Feeding problems in infants range from mild fussiness and preferences to complex disorders that significantly affect a child's growth, development, and family wellbeing. Understanding what is and isn't normal can help parents seek appropriate support.

What Is a Paediatric Feeding Disorder?

A paediatric feeding disorder (PFD) is defined as impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, or psychosocial dysfunction. It is distinct from occasional fussiness or typical developmental variation in food preferences.

Common Signs of Feeding Difficulties in Infants

Prolonged feeds (more than 30 minutes per feed)

Arching of the back or turning away during feeding

Gagging, choking, or coughing during feeds

Crying or distress consistently associated with feeding

Refusal to accept the breast or bottle after initially feeding well

Failure to gain weight as expected on growth charts

Drooling excessively or holding food in the mouth (known as "pocketing")

Underlying Causes

Feeding disorders in infants can have several contributing factors:

Medical causes:

Gastro-oesophageal reflux disease (GERD) causing pain with feeding

Cow's milk protein allergy (CMPA)

Eosinophilic oesophagitis

Anatomical problems (tongue tie, cleft palate, laryngomalacia)

Neurological conditions affecting swallowing

Developmental causes:

Oral motor dysfunction (difficulty coordinating sucking, swallowing, and breathing)

Sensory processing differences

Environmental/relational causes:

Parental anxiety around feeding

Traumatic feeding experiences (e.g., nasogastric tube feeding in NICU)

Assessment

A thorough assessment involves:

Detailed feeding history and observation of a feed

Growth assessment

Medical evaluation to rule out underlying conditions

Sometimes a video fluoroscopic swallow study (a special X-ray to assess swallowing function)

The Role of a Multidisciplinary Team

Feeding disorders in infants are best managed by a multidisciplinary team, which may include:

Paediatric gastroenterologist (to assess and treat underlying medical causes)

Paediatric dietitian (to assess nutritional adequacy and develop a feeding plan)

Speech-language pathologist (to assess and treat swallowing and oral motor function)

Occupational therapist (especially for sensory-based feeding difficulties)

Psychologist (if there are significant behavioural or relational components)

If your infant is having significant feeding difficulties, ask your GP or paediatrician for a referral. Dr Harveen Singh FRACP assesses infants and children with feeding disorders at clinics across Sydney.

Last reviewed by Dr Harveen Singh FRACP, Paediatric Gastroenterologist & Hepatologist