Food Refusal and Selective Eating

Food refusal can be characterized as a severe feeding problem wherein an individual fails to eat sufficient quantity and/or variety of foods/liquids to maintain his or her weight and height (e.g., Babbitt et al. in Pediatric feeding and swallowing disorders: Pathology, diagnosis, and treatment. Singular Publishing Group, San Diego, 1994). In addition, food refusal may encompass selective eating where weight and growth are not of concern but where nutritional status may be compromised. Feeding problems can occur in about 25–45 % of typically developing children and up to 80 % of children with intellectual and developmental disabilities. The etiology of feeding problems is not well understood but may develop as a result of medical issues, anatomical abnormalities and/or oral-motor skill deficits, and behavioral/environmental factors (Rommel et al. in J Pediatr Gastroenterol Nutr 37:75–84, 2003). Given the complex etiology of feeding problems, assessment and treatment should be conducted by an interdisciplinary treatment team of professionals involving speech and language pathologists, registered dieticians, and physicians (Laud et al. in Behav Modif 33:520–536, 2009; Silverman in Nutr Clin Pract 25:160–165, 2010). This chapter reviews empirically-supported assessment and treatment of food refusal and selective eating and provides recommendations for practitioners.