Does your child spit out food, turn his head, swat at the spoon, throw food and cry or scream during mealtime?  Do you ever wonder if other parents encounter the same difficulties during mealtime?  If you answered "yes" to both, you're not alone. For children with developmental or intellectual disabilities, they face a variety of challenges in their life.  Pediatric food refusal happens to be one of the most common types of problems these children face (Kerwin, 1999). 

To qualify for a formal feeding disorder diagnosis, a child must refuse or be unable to eat a sufficient amount or variety of food that results in the child losing weight or failing to gain weight or meet their nutritional needs (Shore & Piazza, 1997).  A child with a feeding disorder may refuse to consume solid foods entirely or may be food selective in which only certain types or textures of foods will be accepted (i.e., smooth textures like pudding, yogurt, applesauce or mashed potatoes are rejected or only crunchy, brown peanut butter flavored cookies, granola bars and pretzels are consumed).  In other cases, children may display food selectivity based upon the presentation of the food, such as consuming plain white rice only but rejecting white rice if combined with vegetables, sauces, herbs or wild rice.  A peanut butter sandwich might be consumed but only if the peanut butter and jelly are each distributed on their own piece of bread without the pieces touching on the plate.  Over time, the variety of foods a child will consume shrinks and/or the list of rules about how certain foods must be presented in order to accept them grows, resulting in further weight loss and nutritional deterioration for the child. 

While approximately 25% of typically developing children experience a feeding disorder, the rates are as high as 80% for children with developmental disabilities.  Thus, this is a common problem challenging caregiver.  Pediatric food refusal is classified into one of three categories:  organic (medical), non-organic (behavioral) or mixed .  The research indicates that children who engage in food refusal of the non-organic or mixed type engage in refusal because often the demand to consume the foods is withdrawn.  This results in an increase in refusal or other problem behaviors in the future during mealtimes (Woods, Borrero, Laud and Borrero, 2010)

If you are concerned with your child's nutrition or if your child is displaying some of the symptoms described above, your child should be evaluated by a medical professional (i.e., pediatrician) to determine if your child's nutrition is deficient and the cause.  Your child's doctor will determine if a referral to other professionals, such as a speech pathologist, registered dietitian or OT, is necessary.  If medical variables have been ruled out and it is determined the problem is behavioral in nature, a Board Certified Behavior Analyst with specialized training in using Applied Behavior Analysis (ABA) can work with your child to increase acceptance of a wider array of foods and liquids.  At Alliant Behavioral Pediatrics, we treat mild to moderate cases of pediatric food selectivity that are not organic (medical) in nature.  Contact us at so we can determine if we can assist you in your child's needs.  Listed below are other recognized, qualified professionals specializing in the treatment of pediatric feeding disorders.   

University of Nebraska Medical Center:  Munroe-Meyer Institute
Dr. Cathleen Piazza

The Marcus Autism Center-Pediatric Feeding Disorders Program
Dr. David Jaquess

University of MN:  Pediatric Feeding Clinic

Woods, J., Borrero, J., Laud, R., & Borrero, C.  (2010).  Descriptive analyses of pediatric food refusal:  The structure of parental attention.  Behavior Modification, 34(1), p. 35-56.

Kerwin, M. (1999).  Empirically supported treatment in pediatric psychology:  Severe feeding problems.  Journal of Pediatric Psychology, 24, 193-214.

Shore, B, & Piazza, C.  (1997).  Pediatric feeding disorders.  In E.A. Konarski, J.E. Favell, & J.E. Favell (Eds.), Manual for the assessment and treatment of the behavior disorder of people with mental retardation (pp. 65-89).  New York:  Guilford.


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