Here are a few thoughts on combining Feeding and Eating Disorders: - It makes sense to group them together as they are both disorders involving food/nutrition. Looking at them together provides a more holistic perspective. - Feeding disorders often occur in infants/children while eating disorders usually emerge later, but there is overlap in symptoms, behaviors and treatments. Combining the categories acknowledges the relationships and developmental trajectories. - An integrated approach may help identify issues earlier on before they escalate into more serious disorders. It also promotes considering the biological, psychological and social aspects of each. - Parents/practitioners may find it less confusing than separate categories. It provides a unified framework for assessment, diagnosis and intervention across

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(Rozantes M., 2012)
FEEDING DISORDERS
BICH THAO THI NGUYEN

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DIAGNOSTIC CRITERIA
Diagnostic and Statistical Manual of Mental
Disorders, 4th edition text revision (DSM-IV-TR)
International Statistical Classifications of Diseases-
10 (ICD-10)
 For classification of diseases and health problems
on “health and vital records including death
certificates and health records.” (WHO, 2012)

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DIAGNOSTIC CRITERIA
DSM-IV-TR, 307.59, Feeding Disorder of
Infancy or Early Childhood:
A. Feeding disturbance as manifested by
persistent failure to eat adequately with
significant failure to gain weight or
significant loss of weight over at least 1
month.
(Behavenet, 2012)

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DIAGNOSTIC CRITERIA
DSM-IV-TR, 307.59
B. The disturbance is not due to an
associated gastrointestinal or other
general medical condition (e.g.,
esophageal reflux).
(Behavenet, 2012)

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DIAGNOSTIC CRITERIA
DSM-IV-TR, 307.59
C. The disturbance is not better accounted
for by another mental disorder (e.g.,
Rumination Disorder) or by lack of available
food.
D. The onset is before age 6 years.
(Behavenet, 2012)

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DIAGNOSTIC CRITERIA
DSM 5
 Feeding and Eating Disorders
“…it is being recommended that the Eating
Disorders category be renamed Feeding and Eating
Disorders to reflect the proposal for inclusion of
feeding disorders…”
(American Psychiatric Association, 2012)

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DIAGNOSTIC CRITERIA
International Statistical Classifications of Diseases-
10 (ICD-10)
 F98.2 Feeding disorder of infancy and childhood:
A feeding disorder of varying manifestations usually
specific to infancy and early childhood.
(WHO, 2012)

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DIAGNOSTIC CRITERIA
ICD-10
 It generally involves food refusal and
extreme faddiness in the presence of an
adequate food supply, a reasonably competent
caregiver, and the absence of organic disease.
(WHO, 2012)

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DIAGNOSTIC CRITERIA
ICD-10
 There may or may not be associated
rumination (repeated regurgitation
without nausea or gastrointestinal
illness).
(WHO, 2012)

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CHARACTERISTICS
Food refusal
Inappropriate behaviors during mealtime
Failure to thrive
Food Selectivity
(Piazza & Carroll-Hernandez, 2004)

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CHARACTERISTICS
Food Refusal
 Refusing food and/or drink
 May lead to failure to thrive
 Skill deficits:
Oral motor behaviors (i.e., chewing)
Fine motor behaviors (i.e., self-feeding)
(Piazza & Carroll-Hernandez, 2004)

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CHARACTERISTICS
Failure to thrive
 Child loses weight over time
Lack of nutrients
Unable to take in, retain, or utilize the calories
(Piazza & Carroll-Hernandez, 2004)

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CHARACTERISTICS
Inappropriate behaviors during mealtime:
 Crying
 Screaming
 Aggression
 Gagging
 Vomiting
(Gutshall, 2012)

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CHARACTERISTICS
Food selectivity:
 Texture (smooth v. crunchy)
 Type (carbohydrate v. fruits)
 Presentation (on specific plate or specific
location)
 Brand (Hunt’s ketchup v. Heinz’s ketchup)
(Gutshall, 2012)

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COMMON TREATMENTS
Multidisciplinary Treatment (Team approach):
Physician, Speech Language Pathologist (SLP),
occupational therapist (OT), physical therapist
(PT), and behavioral analyst
Behavioral
Therapy (AKA Contingency
Management)
Diet Therapy: Gradually increasing nutrient intake
Supplemental feedings: Tube Feeding

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COMMON TREATMENTS
Supplemental feedings (Tube Feeding):
 Gastrostomy tube (G-tube): A tube is inserted through the
abdomen and then nutrients are delivered into the stomach
1st year $46,875.55
2nd year $80,959.10
5 years+ $183,209.80
 Nasogastric tube (NG-tube): a tube is inserted through the
nasal canal and then nutrients are delivered into the
stomach
 Child becomes dependent
(Piazza & Carroll-Hernandez, 2004)

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COMMON TREATMENTS
Behavioral Therapy
 Increased in food consumption and “may be more effective
than other strategies”
 Decreased in supplemental feedings
 2 year+ $48,000
 Compared to G-tube, cost savings $135, 209.80 for 5 year+
(Piazza & Carroll-Hernandez, 2004)

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Special Considerations for Behavior
Analysts
Components that should be looked at:
 Biological
 Medical issues: Are there any medical problems? (e.g., food
allergies, reflux issues, GI problems, etc.)
 Skill deficits
 Oral
 Motor
 Problem behaviors during mealtime
 Functional Analysis
 Parent education
 Educate parents

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References
 American Psychiatric Association. (2012). Retrieved October 31, 2012, from:
http://www.dsm5.org/PROPOSEDREVISION/Pages/
FeedingandEatingDisorders.aspx
 Gutshall, K. (2006). Q&A: Feeding Disorders. Retrieved October 30, 2012, from:
http://blog.centerforautism.com/2012/01/11/qa-feeding-disorders/
 Piazza CC, Carroll-Hernandez TA. Assessment and treatment of pediatric feeding
disorders. In: Tremblay RE, Barr RG, Peters RDeV, eds. Encyclopedia on Early
Childhood Development [online]. Montreal, Quebec: Centre of Excellence for Early
Childhood Development; 2004:1-7. Available at: http://www.child-
encyclopedia.com/documents/Piazza-Carroll-HernandezANGxp.pdf. Accessed
[October 31, 2012].

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References
 Rozantes, M. (2012). Treating Children with Feeding Disorders. Retrieved October
28, 2012, from:
http://teamchatterboxes.blogspot.com/2012/07/treating-children-with-feeding.html
 Unknown. BehaveNet. (1995-2012). Retrieved October 29, 2012, from:
http://behavenet.com/node/21491
 World Health Organization. (2012). Retrieved October 31, 2012, from:
http://www.who.int/en/

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Question
Whatdo you think about Feeding
and Eating Disorders being
combined together?