Ask the Expert: What are feeding disorders, and what causes them?

Manhattan speech-language pathologist Heather Boerner explains the common types and causes of feeding disorders in children, including reflux, low muscle tone, structural issues, aspiration, and oral sensory deficits, and how they are diagnosed.

When a child isn't eating well or is having difficulties during mealtime and we suspect a feeding disorder, a speech-language pathologist or feeding specialist is called in. A lot of children come to our center who are having trouble transitioning from the bottle, or they may have difficulty moving from a pureed texture to a harder texture, or sometimes they might be intolerant of a particular texture or taste or temperature.

The first thing I do is act like a detective to figure out why the child is having difficulty with a particular food texture. Many times there’s usually some underlying cause contributing to why a child is a picky eater or why a child is lacking a variety of food in his diet. Some of these common causes are:

1. Reflux, which can cause the child to have a negative sensation while eating. That could cause a whole host of other issues where they don’t want to eat because they’ve had negative experiences or they know they experience reflux. If a child comes in having difficulties at mealtime and I suspect reflux, I might make a referral to a gastroenterologist [who would be able to confirm the diagnosis].

2. Another common issue is low muscle tone, when the child’s jaw muscles are weak and they need to build up the strength of their facial muscles and jaw muscles so they can tolerate harder textures. A child who presents with low tone has a weak jaw, has difficulty transitioning from soft to hard textures, and fatigues easily during meals.

3. Another less common issue is that they have a structural issue, such as a cleft palate, in which case you need to address those structural issues first before they can have success while eating. An ENT doctor will look at a child’s vocal folds to rule out any structural abnormalities—it’s not common, but sometimes there are structural issues that haven’t been identified.

4. Another thing I may do is refer the child out for what's called a modified barium swallow, also called a "swallow study," which is basically an X-ray taken of the child while he’s eating. I may make the referral if I think the child is aspirating, which means the food or liquid is going into their lungs because the epiglottis isn’t closing properly. This might be seen in children who are born premature or who have significant neurological issues. It doesn’t happen very often, but it’s extremely important to rule out that situation if you suspect it because it’s not safe for them to eat at that point.

5. And a child may have oral sensory deficits, which means they're intolerant of certain textures, temperatures, or taste, and we work on increasing their tolerance for that particular texture. Oftentimes children who have oral sensory deficits might have an underlying sensory deficit, which means they have difficulty accepting new textures in their mouth or they might just be sensitive to touch in general. A child with an overall sensory processing disorder has difficulty processing the information coming into them on daily basis—whether it be auditory information, tactile information—and in those instances I work together with an occupational therapist to improve how a child responds to processing information from their environment.

Also see: Boerner explains how to treat feeding disorders in children and how to get picky eaters to try new foods

Heather Boerner, MA, CCC/SLP, is a pediatric speech-language pathologist and the founder of Chatty Child Speech Therapy, PLLC in Manhattan. Boerner graduated from New York University with an MA in speech-language pathology and a minor in education, and she is licensed to teach speech- and hearing-disabled students.