CLASSIFYING COMPLEX PEDIATRIC FEEDING DISORDERS

Background: This study defines the multiple characteristics associated with complex pediatric feeding problems and determines the relative f requency of each classification in a population referred to an interdi sciplinary feeding team.Methods: The written reports from team evaluat ions on 103 children (64 males, 39 females; age range 4 months to 17 y ears) were reviewed. Prematurity and/or presence of developmental dela y was coded. Identified factors related to current feeding problems we re coded according to five categories: structural abnormalities, neuro logical conditions, behavioral issues, cardiorespiratory problems, met abolic dysfunction. Results: Interrater reliability for the classifica tion coding was 88%. Thirty-eight percent of the children had a histor y of pre maturity and 74% were reported to have evidence of developmen tal delay. The following five categories or combinations were coded mo st frequently: structural-neurological-behavioral (30%), neurological- behavioral (27&), behavioral (12%), structural-behavioral (9%), and st ructural-neurological (8%). Overall, behavioral issues were coded more often (85%) than neurological conditions (73%), structural abnormalit ies (57%), cardiorespiratory problems (7%), or metabolic dysfunction ( 5%). Conclusions: Data analysis using this classification system revea led that the majority of children in this sample had a behavioral comp onent to their complex feeding problem, regardless of concurrent physi cal factors. These findings suggest that complex pediatric feeding pro blems are biobehavioral conditions in which biological and behavioral aspects mutually interact, and both need to be addressed to achieve no rmal feeding.