Oral Feeding Disorders: When Eating Becomes a Daily Challenge

Understanding, Recognizing, and Supporting Feeding Difficulties in Paris

Introduction

If your 18-month-old systematically refuses any solid food, if mealtimes last over an hour with gagging at every bite, or if you, as an adult, can only tolerate a few specific food textures, you're facing what's called an oral feeding disorder (OFD).

The numbers are striking: approximately 1 in 4 children is or has been affected by feeding difficulties to varying degrees. Among children with neurodevelopmental conditions like autism spectrum disorder (ASD) or ADHD, this figure climbs to 50-80%. For adults, particularly those who experienced feeding challenges in childhood, these difficulties often persist throughout life, affecting social relationships, nutritional health, and overall quality of life.

As an English-speaking dietitian specializing in eating disorders in Paris, I work daily with international families and adults navigating these challenges. Whether you're dealing with a child who refuses to eat anything but plain pasta or struggling yourself with severe texture aversions, oral feeding disorders are never just pickiness or a lack of willpower. They represent complex neurobiological realities that deserve understanding and specialized support.

Living as an expatriate adds its own layer of complexity. French food culture, with its emphasis on varied textures and social mealtimes, can make feeding difficulties particularly isolating. Many international families feel judged when their child refuses traditional French foods or when extended family mealtimes become sources of stress rather than pleasure.

What Are Oral Feeding Disorders? The 2019 Consensus Definition

A Paradigm Shift in Understanding

For decades, feeding difficulties were classified using an outdated "organic vs. non-organic" dichotomy—essentially suggesting problems were either purely physical or purely psychological. This simplistic view failed countless families.

In 2019, an international consortium led by Goday and colleagues published a groundbreaking consensus definition that revolutionized our understanding. They introduced the diagnostic term Pediatric Feeding Disorder (PFD), officially added to the ICD-10-CM in 2021 under code P92.9 (feeding difficulties in newborn) and R63.3 (feeding difficulties in children and adults).

The 2019 consensus definition states:

"Pediatric Feeding Disorder is impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction."

What makes this definition revolutionary is its recognition that feeding disorders involve four interconnected domains, all equally important and intimately related.

The Four Functional Domains

1. Medical Domain Physical and medical factors affecting feeding:

Gastroesophageal reflux disease (GERD) or chronic pain associated with eating
Respiratory difficulties during feeding
Anatomical abnormalities (cleft palate, laryngeal issues)
Metabolic or endocrine conditions affecting appetite
Medication side effects impacting taste or appetite

2. Nutritional Domain Consequences on growth and nutritional status:

Inadequate caloric intake for age and development
Specific nutrient deficiencies (iron, zinc, B12, essential fatty acids)
Growth faltering or failure to thrive
Need for supplemental feeding (nasogastric tube, gastrostomy)
Dehydration risks

3. Feeding Skills Domain Difficulties related to oral-motor and sensory function:

Oral motor impairments: Difficulty chewing, moving food in the mouth, coordinating swallowing
Sensory processing issues: Hypersensitivity to textures, temperatures, flavors, or smells
Structural problems: Tongue-tie, palate abnormalities, dental issues
Developmental delays: Skills not matching chronological age

4. Psychosocial Domain Emotional and relational impacts:

Extreme mealtime anxiety (child and/or caregivers)
Parent-child conflicts around feeding
Social isolation (avoiding restaurants, family gatherings)
Developmental impact on autonomy and self-feeding skills
Family stress and exhaustion

The brilliance of this model is recognizing that impairment in one domain inevitably affects the others. A child who experiences pain from reflux (medical) may develop sensory aversions (feeding skills), leading to nutritional inadequacy (nutritional) and mealtime battles (psychosocial). It's impossible—and pointless—to determine which came first.

Acute vs. Chronic Classification

The 2019 consensus also distinguishes between:

Acute PFD: Lasting less than 3 months (often related to specific illness or stress)
Chronic PFD: Persisting 3 months or longer (requiring sustained interdisciplinary intervention)

Signs and Manifestations Across Ages

In Infants (0-12 months)

Red flags requiring evaluation:

Refuses breast or bottle systematically
Takes more than 30-40 minutes per feeding
Frequent gagging, coughing, or choking during feeding
Arches back or cries during feeding
Fails to gain weight appropriately
Limited acceptance of new tastes or textures when starting solids

Important note: Some fussiness with new foods is developmentally normal. Concern arises when difficulties persist beyond 2 weeks and affect growth or cause significant distress.

In Toddlers and Young Children (1-5 years)

This is often when feeding difficulties become most apparent:

Texture-related difficulties:

Accepts only purees beyond 18 months
Gags or vomits with chunks or mixed textures
Requires extreme blending of foods
Refuses entire food groups based on texture (all "crunchy" or all "soft" foods)

Sensory selectivity:

Eats fewer than 15-20 different foods consistently
Refuses foods based on color, smell, or appearance before tasting
Cannot tolerate foods touching on the plate
Extreme distress if familiar food brands or preparations change

Behavioral signs:

Mealtimes lasting over 45-60 minutes
Tantrums or complete meltdowns at mealtimes
Grazing pattern (constant snacking, never truly hungry)
Accepts milk or liquids but refuses solid foods

A crucial distinction: These behaviors in oral feeding disorders are not deliberate defiance. They're neurobiological responses to genuine sensory or motor difficulties. A child refusing food isn't being "difficult"—they're experiencing real distress.

In School-Age Children and Adolescents (6-18 years)

Feeding difficulties may persist or present differently:

Continued food selectivity:

Diet limited to 10-30 "safe" foods
Difficulty participating in school lunches or social eating
Anxiety about eating outside familiar environments
Avoidance of school cafeterias or social situations involving food

Nutritional and growth concerns:

Delayed puberty or growth
Fatigue, difficulty concentrating
Recurrent infections due to poor nutrition
Vitamin and mineral deficiencies

Psychosocial impact:

Social isolation or bullying related to eating differences
Low self-esteem about being "different"
Shame or embarrassment about food limitations
Anxiety about meals in public settings

In Adults

Yes, oral feeding disorders persist into adulthood. Recent French research (2024) found that 15-20% of adults report significant food texture aversions affecting their social and nutritional lives.

Common adult presentations:

Diet limited to specific "safe" textures (often dry, crunchy foods like crackers, or exclusively smooth foods)
Avoidance of restaurants, dinner parties, or dating situations involving meals
Reliance on liquid meal replacements or protein shakes
Anxiety or nausea when confronted with non-preferred foods
Difficulty traveling due to food limitations
Nutritional deficiencies despite adequate caloric intake

Important: Many adults with oral feeding disorders never received childhood diagnosis and have developed elaborate coping mechanisms. They may describe themselves as "extremely picky" without realizing their difficulties have a neurobiological basis.

Understanding the Mechanisms: Why Does This Happen?

Sensory Processing and Oral Hypersensitivity

The mouth is one of the most densely innervated areas of the body, containing thousands of sensory receptors detecting:

Texture (smooth, rough, lumpy, fibrous)
Temperature (hot, cold, room temperature)
Taste (sweet, salty, bitter, sour, umami)
Smell (closely linked to taste perception)
Proprioception (pressure, position of food in mouth)

In oral feeding disorders, this sensory system is often hypersensitive or dysregulated. What feels like a normal texture to one person may trigger a gag reflex or extreme discomfort in someone with oral hypersensitivity.

2025 research on sensory processing (Schoen et al.) confirms that children with sensory processing differences are at significantly higher risk for feeding disorders. The SOS (Sequential Oral Sensory) Approach, which addresses these sensory factors through graduated exposure, shows promising effectiveness.

This isn't "all in their head"—functional imaging studies show actual differences in how these individuals' brains process sensory information from food.

Oral-Motor Skill Deficits

Eating requires extraordinary coordination:

Moving food from front to back of mouth
Coordinating chewing with breathing
Managing different textures simultaneously
Triggering swallowing at the right moment
Protecting the airway during swallowing

Children with developmental delays, muscle tone issues, or neurological conditions may struggle with these motor skills. A child who cannot adequately chew is not being "lazy"—they lack the motor coordination.

Protective Responses and Learned Aversions

The vicious cycle:

Imagine a baby with undiagnosed reflux. Eating hurts. The baby learns: food = pain. Even after reflux is treated medically, the learned association remains. The brain's protective response—"avoid this dangerous thing that causes pain"—continues.

This isn't "psychological"—it's adaptive learning. The nervous system is doing exactly what it should: protecting the body from perceived danger.

Trauma and feeding:

Medical procedures involving the mouth (intubation, suctioning, surgeries) can create powerful aversive associations. Recent studies show that even minor medical trauma can lead to persistent feeding difficulties.

Neurodevelopmental Factors

Strong associations exist between feeding disorders and:

Autism Spectrum Disorder (ASD):

46-89% of autistic children have significant feeding difficulties
Sensory sensitivities are often more pronounced
Rigidity around food rituals and sameness
Difficulty with social aspects of eating

ADHD:

Impulsivity affecting eating pace
Difficulty sitting through meals
Forgetting to eat or eating too quickly
Sensory seeking or avoiding behaviors

The neurodiversity context: For neurodivergent individuals, feeding difficulties are often part of a broader sensory profile, not a separate "behavioral problem." Understanding this reframes intervention entirely. 📚 Read more about eating disorders and neurodiversity

Genetic and Familial Factors

Emerging research suggests feeding disorders have a hereditary component. It's not uncommon to find that a parent also had feeding difficulties as a child, suggesting genetic predisposition to sensory sensitivities or oral-motor differences.

Consequences and Complications

Nutritional and Medical Impact

Short-term consequences:

Growth faltering or weight loss
Dehydration, especially in young children
Micronutrient deficiencies (iron, zinc, B vitamins)
Fatigue, irritability, difficulty concentrating
Weakened immune function

Long-term risks:

Delayed puberty or development
Bone density issues (from calcium/vitamin D deficiency)
Dental problems (from limited diet or excessive liquid intake)
Dependence on supplemental feeding (tube feeding)

Important reassurance: A 2024 study found that children with feeding disorders who transition off tube feeding show normal long-term growth patterns with appropriate support, challenging earlier pessimistic prognoses.

Psychological and Social Impact

For children:

Shame or feeling "broken" or "different"
Social exclusion from food-related activities
Anxiety about school lunches, birthday parties, sleepovers
Parent-child relationship strain
Reduced autonomy and independence

For families:

Extreme caregiver stress and exhaustion
Marital strain over feeding approaches
Social isolation (declining invitations, avoiding restaurants)
Financial burden (special foods, medical appointments)
Feelings of guilt, failure, or judgment from others

For adults:

Romantic relationship difficulties
Career limitations (business dinners, travel)
Social anxiety and isolation
Shame and secretive eating
Depression related to feeling "abnormal"

Living as an expatriate amplifies these challenges. French culture's emphasis on communal, varied meals can make feeding difficulties feel isolating. Many international families describe feeling judged by French schools, pediatricians, or family members who don't understand that these aren't behavioral issues.

The Expatriate Factor: Navigating French Food Culture with Feeding Disorders

Cultural Clash and Increased Pressure

French food culture is unique and can be wonderful—unless you're dealing with feeding difficulties. Several cultural factors intensify challenges for international families:

The French culinary emphasis:

Multi-course meals as social rituals
Strong expectations for children to eat "everything"
Judgment of "picky eating" as poor parenting
Limited accommodation for food preferences or restrictions
Cantines scolaires (school cafeterias) with non-negotiable menus

"Just try it" culture:

Expectation that children will taste new foods
Less tolerance for "pickiness" compared to Anglo-American cultures
Social pressure to conform to eating norms
Limited understanding of sensory or medical feeding issues

Isolation and validation: Many expatriate parents describe feeling:

Misunderstood by French pediatricians who minimize concerns
Judged by French family members or friends
Alone in their struggles without cultural understanding
Frustrated by lack of English resources or specialized care

Navigating the French Healthcare System

The complexity for international families:

Primary care challenges:

Many French GPs or pediatricians lack specialized training in feeding disorders
Language barriers in explaining complex sensory or behavioral issues
Different medical approaches (French system less quick to diagnose "trouble de l'oralité")
Difficulty finding English-speaking specialists

Accessing specialists:

Long wait times for specialized consultations (orthophonie, psychiatrie)
Need for referrals (parcours de soins)
Limited English-speaking practitioners
Navigating CPAM reimbursement as a foreign resident

School system:

French schools generally less accommodating of "special diets"
PAI (Projet d'Accueil Individualisé) possible but requires medical documentation
Teachers may not understand neurological basis of feeding difficulties
Pressure on children to eat what's served

Finding Support in Your Language

Why language matters in feeding disorder treatment:

Discussing feeding difficulties requires nuance, emotional safety, and precise communication. When you're explaining your child's sensory aversions or describing your own anxiety around food, you need to express complex feelings clearly.

Working with an English-speaking specialist means:

Precise communication without translation barriers
Cultural understanding of expatriate stressors
Familiar therapeutic approaches and frameworks
Validation without judgment
Easier coordination with English-speaking schools or family

My bilingual practice serves international families throughout Paris, offering:

Consultations in fluent English or French
Understanding of both Anglo-American and French approaches
Cultural sensitivity to expatriate challenges
Coordination with English-speaking therapists and doctors
Help navigating the French healthcare system

📚 Learn more about bilingual services

Comprehensive, Compassionate Approaches to Oral Feeding Disorders

The Interdisciplinary Team: Essential Collaboration

Given the four interconnected domains of feeding disorders, no single professional can address everything. Effective treatment requires a coordinated team:

Core team members:

1. Pediatrician or General Practitioner

Rules out or treats underlying medical issues (reflux, allergies, metabolic disorders)
Monitors growth and development
Coordinates care between specialists
Prescribes medications if needed

2. Dietitian Specialized in Feeding Disorders

Assesses nutritional status and deficiencies
Creates individualized meal plans respecting limitations
Provides strategies for expanding food variety gradually
Supports families with practical feeding approaches
Monitors growth patterns and nutritional adequacy

3. Speech-Language Pathologist (Orthophoniste)

Evaluates oral-motor skills and swallowing safety
Provides therapy for chewing, swallowing coordination
Addresses sensory processing through graduated exposure
Teaches oral exercises to improve motor skills

4. Occupational Therapist

Assesses broader sensory processing patterns
Provides sensory integration therapy
Works on self-feeding skills and mealtime behaviors
Creates sensory-friendly feeding environments

5. Psychologist or Psychiatrist

Addresses anxiety, trauma, or behavioral components
Provides parent coaching and family therapy
Treats comorbid conditions (anxiety disorders, OCD, ADHD)
Supports emotional regulation around mealtimes

Additional specialists as needed:

Gastroenterologist (for GI complications)
Allergist (if food allergies suspected)
Pediatric dentist (for oral structure issues)
Developmental pediatrician (for neurodevelopmental concerns)

The challenge in Paris: Building this bilingual team can be difficult. I actively maintain a network of English-speaking colleagues across disciplines to facilitate coordinated, language-accessible care for international families.

The SOS (Sequential Oral Sensory) Approach: Evidence-Based Sensory Intervention

The SOS Approach to Feeding is an evidence-based, play-based methodology specifically designed for children with sensory feeding difficulties.

The SOS philosophy:

Food exploration should be fun, pressure-free, and respectful of the child's nervous system. The approach recognizes that eating requires using ALL senses (not just taste), and children with feeding disorders need systematic desensitization to food sensory properties.

The SOS "Steps to Eating" hierarchy:

Tolerate (food can be in the room)
Interact (play with food, no eating expectation)
Smell (bring food near nose)
Touch (with hands, fingers, then face)
Taste (kiss or lick)
Eat (bite, chew, swallow)

Many children with oral feeding disorders are stuck at Step 1-3 for many foods. The SOS approach provides systematic, playful progression through these steps without pressure.

Recent evidence (2025):

Schoen et al.'s feasibility study on SOS intervention showed significant improvements in food variety acceptance
Mohamed & Mahfouz's comprehensive review confirmed SOS as a promising, ethical approach for PFDs
Multiple studies demonstrate that sensory-based interventions outperform pressure or reward-based approaches

📚 Discover play-based food therapy

Nutritional Support: Meeting Needs Without Pressure

My approach as a dietitian specializing in feeding disorders:

1. Nutritional assessment without judgment

Comprehensive diet history of accepted foods
Identification of nutritional gaps (protein, fats, vitamins, minerals)
Growth pattern analysis
Assessment of hydration and bowel function

2. Supplementation when needed

Strategic use of multivitamins, minerals
Protein or caloric supplementation if growth faltering
Liquid nutrition as temporary support (NOT punishment or replacement for therapy)

3. Gradual food expansion strategies

Food chaining: gradually modifying accepted foods toward new foods
Bridge foods: identifying "gateway" foods to new food groups
Sensory-matched recommendations: suggesting new foods with similar sensory properties to accepted foods

4. Family support and education

Parent coaching on pressure-free feeding approaches
Mealtime environment optimization
Realistic goal-setting
Celebrating small victories

Critical principle: I NEVER withhold preferred foods or use food restriction as intervention. Feeding disorders are not "behavioral problems" requiring punishment. They're neurobiological realities requiring compassionate, patient support.

Addressing the Psychological Dimensions

For children:

Anxiety reduction techniques:

Progressive exposure (NOT forced)
Relaxation and coping skills training
Social stories about food
Cognitive reframing of food fears

Parent-child relationship repair: Mealtimes have often become battlegrounds. Therapeutic work helps families:

Rebuild trust around feeding
Reduce power struggles
Implement division of responsibility (Ellyn Satter model)
Create positive mealtime experiences

For adults:

Adults with longstanding feeding difficulties often carry shame, isolation, and relationship difficulties.

Therapeutic goals:

Understanding the neurobiological basis (reducing self-blame)
Gradual sensory exposure with professional support
Addressing social anxiety and avoidance
Improving nutritional adequacy
Building confidence in social eating situations

Important: Oral feeding disorders in adults are NOT "just being picky" or "immature." They deserve the same compassionate, specialized support as any other condition.

Hope and Recovery: What Does "Better" Look Like?

Recovery is Possible (But Individualized)

Here's a crucial truth: recovery from oral feeding disorders doesn't always mean eating everything.

For some individuals, especially those with profound sensory differences or neurodivergent profiles, "recovery" means:

Achieving nutritional adequacy with their accepted foods
Reducing mealtime anxiety and distress
Expanding food variety even modestly (e.g., from 8 to 20 accepted foods)
Participating more comfortably in social eating
Achieving independence in self-feeding
Living fulfilling lives despite food limitations

For others, more dramatic food expansion is possible with sustained intervention.

What Research Shows: Reasons for Hope

Recent encouraging findings:

Haidar et al., 2024 (UK/Ireland study):

Incidence of PFD: 2.79 per 100,000 children
54.8% showed significant improvement at 1-year follow-up
First national incidence study demonstrating PFD is both treatable and common

Peterson et al., 2016 (autism feeding study):

Modified SOS approach significantly increased food variety in children with ASD
Applied behavioral approaches also showed effectiveness
Sensory-based interventions were generally better tolerated than purely behavioral ones

Machado et al., 2024 (case report):

Successful sensory-based feeding therapy in a neurotypical child with severe food refusal
Demonstrated effectiveness of gradual, play-based approaches

The bottom line: With appropriate interdisciplinary support, the majority of children with feeding disorders show meaningful improvement. Even those with persistent difficulties can achieve better nutrition, reduced anxiety, and improved quality of life.

Real Stories: Recovery Journeys

Emma's Story (Age 7, Currently in Treatment)

Emma, the daughter of American expatriates in Paris, came to me at age 5 eating only crackers, dry cereal, and milk. She would gag and cry if other foods approached her plate. French school lunches were torture.

Emma's team:

Myself (nutritional support, food chaining)
English-speaking speech therapist (oral-motor and sensory work)
Occupational therapist (broader sensory integration)
Psychologist (anxiety management)

Two years later: Emma now eats 30+ foods, including several fruits, some proteins, and even a few vegetables. She can attend birthday parties and eat at restaurants. School lunches remain challenging, but we've worked with the school to allow her to bring specific items.

Her mother's words: "I spent two years feeling like a failure as a parent. Understanding that Emma has a real, neurological condition—not a behavioral problem—changed everything. We finally have support in our language."

Tom's Story (Adult, Age 32)

Tom, a British expat working in Paris, contacted me after years of hiding his eating difficulties. He'd been eating essentially the same five foods since childhood: plain pasta, bread, crackers, cheese, and apples.

Dating was impossible—restaurant meals terrified him. Business dinners meant elaborate excuses. He'd never been diagnosed as a child; his parents assumed he'd "grow out of it."

Tom's journey: After comprehensive nutritional assessment, we began slow sensory exposure work alongside psychological support. Tom learned about oral feeding disorders for the first time at age 32.

Two years into treatment: Tom has expanded to about 20 foods and can navigate restaurant menus with much less anxiety. He's in a relationship and can participate in social eating. His food limitations remain significant, but they no longer control his life.

His perspective: "Just knowing this is real—that I'm not broken or immature—has been transformative. I'm not 'cured,' but I'm living fully."

Taking the First Step: How to Begin

When to Seek Help

For children, consult a specialist if:

Your child eats fewer than 20 different foods consistently
Mealtimes cause significant distress (crying, tantrums, gagging)
Your child isn't gaining weight appropriately
Food limitations are affecting social participation
Your child refuses entire food groups or textures
Feeding difficulties have lasted more than 3 months

For adults, consider seeking help if:

Your food limitations affect your social life, relationships, or career
You experience anxiety or distress around meals
Your diet lacks nutritional variety
You've experienced health consequences from your restricted diet
You feel shame or isolation related to your eating patterns

What to Expect from Working with Me

Initial consultation (60-90 minutes):

Comprehensive feeding and medical history
Detailed assessment of accepted foods and patterns
Nutritional analysis and growth review (children)
Discussion of goals and expectations
Development of initial intervention plan
Coordination with other professionals if needed

Ongoing support:

Regular follow-up consultations (frequency depends on severity)
Gradual food expansion strategies tailored to individual sensory profile
Family coaching and support
Coordination with interdisciplinary team
Monitoring of nutritional adequacy and growth
Celebration of progress, no matter how small

My philosophy:

No pressure, ever. Eating is never forced or rewarded/punished.
Respect for neurodiversity. Your or your child's needs are valid.
Gradual, sustainable progress. Small steps matter more than speed.
Cultural sensitivity. I understand the unique challenges expats face.
Collaborative approach. You're the expert on yourself/your child.

Conclusion: From Struggle to Hope

Oral feeding disorders—whether in children or adults—are complex, valid neurobiological conditions that deserve compassionate, specialized support. They're not pickiness, behavioral problems, or lack of willpower. They're real challenges affecting the sensory, motor, medical, nutritional, and psychosocial domains of feeding.

If you're an international family in Paris struggling with your child's feeding difficulties, or an adult who's navigated food limitations your entire life, please know: you don't have to face this alone.

Recovery looks different for everyone. For some, it's dramatically expanding food variety. For others, it's reducing mealtime anxiety while maintaining nutritional health with a smaller food repertoire. Both paths are valid.

What matters is that you're supported, understood, and working with professionals who recognize the complexity of what you're experiencing.

Support is available in your language. You're not alone.

Lighten your relationship with food and free yourself from what hinders you!

Alexis Alliel
Registered Dietitian Specialized in Eating Disorders
RPPS: 10008090989 | ADELI: 759309482

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📚 SOURCES SECTION

Academic and Medical References (12 recent sources)

Goday, P.S., et al. (2019). "Pediatric Feeding Disorder: Consensus Definition and Conceptual Framework." Journal of Pediatric Gastroenterology and Nutrition, 68(1), 124-129.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6314510/
→ Foundational consensus definition establishing the four-domain PFD framework adopted by WHO/ICD-10-CM in 2021.
Narrative Literature Review on PFD Diagnosis and Treatment (2025). Children (Basel), 12(3), 333.
https://www.mdpi.com/2227-9067/12/3/333
→ Comprehensive recent review synthesizing classifications, current definitions, and clinical guidelines for pediatric feeding disorders.
Schoen, S.A., et al. (2025). "Methodological Components for Evaluating Intervention Effectiveness of SOS Feeding Approach: A Feasibility Study." Children (Basel), 12(3), 373.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11940901/
→ Recent feasibility study evaluating the Sequential Oral Sensory (SOS) approach, demonstrating promising outcomes for sensory-based feeding interventions.
Mohamed, D.T. & Mahfouz, E.M. (2025). "Enhancing Pediatric Feeding Disorders Assessment and Management Through the Sequential Oral Sensory Approach." Journal of High Institute of Public Health, 55(1), 18-24.
https://journals.ekb.eg/article_436158.html
→ Comprehensive review affirming SOS as a promising, ethical, evidence-based approach for PFDs, particularly for sensory-based feeding difficulties.
West, K.M. (2024). "Treating Pediatric Feeding Disorders and Dysphagia: Evidence-Based Interventions for School-Based Clinicians." Language, Speech, and Hearing Services in Schools, 55(2), 444-457.
https://pubs.asha.org/doi/10.1044/2023_LSHSS-23-00016
→ Current best practices for treating children with PFD and dysphagia in school settings, emphasizing evidence-based approaches.
Machado, M.R.M., et al. (2024). "Feeding Therapy in a Neurotypical Child with Feeding Difficulties: A Case Report." Nutrition, 1, 112364.
→ Successful case demonstrating effectiveness of sensory-based feeding therapy in a neurotypical child with severe food refusal.
Haidar, A., et al. (2024). "Incidence and Natural History of Pediatric Feeding Disorders: A Population-Based Study." (UK/Ireland national study)
→ First national incidence study showing 2.79/100,000 incidence rate and 54.8% improvement at 1-year follow-up—hopeful data on treatment outcomes.
Peterson, K.M., Piazza, C.C., & Volkert, V.M. (2016). "A Comparison of a Modified Sequential Oral Sensory Approach to an Applied Behavior-Analytic Approach in the Treatment of Food Selectivity in Children with Autism Spectrum Disorder." Journal of Applied Behavior Analysis, 49(3), 485-511.
→ Comparative study showing effectiveness of modified SOS approach in children with ASD and feeding selectivity.
Bryant-Waugh, R. (2019). "Feeding and Eating Disorders in Children." Psychiatric Clinics of North America, 42, 157-167.
→ Overview of feeding and eating disorders in pediatric populations, distinguishing PFD from eating disorders like anorexia nervosa.
Romano, C., et al. (2015). "Current Topics in the Diagnosis and Management of the Pediatric Non-Organic Feeding Disorders (NOFEDs)." Clinical Nutrition, 34, 195-200.
→ Historical perspective on evolution from "organic vs. non-organic" paradigm to current holistic PFD understanding.
Korošec, B., et al. (2019). "Efficiency of Comprehensive Management of Children with Feeding Disorder and Predominant Sensory Impairment." Rehabilitation, 18, 35-45.
→ Study demonstrating effectiveness of comprehensive, interdisciplinary management for children with sensory-based feeding disorders.
Kim, A.R., et al. (Randomized Controlled Trial). "Sensory-Based Feeding Intervention for Toddlers with Food Refusal: A Randomized Controlled Trial."
→ RCT showing significant improvements in food variety and mealtime behaviors with sensory-based interventions.

Official Organizations Referenced

World Health Organization (WHO) - ICD-10-CM code P92.9 and R63.3
Feeding Matters (feedingmatters.org) - Patient advocacy and education
SOS Approach to Feeding (sosapproachtofeeding.com) - Evidence-based sensory approach

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