Delays in communication and cognitive development. May be associated with prematurity, chromosomal anomalies, genetic conditions, neurological disorders and Autism Spectrum Disorder or other Pervasive Developmental Disorders.  Impact on development of feeding difficulties may include:

• Communication delays - difficulty communicating, hunger, satiety and food preferences.
• Cognitive delays - difficulty understanding mealtime routines, and generalizing skills to different environments.  May be associated with rigid thinking and need for sameness. 

Aversive conditioning. Child learns from experience that eating is painful or unpleasant leading to food refusal or limited food choices e.g.

• Pain with eating may be associated with gastro-oesophageal reflux, allergic reactions to food.
• Use of force feeding such that eating is not enjoyable.

Positive reinforcement.

• Inadvertent rewarding of food refusal with attention leads to further food refusal. 
• Inadvertent over reaction to child who gags and vomits may be interpreted by child as a positive leading to further gagging and vomiting. Child may ultimately learn to vomit for attention or in response to external cues such as seeing the bowl offered to ‘catch the vomit’

Testing boundaries/ Asserting control. Child has learnt that food or mealtime behaviors can be used to assert control e.g. Providing an alternative meal when food is refused puts child in control.

Food neophobia – increased apprehension in trying new foods extends to an irrational fear.

Further reading:

Suzanne Evans Morris, Marsha Dunn Klein. Pre-Feeding Skills: A Comprehensive Resource for Mealtime Development. The Psychological Corporation USA. 2001.

Suzanne Evans Morris website new Visions