NUTRITION
Feeding problems in infancy
and early childhood:
Identification and management
Debby Arts-Rodas RD, Diane Benoit MD FRCPC, Department of Psychiatry Research, The Hospital for Sick Children,
Toronto, Ontario
D Arts-Rodas, D Benoit. Feeding problems in infancy and early child-
hood: Identification and management. Paediatr Child Health
1998;3(1):21-27.
The purpose of this paper is to present a structured method to assess and
manage feeding problems in children under three years of age and a
newly developed instrument to assist in the assessment and monitoring of
these feeding problems. Simple management strategies and practical sug-
gestions are described, derived from clinical experience and a pertinent
review of the literature. Because feeding problems are so prevalent (af-
fecting up to 35% of infants), the use of structured parent questionnaires,
interviews and observation scales is important when assessing and manag-
ing these problems.
Key Words: Feeding assessment, Feeding problems, Food aversion, Food
refusal, Infancy
F eeding problems are estimated to occur in up to 25%
of normally developing children (1) and in up to 35%
of children with neurodevelopmental disabilities (2). One
common definition of feeding problems is the inability or
refusal to eat certain foods (2,3). Problems with feeding
may lead to significant negative nutritional, developmen-
tal and psychological sequelae (4-7). Because the severity
of these sequelae is related to the age at onset, degree and
duration of the feeding problem (8), early recognition and
management are important. The purpose of this paper is
to provide guidelines to identify feeding problems in the
first three years of life; to present a newly developed in-
strument to assess the presence of feeding problems and
monitor the effects of management; and to describe basic
management strategies that may eliminate or improve
feeding dysfunction.
Correspondence and reprints: Ms Arts-Rodas, Department of Psychiatry Research, The Hospital for Sick Children, 555 University Avenue, Toronto,
Ontario M5G 1X8. Telephone 416-813-5232, fax 416-813-6565, e-mail debby.arts@mailhub.sickkids.on.ca
Paediatr Child Health Vol 3 No 1 January/February 1998
L’identification et la prise en charge des problèmes
d’alimentation pendant la première et la petite
enfance.
RÉSUMÉ : Le présent article vise à présenter une méthode structurée
d’évaluation et de prise en charge des problèmes d’alimentation chez
les enfants de moins de trois ans ainsi qu’un nouvel instrument
permettant de contribuer au bilan et à la surveillance de ces
problèmes d’alimentation. On y décrit des stratégies de prise en
charge simples et des suggestions pratiques tirées de l’expérience
clinique et d’un examen pertinent de la documentation scientifique.
Puisque les problèmes d’alimentation sont très prévalents (ils
touchent jusqu’à 35 % des nourrissons), le recours à des
questionnaires structurés aux parents, à des entrevues et à des
échelles d’observation s’impose.
IDENTIFYING FEEDING PROBLEMS
Issues of definition and classification
The identification of feeding problems in infancy and
early childhood is no simple task because there is no uni-
versally accepted definition or classification system (6,9).
Furthermore, feeding problems are heterogeneous in na-
ture as illustrated by the following list of symptoms of
young children with feeding problems: multiple food dis-
likes (food selectivity, ‘pickiness’) (2); partial to total food
refusal (10); difficulty sucking, swallowing or chewing (2);
vomiting (10); colic (10); prolonged subsistence on inap-
propriate textures (inability to graduate to textured foods)
(2); delay in self-feeding (2); tantrums and other problem
mealtime behaviours (2); rumination (9); and pica (9). In
addition, etiological factors contributing to feeding prob-
lems are often multifactorial and may interact to lead to
21
Arts-Rodas and Benoit
Child characteristics
Health problems
– Neurological deficits
– Anatomical/mechanical problems
of upper airway and GI tract
– Acquired/congential defects of larynx,
trachea, esophagus
– Drug side effect
– Chronic illness
– Multiple food allergies
– Genetic and metabolic disorders
– Other
Developmental history
– Regulatory capacity
Feeding/growth history
– Traumatic feeding experiences
Does the child have
growth failure?
YES NO
High energy feeds Provide information
and/or tube about nutritionally
feeding and developmentally
appropriate diet
YES
Is the child willing to eat?
YES
OT/SLP intervention and/or
behaviour modification program
Figure 1) Decision tree for assessment and management of feeding and/or swallowing problems. GI Gastrointestinal; OT Occupational therapist; SLP Speech
and language pathologist
the final clinical picture of a child with feeding and/or
swallowing problems (Figure 1).
Clinical assessment
Given that feeding problems in childhood are complex,
multifactorial and lack universally accepted definitions
and classification systems, health professionals need to
rely on clinical assessments to determine the presence of
such problems. A comprehensive clinical assessment, in-
cluding parental report (parents’ perceptions of mealtime
behaviours and nutrient intake), review of the child’s
health and developmental, feeding and growth history,
and observation of a meal, may help to identify the pres-
ence and severity of a feeding problem.
Parental report: An established part of child health su-
pervision includes asking caregivers about their child’s
22
Other characteristics
Feeder-infant relationship
– Caregiving environment
– Parenting skills
– Other psychosocial factors
Feeding and/or
swallowing problems
Is there a feeder-child
Is the child safe to feed? relationship problem?
YES NO YES NO
Is the child able to eat – No oral feeds Refer to mental Provide support
(anatomically and – Tube feeds health professional to feeder
developmentally)? – OT/SLP
intervention
NO
OT/SLP intervention
and/or tube feeding
NO
Basic management strategies
(Table 2) and/or behaviour
modification program
feeding (11). Simple questions such as “How often do you
find your child is difficult to feed?” can help ‘quantify’ the
caregiver’s experience with the feeding problem. More
open-ended questions, such as “How do you find your
child is doing with feeding?”, may provide additional in-
formation. Despite its usefulness in identifying the pres-
ence of some feeding problems, parental report may not
be the most reliable method to detect feeding problems.
Parents may not be aware that their child has a feeding
problem (12). For instance, Linscheid (12) presented the
case of a mother who reported that her child was feeding
well, only to discover on further questioning that the child
only ate in the bathtub. On the other hand, some parents
may be so anxious about feeding their child that they per-
ceive minor problems as major (6).
However, the monitoring of parents’ subjective experi-
Paediatr Child Health Vol 3 No 1 January/February 1998

ence of their child’s feeding may indicate problems with
feeding. This monitoring can be facilitated by using in-
struments such as the newly developed Infant Feeding Be-
haviours – Parent checklist (Appendix 1). Using this
checklist, the parent is asked to rate 30 behaviours that
might be exhibited by their child at mealtimes on a five-
point Likert-type scale. A high rating suggests that the be-
haviour occurs almost always or that it is perceived as a
significant problem. A total score is derived by adding
parents’ ratings of each of the 30 items. The higher the to-
tal score, the more severe the feeding problem is per-
ceived to be by the parent. A decrease or increase in the
total score over time may signal an improvement or dete-
rioration in the feeding problem (13). Nutrient intake rec-
ords or ‘food diaries’ may reveal information about
current feeding practices. The parent is asked to docu-
ment prospectively all foods consumed by the child over a
three-day period. Alternatively, for the child who eats or
drinks only one or two items daily, 24 h recall may be suf-
ficient. Analysis of three-day food diaries or 24 h recall
can provide information about the types, textures and vol-
umes of foods ingested, duration of the meal and meal-
time schedules. A detailed food diary may help to identify
children who are fed textures that are developmentally in-
appropriate, for excessively long or short periods and ‘on
demand’ versus a structured schedule.
Review of health, and developmental, feeding and
growth history: A review of the child’s health history pro-
vides information about medical conditions that may con-
tribute to feeding and/or swallowing problems (Figure 1).
For instance, feeding and/or swallowing problems may be
associated with any combination of the following: neuro-
logical deficits (eg, cerebral palsy); anatomical/mechani-
cal problems of the upper airway (eg, choanal atresia);
acquired/congenital defects of the oral cavity, larynx, tra-
chea and esophagus (eg, cleft palate, tracheoesophageal
fistula); drug side effect (eg, chemotherapy); chronic ill-
ness (eg, gastroesophageal reflux, cardiac and lung prob-
lems); multiple food allergies; and genetic or metabolic
disorders (eg, Down syndrome, phenylketonuria) (14). In
addition, traumatically acquired conditioned dysphagia
(15) and post-traumatic feeding disorder (16) have been
described as possible causes of persistent feeding prob-
lems. Traumatically acquired conditioned dysphagia and
post-traumatic feeding disorder may result from repeated
exposure to noxious substances, experiences or proce-
dures (eg, choking, vomiting, forced feeding, repeated suc-
tioning or insertion of tubes for feeding) in and around the
mouth. The prevalence of these types of feeding problems
may be on the rise because advances in medical technol-
ogy enable more children with severe illnesses to survive.
A comprehensive review of all health problems that may
contribute to feeding and/or swallowing difficulties is be-
yond the scope of this paper. Extensive lists of medical di-
agnoses associated with feeding problems may be found
elsewhere (14).
Furthermore, it is important to identify infants and
Paediatr Child Health Vol 3 No 1 January/February 1998
Feeding problems in infancy
young children with swallowing dysfunction. These young
children may have an inability to protect their airway dur-
ing feeding, thus rendering oral feeding unsafe. Symp-
toms of swallowing dysfunction may include history of
recurrent pneumonias, respiratory illnesses, slow feed-
ing, oral or nasal regurgitation, gagging, choking, or
coughing before and/or during the swallow. When swal-
lowing dysfunction is suspected, further clinical and labo-
ratory evaluation (4,14) is necessary to ensure a safe
swallowing mechanism.
However, feeding problems are not encountered exclu-
sively in children with health problems (Figure 1). For in-
stance, problems with regulation of internal states (17),
sensory integration, quality of caregiving and behavioural
mismanagement (eg, excessive parental anxiety at meal-
times, forced feeding) may play an important role in the
development of feeding problems in early childhood
(2,3,18). Quality of caregiving should be suspected as a
possible contributing factor to the feeding problem when
the parent is angry with the child, is overwhelmed by the
feeding problems, has become indifferent towards the
child (eg, has given up) or complains that the child’s feed-
ing problems are affecting other family members and/or
other areas of family life.
An in-depth feeding history not only provides informa-
tion about present feeding habits but also investigates
feeding patterns from birth. Benoit (19) developed a
Feeding History Questionnaire that is completed by the
caregiver and may be useful clinically. The questionnaire
inquires about progression to various textures, choking
and other traumatic incidents, pica, duration of meals,
feeding schedule, food intolerance, preferred foods and
textures, previous treatment of feeding problems, and
family history of eating/feeding disorders.
A review of growth parameters – height and weight – is
an essential part of any comprehensive assessment of
feeding problems because it can help to identify children
with growth failure. A discussion of growth failure or fail-
ure to thrive is beyond the scope of this paper. However, it
is important to emphasize that there is no empirical evi-
dence documenting the frequency of association between
feeding problems and growth failure (9,20).
Mealtime observation: Observation should focus on
child-feeder interactions, the child’s oral motor skills and
behaviours, the caregiver’s responses to adaptive and
maladaptive feeding behaviours, and the feeding’s sur-
roundings. To guide and organize observations, struc-
tured instruments such as feeding interaction scales (21)
and child maladaptive feeding behaviour scales (Appen-
dix 1) can be used. Table 1 provides some guidelines for
mealtime observations.
MANAGEMENT OF FEEDING PROBLEMS
Many parents and health professionals fail to identify
or underestimate the severity of feeding problems (12)
and often use a wait-and-see approach (3,22). Unfortu-
nately, the wait-and-see approach may make treating
23
Arts-Rodas and Benoit
TABLE 1: Mealtime observation guidelines
A. General observations
1. Positioning of the child. Is the child positioned in a develop-
mentally appropriate manner?
2. Surroundings. Are toys/distractions used to coax the child to
feed? Are the surroundings noisy (eg, loud music, television,
etc)?
3. Types and amounts of food offered and consumed. Are they
developmentally appropriate?
4. How typical is the observed meal compared with meals at
home?
B. Interactions between feeder and child
1. How does the feeder offer the food? Is the child coaxed, dis-
tracted, entertained to eat? Is the feeder angry, intrusive, anx-
ious, unavailable for interaction, too laid back? Is the child
given the opportunity to self-feed if age appropriate? Is the
food offered too quickly or too slowly? Is the child force fed?
How does the feeder react to oppositional behaviours and/or
adaptive eating behaviours?
2. Is the child defiant, provocative, compliant or passive in re-
sponse to the feeder’s requests? Are oppositional behaviours
(tantrums, pushing/throwing the food, etc) present?
C. Child’s behaviours at mealtime
1. The child’s willingness to accept food. Does the child try to
self-feed if age appropriate? How competent is the child at
self-feeding? Does the child accept food willingly? Is the child
eating too fast/too slowly? Does the child eat enough?
2. How is the food handled once inside the mouth? Is the food
swallowed? Is there obvious nasopharyngeal reflux, poor suck,
coughing, gagging, vomiting, spitting, loss of food from the
sides of the mouth? Does the child hold food in the mouth for
extended periods of time?
3. How does the meal end? Is the feeder or child frustrated or
calm and relaxed?
feeding problems more difficult for four major reasons.
First, mealtimes with young children who have feeding
problems are often very frustrating and anxiety-
provoking for the child, the feeder and the entire family
(6). The longer these mealtime conflicts persist, the more
resistant they become to change (3,19). Second, the de-
layed introduction of developmentally appropriate foods
at critical or sensitive periods may interfere with the ex-
pected progression of oral motor skills (5). Third, persis-
tent feeding problems may lead to nutritional deficiencies
that may be severe enough to warrant supplemental tube
feeding (7). Fourth, children with unidentified swallowing
dysfunction may develop chronic lung disease or die as a
result of aspiration pneumonia (14). Early identification
and management may prevent these problems (11,22).
A comprehensive clinical assessment should provide
the information needed to develop the most appropriate
management plan. When underlying health problems are
identified as the major contributors to the child’s feeding
problems, they should be managed accordingly. A de-
tailed discussion of the medical and/or surgical manage-
ment of all health problems associated with feeding
problems is beyond the scope of this paper.
24
TABLE 2: Basic management strategies
A. Physiological and environmental changes (for all ages)
1. A structured mealtime schedule (eg, every 4 h) should be
provided. No food or drinks are permitted between scheduled
meals. However, if the child is thirsty, water may be offered for
up to 2 h before the next scheduled meal.
2. Meals should be time limited, eg, 30 mins.
3. The child should be fed in a quiet place with few distractions
(eg, no loud radio or television, no toys).
4. The feeder should have a calm, positive attitude at mealtimes.
5. The child should be positioned comfortably and in a develop-
mentally appropriate ‘seat’, ie, high chair, if the child is able to
sit independently.
6. A limited number of feeders (ideally one person) should feed
the child.
B. ‘Food rules’ (for children with self-feeding skills) (25)
1. The child should be encouraged to self-feed as much as
possible.
2. Food should not be given as a present or reward (8).
3. Mealtime is not playtime. Games should not be used to coax
the child to feed (8).
4. Food should be removed after 10 to 15 mins if child seems to
play with the food without eating.
5. The meal should be terminated if the child throws food in
anger.
C. ‘Mealtime rules’ (for children with self-feeding skills) (11,22)
1. Limits for the circumstances surrounding the ingestion of food
should be set. A set of mealtime rules should be set (eg, remain
seated, use silverware not fingers, no throwing of food). The
rules should be reasonable and based on the age of the child,
starting with two to three rules and gradually adding a few
more rules until the child has learned appropriate mealtime
behaviour.
2. Mealtime rules should be explained without nagging before
each meal until the child is complying consistently.
3. Mealtimes should be pleasant; children should be included in
conversations. Mealtimes should be an opportunity to praise
appropriate behaviours. Children cannot be praised too often.
Nagging the child to hurry should be avoided.
4. If mealtime rules are broken, the child should practise correct
behaviours. The third time that the rules are broken, the child
should be disciplined with a time-out.
5. Small portions of foods should be offered. The child should be
praised for eating the amount provided. The amount of food
required to receive praise should be gradually increased.
6. When mealtime is up, plates should be removed from the ta-
ble regardless of whether the child is finished. If the child has
not finished the meal, the food should be removed without
lectures or condemnation for not eating. If the child has not
finished the meal, no dessert or snacks should be offered until
the next meal. If the child continues to whine and ask for
snacks, a time-out is required. Parents should not ‘give in’ and
allow the child to eat snacks, this will only make the teaching
process much longer.
In addition to treating the underlying health problems,
three main questions should be addressed simultane-
ously when developing a management plan: Does the
child have growth failure? Is the child safe to feed (and if
so is the child able to eat? and is the child willing to
Paediatr Child Health Vol 3 No 1 January/February 1998

eat?)? Is there a feeder-child relationship problem? (Fig-
ure 1). The answers to these questions should direct in-
tervention strategies. For instance, infants and children
who demonstrate significant growth failure and/or inabil-
ity to protect their airway during feeding may require sup-
plemental tube feeding to achieve nutritional rehabilita-
tion and/or prevent pulmonary aspiration. In addition to
tube feeding, infants who are unable to swallow safely
may require an oral stimulation program (if considered
safe) in an attempt to prevent oral hypersensitivity
(4,7,14).
Infants who are able to swallow safely but are unable
to eat, such as a child with cerebral palsy, may be willing
to accept food placed in the mouth but may not have the
motor ability to place the food in the mouth him- or her-
self, chew and move the bolus efficiently. Children with
these types of feeding problems may benefit from occupa-
tional therapy or speech-language pathology interven-
tions. These interventions focus on oral motor skills (eg,
increasing strength and range of motion of oral motor
structures, preventing hypersensitivity, promoting
proper positioning, bolus modification) while encourag-
ing positive parent-child interactions (2,4,7,14).
Infants and young children who are able to swallow but
are unwilling to eat may turn the head away and refuse to
open the mouth when the food is offered, may spit the
food out or hold it in the mouth for extended periods.
Children who are unwilling to eat may benefit from be-
haviour modification programs. Behaviour modification
techniques have been reviewed elsewhere (3,12,14).
These interventions focus on increasing the frequency of
adaptive behaviours (ie, appropriate feeding behaviours)
and decreasing the frequency of maladaptive behaviours
(Appendix 1). The basic management strategies de-
scribed in Table 2 are examples of simple and generic be-
haviour modification techniques that may be used indi-
vidually or in conjunction with other more specific and
refined techniques.
When problems between the parent and child are sus-
pected, referral to a mental health professional should be
made for further assessment and treatment. If it is deter-
mined that no parent-child relationship problem exists,
support for parents should be provided.
Because feeding problems are complex and multifac-
torial in nature it is often necessary to have several disci-
plines providing intervention to one child at any given
time. The decision tree illustrated in Figure 1 provides
some guidance in choosing appropriate interventions for
the management of infants and young children with feed-
ing problems.
Finally, it is important to recognize that an integral
part of management includes appropriate follow-up.
Follow-up should include weight monitoring, a review of
the child’s nutrient intake (feeding diaries) and monitor-
ing of management strategies (by observing a meal and in-
quiring about ease of implementation, and the child and
caregiver’s progress).
Paediatr Child Health Vol 3 No 1 January/February 1998
Feeding problems in infancy
CONCLUSION
Although feeding problems are estimated to affect one
in three to four infants and young children, there are no
universally accepted methods of management. This may
reflect, in part, the heterogeneity of feeding problems and
the lack of a unifying classification system. Yet the early
recognition of feeding problems is important because it
may prevent simple feeding problems from becoming
pervasive or resistant to treatment (11,22). In this paper,
a systematic approach to the assessment and manage-
ment of feeding problems is proposed based on clinical
experience and findings from the literature.
The use of parent questionnaires and observational
rating scales, in addition to a structured clinical inter-
view, is important when assessing infants and young chil-
dren with feeding problems. Indeed, such instruments
provide clinicians and researchers alike with structured
ways to collect information, to compare individual chil-
dren and larger groups, to identify the presence of feeding
problems, to ‘quantify’ the severity of the feeding prob-
lems, and to measure the effectiveness of treatment. The
failure to use structured assessment protocols and tools
that permit comparison of subjects across studies has
greatly impeded research in the field (9). An important fo-
cus of future research is the validation of instruments
such as the Infant Feeding Behaviours – Parent and Rater
checklists, the Feeding History Questionnaire, and other
parent questionnaires and observational measures that
help to structure assessment and treatment protocols of
young children with feeding problems.
Poor outcomes associated with feeding problems early
in life have been documented, including detrimental ef-
fects on family life (6) and behavioural problems (3,23)
and eating disorders such as anorexia nervosa and buli-
mia (24). These serious short term and long term se-
quelae emphasize the importance to treat feeding prob-
lems early. The question of when interventions such as
behaviour therapy, multidisciplinary approach nutrition
counselling and occupational therapy should be used to
treat young children’s feeding problems needs to be ex-
amined formally. More research is clearly needed to un-
derstand which single or combined treatment methods
are the best to treat which feeding problems.
REFERENCES
1. Sisson LA, Van Hasselt VB. Feeding disorders. In: Luiselli JK, ed.
Behavioral Medicine and Developmental Disabilities. New York:
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2. Palmer S, Horn S. Feeding problems in children. In: Palmer S,
Ekvall S, eds. Pediatric Nutrition in Developmental Disorders.
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JG, eds. Early Occupational Therapy Intervention: Neonates to Three
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25
Arts-Rodas and Benoit

Infant feeding behaviours (Parent) - 3.1 (Benoit, 1994)

Date: _____/____/___ ID:_________
Month/ Day /Year
How often is your child hard to feed? (please check only one answer)
_____1. less than 25% of the time _____2. between 25% and 50% of the time
_____3. between 51% and 75% of the time _____4. more than 75% of the time

Below is a list of things that babies and young children sometimes do at meal times. Please use the rating scale to help you choose how often
you think your child does these things. Put your answer in the blank space.
For example: If you answer “occasionally” to question 1: “turn head away from food/shake head no”, then write 2 in the blank space.
0 1 2 3 4 5
Never Rarely Occasionally Frequently Very frequently Almost always
How often does your child
1. Turn head away from food/shake head no ___________
2. Refuse to open mouth/delay in opening mouth ___________
3. Cover mouth (eg, with hands, arms, object) ___________
4. Push food away (including offering food to feeder or giving spoon/glass back without emptying) ___________
5. Throw food/utensils away ___________
6. “Hide” chin in shoulder, chest ___________
7. Arch back ___________
8. Squirm/turn entire body on chair (even if eating) ___________
9. Touch food with lips/tongue but does not eat ___________
10. Bite on spoon/nipple ___________
11. Remove food from mouth with fingers/wipe food away from lips ___________
12. “Bunch” tongue at the back of mouth ___________
13. Not chew/suck/move food in mouth (more than 5 s)/passively refuse to swallow ___________
14. Chew/suck on food but does not swallow ___________
15. Swallow in “gulps” ___________
16. Use tongue thrusting (or push food out with tongue)/spit ___________
17. Gag/retch/cough ___________
18. Vomit ___________
19. Cry/fuss/whine/tantrum/appear angry ___________
20. Appear “tired”/fall asleep (“pretend” or not) ___________
21. Appear disinterested/unmotivated to eat/not hungry ___________
22. Appear frightened/panicky/tense ___________
23. Appear distracted from eating (by toys, food, etc) ___________
24. Appear distracted while eating (by toys, soother, food, etc) ___________
25. Get out of chair/wander/stand ___________
Does your child Yes No
26. Cry/cough/gag at the sight of food/bottle q q
27. Eat with a slow pace q q
28. Sit comfortably and appropriately (ie, given developmental age) to promote good eating q q
29. Take only a small amount of food q q
30. Show other maladaptive behaviours q q
If yes, describe ________________________________________________________________________________________________

Appendix 1) Parental report of problem feeding behaviours

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8. Skuse D. Identification and management of problem eaters. Arch Dis
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9. Benoit D. Failure to thrive and feeding disorders. In: Zeanah CH, ed.
Handbook of Infant Mental Health. New York: Guilford Press,
1993:317-31.
10. Dahl M, Sundelin C. Early feeding problems in an affluent society.
Acta Paediatr 1986;75:370-9.
11. Finney JW. Preventing common feeding problems in infants and
young children. Pediatr Clin North Am 1986;33:775-88.
12. Linscheid TR. Eating problems in children. In: Walker CE, Roberts
MC, eds. Handbook of Clinical Child Psychology. Toronto: John
Wiley & Sons, 1983;25:616-39.
13. Benoit D, Green D. The Infant Feeding Behaviors-Rater Checklist:
Preliminary data. Poster presented at the Annual Meeting of the
American Academy of Child and Adolescent Psychiatry. New
Orleans, Louisiana, October 17-20, 1995.
14. Tuchman DN, Walter RS. Disorders of Feeding and Swallowing
in Infants and Children. San Diego: Singular Publishing, 1994.
15. Di Scipio WJ, Kaslon K, Ruben RJ. Traumatically acquired
conditioned dysphagia in children. Ann Otol Rhinol Laryngol
1978;87:509-14.
16. Chatoor I, Kerzner B, Menvielle E, et al. Multidisciplinary team

26 Paediatr Child Health Vol 3 No 1 January/February 1998


approach to complex feeding disorders in technology dependent
infants. Symposium presented at 5th Biennial National Training
Institute. Washington, DC, December 4-6, 1987.
17. Lyons-Ruth K, Zeanah CH, Benoit D. Disorder and risk for
disorder during infancy and toddlerhood. In: Mash EJ, Barkley RA,
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1996:457-91.
18. Budd KS, McGraw TE, Farbisz R, et al. Psychosocial concomitants
of children’s feeding disorders. J Pediatr Psychol 1992;17:81-94.
19. Benoit D. Diagnostic assessment of feeding disorders. Workshop (WF
20) presented at the World Association for Infant Mental Health, Sixth
World Congress. Chatoor I, chair. Tampere, Finland, July 25-28, 1996.
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Feeding problems in infancy
21. Chatoor I, Menvielle E, Getson P, O’Donnell R. Manual:
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