend beyond difficult dinners. Dr. Silverman emphasized that inadequate nutrition can impact both physical and psychological development in growing children.

"On the physical side, we may see growth stunting, where a child just stops growing taller. We may see wasting, where they're losing body fat reserves or muscle reserves. On the psychological side, when children experience poor nutrition, they're at higher rates of having things like ADHD, and they tend to have more disruptive behavioral problems, and they may have other comorbidities, like sleep disruption," Dr. Silverman shared.

An important distinction that Dr. Silverman highlighted is the difference between caloric intake and nutritional quality. Some children may consume an adequate number of daily calories but still suffer from malnutrition due to limited food variety. This is a concern that's particularly relevant for families navigating modern food environments.

"You can have both overweight and malnutrition at the same time. Even though your child may be growing just fine and your pediatrician may be saying, ‘Don't worry, the growth chart looks great,’ if your child is really limited to foods that don't have a lot of nutrition in them or if they're missing complete food categories, that's something that you should be discussing with your doctor," he explained.

An Interdisciplinary Approach to Treatment

Treatment for pediatric feeding disorders is most effective when approached from multiple perspectives. At MCW, Dr. Silverman leads an interdisciplinary team that includes a physician, dietitian, speech and language pathologist, and psychologist, who all work together to address the complex factors that contribute to feeding difficulties.

This collaborative approach allows each specialist to contribute their unique expertise. Physicians evaluate medical conditions and medication needs, speech and language pathologists review chewing and swallowing skills, dietitians give nutritional guidance, and psychologists examine the behavioral and family dynamics around feeding.

For families who don't have access to comprehensive interdisciplinary care, Dr. Silverman recommends coordinating care among individual specialists while using the child’s pediatrician as the central provider who coordinates treatment.

Practical Support for Wisconsin Families

Dr. Silverman offered several evidence-based strategies for parents concerned about their child's eating habits. The foundation of healthy eating begins with family modeling.

"The first and most important thing that you can do is provide good modeling for the child about your own eating habits," Dr. Silverman advised. This includes making sure fruits and vegetables are present in the home and that adults demonstrate healthy eating behaviors.

For families seeking additional support, Dr. Silverman recommended Feeding Matters, an organization that provides screening tools, educational resources, and support networks for families navigating feeding challenges. The organization was founded by parents who experienced similar struggles and has grown into a national resource for both families and professionals.

When concerns persist, parents should advocate for specialized care by requesting referrals to appropriate specialists. Dr. Silverman emphasized that pediatricians can help coordinate care and connect families with the right resources, even when comprehensive feeding centers aren't available nearby.

The Importance of Early Intervention

Early identification and intervention are important for successful health outcomes in treating pediatric feeding disorders. Dr. Silverman stressed that the first two years of life are particularly important for identifying potential problems.

The encouraging news is that, with appropriate intervention, children can often return to healthy growth and development patterns. Early identification and treatment not only address immediate nutritional concerns but also help prevent long-term complications related to growth, development, and family dynamics around food.

Learn More About Pediatric Feeding Disorders

To hear more from Dr. Silverman about the science behind pediatric feeding and nutrition disorders and how families can find support, tune into the Coffee Conversations with Scientists episode here: