Photo: Louisa Stokes
In the DSM-IV there are 3 disorders of feeding, or eating that some people are unaware of: Pica, Rumination Disorder and Feeding Disorder of Infancy or Early Childhood (Grilo, 2006). I would like to briefly introduce them.
Pica: persistent pattern of eating non-nutritive substances by young children (e.g. hair, chips of paint etc.). It is often diagnosed in young infants and lasts several months; it usually remits on its own or in conjunction with improved environment and stimulation (Mash & Wolfe, 2010). It’s reported to be mainly prevalent in institutionalised children (and even adults with severe impairments and intellectual disabilities), the degree of severity often relates to the degree of environmental deprivation.
Majority of interventions focus on positive reinforcement of eating the right foods and mild aversive therapy. Additionally, parents are often educated and taught to give positive forms of attention (smiling, tickling and laughing) as often the disorder is related to inadequate interaction with caregivers. Additionally, the caregivers are taught to keep the environment tidy and safe as well as to reinforce behaviours such as play and exploration.
Complications include masses of indigestible material being trapped inside the body (e.g. stomach), infections, intestinal obstruction, lead poisoning and malnutrition.
Rumination disorder: repeated regurgitation (without any observable nausea, disgust or attempt to vomit) and re-chewing of food without any gastrointestinal or medical reason.
Treatment usually utilises behavioural techniques (i.e. mild aversive training), additionally improvements in environment are often suggested and counselling given to caregivers.
The biggest complications of the disorder are: failure to thrive, low immune system and malnutrition.
Feeding disorder of infancy of early childhood: persistent failure to eat adequately and thus gain sufficient weight for age without any medical condition.
The treatment may require hospitalization. Depending on severity different steps are taken, such as increasing amount of calories and fluid intake, correcting vitamin and mineral deficiencies. Treating any underlying illnesses or psychological problems often takes place.
The complication of this disorder is permanently stunned mental and physical development (if sever and long-lasting).
It is best to address any eating issues immediately: Call for an appointment with your paediatrician if you have concerns about your child’s appetite, behaviour, development, or growth.
