Identification and management of problem eaters.

Investigations into the prevalence of feeding problems among preschool children have found a remarkably high proportion are affected. Minde and Minde, reviewing the available epidemiological data, discovered that estimates of between 12-34% were usual.1 The sorts of difficulties that present to paediatricians tend to fall into two broad categories: refusal to eat (often found in association with impaired growth) and excessive faddiness. However, some feeding difficulties that have developmental consequences during infancy are more subtle than this. Many toddlers who decline to eat a normal diet, in terms of quality and quantity, have been difficult feeders from an early age. Often the history one obtains is of a longstanding fussiness, a resistance to try other foods, bouts of colic, and sometimes self induced vomiting in association with mealtimes. The management of specific conditions such as infantile colic, gastro-oesophageal reflux, rumination, feeding difficulties associated with structural defects of the oropharynx, and gastric motility problems are topics outside the scope of this review. Instead, the emphasis will be upon the identification and management of feeding problems of infants and preschool children that are relatively common, but are either missed by the families' medical attendants or are mishandled.