What Are Feeding Disorders?

Today I’m getting to that promised post about Feeding Disorders. A Feeding Disorder is different from an Eating Disorder, and also different from picky eating. It is common for individuals with special needs to have a Feeding Disorder on top of their primary diagnosis, and a little awareness can go a long way when you are interacting with these individuals and their families.

Content Warning: Discussion of Eating Disorders

Eating Disorder vs Feeding Disorder: What’s the Difference?

It is very likely that you have heard of the term “Eating Disorder.” It immediately brings up a mental image of a young adult, usually a woman, skeletally thin. The term “Feeding Disorder” however, doesn’t often bring up a picture in a person’s mind. Without knowing the difference, it would be very easy to just assume that the speaker meant to say “Eating Disorder,” or that “Eating Disorder” and “Feeding Disorder” are interchangeable titles for the same thing. While it is true that both an Eating Disorder and a Feeding Disorder cause a person to drastically restrict their eating and/or have a very abnormal/unhealthy/disordered relationship with food, the causes for this disordered eating is what differentiates these two medial conditions.

Eating Disorders
Eating Disorders primarily affect teens and adults. The two most common disorders are Anorexia Nervosa and Bulimia Nervosa. Eating Disorders tend to be very psychologically-based. For example, an Eating Disorder can develop as a response to trauma, abuse, or chronic stress. They can also be a symptom of Body Dysmorphia. It is very common for a person with an eating disorder to also have depression and/or anxiety.

Feeding Disorders
Feeding Disorders primarily affect children (with the notable exception of disabled adults). Feeding Disorders are considered to be more of a physical health issue than a mental health issue. Feeding Disorders can be mechanically-based (ie. a misaligned jaw that is hampering chewing), or sensory-based (ie. an extreme repulsion to certain textures, colours, or smells due to a Sensory Processing Disorder).

Feeding Disorder vs Picky Eater: What’s the Difference?

Picky Eater
We all know at least one picky eater. Picky eaters like a smaller variety of foods than the average person, or perhaps have whole categories of foods they like to avoid, such as food that is “too spicy.” It is common and completely normal for children to be picky eaters as they develop and grow their food repertoire, and as they experiment with their individuality and independence. Typically, a picky eater will grow out of most of these restrictive preferences as they become adults. It is also normal, even for adults, to have one or two foods that they just can’t stand ever, be it brussels sprouts or cilantro.

Problem Feeder
While picky eating is normal and common, there is a line where a doctor will become concerned with a person’s picky eating. If the different types of food are so limited that entire food groups are eliminated from the person’s diet, or adequate nutrition is not being achieved, or if they are underweight and continuing to drop, a “picky eater” becomes a “problem feeder.” Problem feeders usually receive referrals from their Family Doctor to Nutritionists or Feeding Therapists to try to expand the variety of foods, and improve nutrition. An early intervention caseworker can often make these referrals as well if your child is already seeing one for a preexisting diagnosis, such as Autism.

Feeding Disorder
When a problem feeder is sent to Feeding Therapist, they will assess the client by watching them closely while they eat. They are looking for any mechanical issues that may be making eating difficult and uncomfortable, and for sensory issues that may cause the problem feeder to reject entire categories of food. These categories are often not the nutritional food groups that we are used to, such as dairy or grains; they are sensory categories such as mushy, crunchy, smelly, etc… A problem feeder may come away from this assessment with a Feeding Disorder diagnosis if their eating issues are significant.

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Nutritionist vs Feeding Therapist: What’s the Difference?

Nutritionist
A nutritionist’s job is to see if a person is receiving adequate nutrition to be healthy. A Nutritionist can look at a list of foods in a person’s repertoire and food journals of everything that was eaten over a period of time to get an idea of any essential vitamins or minerals that are missing. They can suggest foods or supplements to round out a person’s diet.

Feeding Therapist
Feeding therapists are more “hands on” than nutritionists. Feeding therapists often work with clients over longer periods of time. They are trained in techniques to help people eat: be it overcoming difficulties with chewing and swallowing, or sensory issues. It is not uncommon for a Feeding Therapist to also be a licensed Speech Pathologist, since some of the skills they teach overlap. (For example, the same tongue exercises that correct a speech problem may also correct a swallowing problem.)

Often a Nutritionist and Feeding Therapist work together with individuals who have Feeding Disorders. For example:

The Nutritionist may see the client first and notice a serious deficit in the variety of foods eaten. They might refer the client to a Feeding Therapist for a Feeding Disorder evaluation to see if there is a root cause for this.
The Feeding Therapist can observe and evaluate the client and give the Nutritionist a list of which mechanical or sensory issues are affecting eating.
Armed with this information, the Nutritionist can recommend foods to fill the nutrition gap that fall into categories that the client can already eat. (ie. Only recommending soft foods vs crunch foods)
If necessary, the client can then go back to the Feeding Therapist to work on overcoming their eating issues and expanding the categories of foods they are able to eat in the future.

So there you have it: a 101-style introduction to Feeding Disorders. Next week I’ll personalize today’s information with some of my own family’s experiences with Feeding Disorders and Feeding Therapy.

In the meantime, I would like to encourage you to be thoughtful with your words around the dinner table. Whether you are sitting down with extended family, or see a “picky eater” at a restaurant, there is a chance that there is more to the story than what you see. The person who is eating differently than you think they should may be dealing with a lot of challenges below the surface, and could use support and encouragement, not criticism.