ReviewFood refusal in children: A review of the literature
Introduction
Childhood feeding problems constitute a broad spectrum, ranging from milder issues that do not involve considerable health risks to significant problems involving malnutrition and the need for supplemental tube feeding. Children with the most significant feeding problems are often described as having food refusal. This article provides a review of the literature, discussing the definition, etiology, and interventions pertaining to food refusal. As will be discussed, food refusal has been defined broadly. For purposes of this literature review, food refusal was defined as a child's refusal to eat all or most foods presented, resulting in the child either failing to meet caloric needs or dependent on supplemental tube feeds. Articles in which the participants did not meet this definition were excluded. The authors searched Medline and Psychinfo from 1979 to 2008 using the key words, “food refusal” and “children” to obtain both descriptive studies of children with food refusal and studies that described interventions for the treatment of food refusal. To ensure a more complete review, these databases were again searched using the key words, “feeding problems” and “children”. For this review, 38 intervention studies were identified whose participants met the definition of food refusal given previously.
Section snippets
Definition
Food refusal has been described and defined in a variety of ways. It has been described as a general term that embraces a wide range of a child's feeding problems (Douglas, 2002) and alternatively as a more specific type of feeding problem, defined as a child's refusal to eat all or most foods presented, resulting in the child's failure to meet his or her caloric or nutritional needs (Field, Garland, & Williams, 2003). Food refusal has also been defined both in terms of decreased appetite (
Etiology
Feeding is a complex process and problems with any stage in the process can result in feeding disorders. It has been suggested that feeding disorders in children are heterogeneous and may include a range of problems including medical, oral-motor, and behavioral (Piazza, 2008). This is especially true for food refusal. A small, but growing body of work has described a wide variety of etiological factors among children with food refusal. In a sample of 349 children with feeding problems evaluated
Intervention
The majority of the interventions for food refusal were implemented in either inpatient (57%) or day treatment (24%) setting, which speaks to the severity of food refusal as a subtype of childhood feeding disorder. While the medical and nutritional issues that are commonly comorbid with food refusal may require monitoring in a more controlled environment such as an inpatient unit or day hospital program, studies have described the treatment of food refusal in outpatient (Chamberlin et al., 1991
Conclusion
The goal of this review was to examine etiology and treatment of children with a specific severe feeding problem. To meet this goal, only studies describing children with food refusal, defined as a child's refusal to eat all or most foods presented which resulted in either the failure to meet caloric needs or dependence on supplemental tube feeds, were included. It should be noted that most studies that used the term, food refusal, did in fact describe participants that met this definition with
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Intervention article included in review.