FOR IMMEDIATE RELEASE
June 22, 1998
CONTACT:  Erin C. Lucero
(804) 828-6605
E-mail: lcrummet@hsc.vcu.edu
http://www.vcu.edu/exrel/news/

VCU FEEDING DISORDERS PROGRAM HELPS CHILDREN OVERCOME BARRIERS

RICHMOND, Va. —  Almost all parents have occasionally watched their children balk at eating an unwanted vegetable or suspicious casserole. But for some parents, however, mealtimes are routinely marked with frustration and anxiety as they try in vain to tempt their child to eat with the rest of the family — or even to eat at all.

Traditionally, childhood feeding disorders programs have focused on medical issues, emphasizing treatments such as tube feedings, medications or occupational therapy. But the new co-director of Virginia Commonwealth University’s Pediatric Feeding Disorders Program, sees psychological roots for many such problems. And he is bringing to the Richmond program an expanded focus that will examine the child’s psychological health and deal with behavioral as well as medical issues.

"Sometimes several factors are involved in a child’s inability or unwillingness to eat," said Ramasamy Manikam, Ph.D., who arrived at VCU after six years in a similar position with Johns Hopkins University in Baltimore." When issues like stress, anxiety, depression or caregiver mismanagement are complicating a medical problem like reflux, it’s essential that a behavioral therapy focus be included in the treatment program."

As many as one in four children seen by pediatricians have some kind of feeding difficulty said Manikam, a behavioral psychologist who has appointments in the departments of pediatrics and psychiatry at VCU’s Medical College of Virginia Hospitals.

While some children refuse all foods, others will eat only selected items — accepting foods with a certain color or texture and gagging or choking on all others.

Manikam describes a young boy who choked on a mouthful of chocolate cake." The experience scared him so badly that he refused to eat anything for days. In his mind, he had eliminated the possibility of choking again, but his parents were at a loss as to how to help him overcome his fear."

Some children might see this as an isolated incident. Others might only refuse to eat chocolate cake. But this child stopped eating entirely. Hunger alone was not enough to change his mind. Before he was comfortable eating normally again, he had to undergo systematic and gradual exposure to foods, beginning with liquids and moving up to solids.

A feeding disorder can also be the child’s way of acting out." Perhaps the child only gets attention from her parents when she behaves badly at the dinner table. She must be taught that she will not be rewarded with attention when she misbehaves, instead she will be given attention when she behaves correctly."

Children with a serious, unresolved feeding difficulty begin a quick decline that begins with weight loss." These children will not keep up with their peers on the growth charts," said Manikam. "If the problem persists, we’ll also start to see intellectual deficits and an increased susceptibility to illness."

A unique group of children who can be helped with behavioral therapy are those who are preparing to move off tube feedings. After the medical need for tube feedings is resolved, some children may need help in overcoming a psychological barrier to eating. In these cases, the tube remains in place, serving as a safety net while the child learns to eat by mouth.

"If eating used to be a painful experience for them — either because of an oral sensitivity or reflux — they must be encouraged and instructed as they try to eat again. Children who have been on tube feedings for most of their life might not know what it is like to feel hungry. They need to be taught that eating can satisfy the ache in their stomach."

The VCU pediatric feeding disorders program is under the direction of Jay A. Perman, M.D., chairman of VCU’s Department of Pediatrics. It is run jointly with the Children’s Hospital and includes three treatment tracks: inpatient; outpatient; and a day program. Nancy Murphy, M.D., with the Children’s Hospital serves as medical director of the program.

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