Food refusal by infants and young children: Diagnosis and treatment

Parents report that 25% of toddlers exhibit food refusal. A subgroup of these children demonstrate such severe food refusal that their nutritional status is compromised, leading to the diagnosis of a feeding disorder. Although food refusal is common, and can pose a significant health risk for some children, few researchers and clinicians have described the different forms food refusal may take, or have related food refusal subtype to feeding disorders subtypes. Such critical issues must be addressed and discussed because different types of food refusal and feeding disorders may necessitate different treatment approaches. This review proposes that food refusal can be expressed in qualitatively different ways, including (a) unpredictable food refusal; (b) selective food refusal,- and (c) fear-based food refusal. Furthermore, it is proposed that each form of food refusal gives rise to a qualitatively different feeding disorder: Unpredictable food refusal is associated with infantile anorexia,- selective food refusal is related to sensory food aversions,- and fear-based food refusal is central to a posttraumatic feeding disorder. Implications for the treatment of each type of feeding disorder are discussed.