Screening Criteria for Diagnosis of Infantile Feeding Disorders as a Cause of Poor Feeding or Food Refusal

Levine, Arie*; Bachar, Lea; Tsangen, Zili*; Mizrachi, Avi*; Levy, Anat*; Dalal, Ilan; Kornfeld, Lia*; Levy, Yuval*; Zadik, Zvi; Turner, Dan§; Boaz, Mona

Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e3181ff72d2
Original Articles: Gastroenterology

Objectives: Infantile feeding disorders (IFDs) are a common cause of food refusal, failure to thrive, and vomiting, but they may be difficult to diagnose. We have previously identified certain patterns of pathological feeding and behaviors as high-risk characteristics for IFDs and subsequently developed the diagnostic Wolfson criteria. Here, we evaluate these high-risk behaviors and prospectively compare the Wolfson criteria with 2 existing classifications of IFD, the Chatoor and that in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

Patients and Methods: Infants and young children referred for food refusal were invited to participate by completing a feeding pattern questionnaire. Following physicians' interview and examination, patients were scored by all 3 criteria and enrolled in a structured treatment program for IFD. Infants whose food refusal was associated with an organic cause served as a comparison group. The ability of the criteria to detect IFD and to predict response to therapy was compared with an intention-to-treat analysis.

Results: Eighty-five infants with new-onset IFD and 55 controls were included. The Wolfson criteria, Chatoor, and DSM-IV accurately diagnosed 100%, 77%, and 56% of the patients with IFD, respectively. Anticipatory gagging occurred in 47% of the children with IFD compared to 2% controls (P < 0.001). The response to therapy was similar among the 3 criteria (73–76%), suggesting that the Wolfson criteria did not incorrectly diagnose organic disease as IFD. The 20 infants who were diagnosed as having IFD by Wolfson but not by Chatoor responded equally well (80%) to an IFD treatment program.

Conclusions: Diagnostic criteria of IFD that are based on food refusal, pathological feeding, and anticipatory gagging have a higher detection rate than the present criteria and are simpler to implement.

Author Information

*Pediatric Gastroenterology and Nutrition Unit, Israel

Pediatric Allergy and Immunology Unit, Epidemiology Unit, Wolfson Medical Center, Tel Aviv University, Holon, Israel

School of Nutritional Sciences, Hebrew University, Rehovot, Israel

§Pediatric Gastroenterology Unit, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Israel.

Received 4 August, 2010

Accepted 17 September, 2010

Address correspondence and reprint requests to Arie Levine, Director, Pediatric Gastroenterology Unit, Wolfson Medical Center, POB 5 Holon, Israel (e-mail:

The authors report no conflicts of interest.

Copyright 2011 by ESPGHAN and NASPGHAN