Chapter 46: Feeding & Eating Disorders of Infancy & Early Childhood

The chapter examines the major diagnostic categories including pica, rumination disorder, and avoidant/restrictive food intake disorder, which the DSM-5 reconceptualized to encompass persistent food refusal, sensory-based food selectivity, and feeding difficulties that occur independently of body image disturbances or weight concerns. Clinical presentation varies widely but commonly includes failure to achieve adequate weight gain, micronutrient deficiencies, underdeveloped oral-motor coordination, anxiety surrounding choking or swallowing, and maladaptive patterns during feeding interactions. Contributing factors are multifactorial, involving constitutional elements such as genetic predisposition and prematurity, medical conditions including gastrointestinal pathology, psychological variables like parental stress or history of traumatic feeding experiences, and relational dynamics within the caregiver-child dyad. The chapter emphasizes understanding these disorders through a transactional developmental framework in which child characteristics, developmental vulnerabilities, and parent-child interaction patterns reciprocally influence symptom maintenance and progression. Epidemiological data demonstrate that transient feeding difficulties occur in approximately half of young children at some developmental stage, yet persistent cases carry significant risk for growth impairment, developmental delays, social difficulties, and increased vulnerability to disordered eating in later childhood and adolescence. Comprehensive assessment integrates detailed developmental history, medical investigation to exclude organic causes, and direct observation of feeding behavior and interaction quality. Treatment requires a multidisciplinary approach combining behavioral modification strategies, caregiver coaching and psychoeducation, systematic desensitization protocols, and coordinated involvement of pediatrics, psychiatry, speech-language pathology, occupational therapy, and nutritional services. Early identification and intervention substantially improve long-term outcomes, underscoring the value of routine developmental and behavioral screening in pediatric practice settings.