Feeding difficulties in children with non–IgE-mediated food allergic gastrointestinal disorders

Objective: To review the signs and symptoms of feeding difficulties in children with non–IgE-mediated food allergic gastrointestinal disorders and provide practical advice, with the goal of guiding the practitioner to timely referral for further evaluation and therapy. Various management approaches are also discussed. Data Sources: Articles and chapters related to normal feeding patterns and the diagnosis and management of feeding difficulties in children were reviewed. Study Selections: Selections were based on relevance to the topic and inclusion of diagnostic and management recommendations. Results: Because most non–IgE-mediated food allergic gastrointestinal disorders occur in early childhood, feeding skills can be disrupted. Feeding difficulties can result in nutritional deficiencies, faltering growth, and a significant impact on quality of life. Specific symptoms related to each non–IgE-mediated food allergic gastrointestinal disorder can lead to distinctive presentations, which should be differentiated from simple picky eating. Successful management of feeding difficulties requires that the health care team views the problem as a relational disorder between the child and the caregiver and views its association with the symptoms experienced as a result of the non–IgE-mediated food allergic gastrointestinal disorder. Addressing the child's concern with eating needs to be done in the context of the family unit, with coaching provided to the caregiver as necessary while ensuring nutritional adequacy. Treatment approaches, including division of responsibility, food chaining, and sequential oral sensory, are commonly described in the context of feeding difficulties. Conclusion: A multidisciplinary approach to management of feeding difficulties in non–IgE-mediated food allergic gastrointestinal disorders is of paramount importance to ensure success.