Food refusal in children: A review of the literature

Abstract

Food refusal is a severe feeding problem in which children refuse to eat all or most foods presented and exhibit problems with growth. This review discusses the definition, etiology, and interventions pertaining to food refusal. The interventions utilized for food refusal typically consist of several treatment components. These treatment components are reviewed and implications for future interventions are discussed.

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.