Feeding disorders: definition, symptoms and treatments

Oral disorders are not a long-recognized clinical entity. On the contrary, they include different eating difficulties, grouped under the term oral disorders. A recent definition has achieved consensus within the medical and scientific community, but it has not yet been adopted by all professionals: it is the term “pediatric eating disorders” that has been retained.

Today, oral disorders are defined as feeding difficulties lasting more than 15 days, whatever the age (from the youngest age to adulthood), whatever the cause. They should in no way be confused with eating disorders, the best known of which are anorexia nervosa and bulimia.

Food orality disorders can appear in a child, from a very young age or older, sometimes without any cause or triggering phenomenon.

Nevertheless, certain circumstances seem to predispose to the development of eating disorders:

• Prematurity;
• The existence of congenital malformations (malformations detected at birth) or multiple disabilities;
• Autism Spectrum Disorders (ASD);
• The existence of one or more chronic illnesses;
• History of nasogastric tube or artificial nutrition use (the longer the tube or artificial nutrition was used, the higher the risk).

The causes, still poorly understood, combine motor functions, sensory functions and/or behavioral functions. Oral hypersensitivity is one of the main causes identified, and can be isolated or accompanied by other forms of sensory hypersensitivity (visual, olfactory, auditory, tactile).

Even if several cases of oral eating disorders can be found within the same siblings, no genetic predisposition has to date been identified. Sometimes, one of the parents may have himself suffered or still suffer from speech disorders, which aggravates his feeling of guilt.

” In all cases, the siblings are impacted by the existence of oral disorders within the family. Indeed, meals are often shared with the family, and can become the place of tension, stress and/or inappropriate behavior on the part of the parents, the affected child or his brothers and sisters. explains Lucie Briatte.

Food orality disorders cover a wide range of symptoms, very variable in nature and intensity depending on the child:

• sensory disturbances;
• Food selectivity: some children are only able to eat a maximum of ten foods », specifies Lucie Briatte;
• A disgust for food, which can cause nausea (nauseous reflex in front of the food) and vomiting even at the mere sight of the food;
• Gastroesophageal reflux: it can be sought in case of oral disorder, because medical care is necessary “, stresses Lucie Briatte;
• A food neophobia, that is to say the refusal to taste a new food, which persists over time.

In practice, food orality disorders result in various difficulties in eating:

• An impossibility or difficulty in switching from milk to purees,
• An impossibility or difficulty in eating pieces,
• A refusal to bring food to one’s mouth, or even to touch it.

All foods can be affected, regardless of their smell, texture or taste.

Oral disorders correspond to pathological signs, which can have significant consequences on the health of the child, or even the future adult that he will become:

• Gastrointestinal and sometimes dental problems (in case of repeated vomiting);
• Slowing down or disorders of growth and/or weight gain,
• Nutritional deficiencies that can affect certain biological functions;
• Personal and relational difficulties due to the important place of food in social relations.

Two critical periods can be distinguished for the onset of eating disorders in young children:

• The transition from a liquid diet (breastfeeding or bottle feeding) to a puree diet (beginning of food diversification, introduction of the first foods, transition to a spoon);
• The transition from a pureed diet to a chunky diet (change to chewing, discovery of new foods).

Whether breastfed or bottle-fed, a baby can develop an eating disorder.

The complex and recent definition of eating disorders, the only recent consensus of the scientific community explain the difficulty of diagnosis observed by health professionals in the field.

” Eating disorders are under-diagnosed and when the diagnosis is made, the process is often long, even though this delay can prolong the duration of treatment and its effectiveness. “, laments Lucie Briatte.

It is essential to be able to spot the early signs of oral disorders. Raising awareness and involving everyone in these disorders is essential:

• Parents and relatives;
• Early childhood staff (childminders, crèche staff);
• The teaching staff;
• Health professionals.

If in doubt, an assessment with a speech therapist should be considered with the doctor or pediatrician.

” As soon as the first signs are identified, the ideal is to be able to consult a pediatrician, or even a gastro-pediatrician, who can look for gastroesophageal reflux or other somatic problems. But specialized consultations are rare, and unevenly distributed across the territory. “, explains Lucie Briatte.

Who to consult in front of a speech disorder? In the majority of cases, the family initially consults for a break in the growth curve. The diagnostic approach gradually, but often belatedly, leads to food orality disorders. In all cases, an organic cause must be sought to rule out certain pathologies that may cause signs similar to oral disorders.

The management of oral eating disorders is by definition multidisciplinary, with networking and several assessments carried out by:

• The general practitioner or pediatrician;
• The speech therapist;
• The psychomotrician;
• The masseur-physiotherapist;
• The occupational therapist;
• The psychologist ;
• The dietitian.

” Each professional brings his perspective on the situation and his contribution to the care of the child “says Lucie Briatte.

The earlier the treatment, the shorter it may be and vice versa. When the diagnosis does not arrive until after the age of 4, treatment can then last longer, sometimes several years.

In addition, parental and family support can be interesting. In specialized consultations, therapeutic education workshops are organized around the sensory domain and therapeutic meals and can help families. But they are not accessible everywhere.

In severe forms of oral disorders, the temporary placement of a nasogastric tube may be necessary to refeed the child and avoid possible complications (nutritional deficiencies, developmental disorders, etc.).

” First of all, it is essential to make the parents feel guilty and give them some advice for everyday life, for example not to judge their child, to avoid bad behavior, not to let themselves be influenced by the gaze of the entourage, … “, advises Lucie Briatte.

Meals punctuate the daily life of the child and his family and the occurrence of oral disorders can quickly alter daily life, not to mention the gaze or judgment of loved ones. Faced with this situation, some useful advice can be given to parents:

• Lighten the educational aspect concerning food, above all do not force, do not go into blackmail, avoid permanent negotiations;
• Prevent meals from becoming moments of conflict;
• Involve the child in shopping, cooking, introduce him to new textures;
• Install the child properly to eat (their feet must be able to rest on a fixed shelf, which is not the case with many high chairs);
• Present food in a fun way;
• Keep the different foods separate on the plate.

” For those who wish to know more about oral disorders, I invite you to read the book that I co-wrote with Lauriane Barreau-Drouin, Pediatric Food Disorders, published in 2021 by Tom Pousse editions concludes Lucie Briatte.

Feeding disorders encompass a broad and complex set of pediatric feeding difficulties. Still largely unknown to the general public, better awareness is essential both to better support the families affected, but also to fight against certain well-established preconceived ideas about the diet of young children.