開啟進食職能治療的旅程-餵食困難

職能是日常生活的意思，身為職能治療師的我最喜歡的職能就是吃了xd

而在學前發展中心擔任職能治療師的我，最有成就感的事情就是我的策略成功讓孩子自己願意吃飯的剎那

我常常在想，為什麼吃飯這麼本能的事情，我的孩子們學得這麼辛苦、吃飯時間這麼不快樂呢？

進食問題Feeding Problem

根據研究¹指出，典型兒童中，有25-40%會有進食問題（feeding problem） 而進食問題可以分為以下幾類：

挑食（picky eating）/難餵養的（fussy eating）
比如不喜歡吃青菜、只喜歡特定溫度的食物、只吃媽媽煮的口味
拒食（food refusal）
比如不願意在家裏以外的地方進食、拒絕進食
選擇性進食（selective eating/ food selectivity）
比如不願意吃任何飯，只吃餅乾、炸物；不願意吃白色以外的食物
受限的營養（dietary restriction）
比如只願意用奶瓶喝奶；有限的口腔動作導致只能吃糊狀物；進水量不足
其他行為問題
比如沒有坐著自己吃過飯；吃飯就生氣、哭、抱頭崩潰
（註：分類名稱參考研究，舉例為我個人臨床經歷）

臨床診斷

而根據DSM-5，其中的一項餵食及飲食障礙(Feeding and Eating Disorder)，將障礙分為六大類

而在我搜尋相關的資料後發現，目前針對兒童的餵食困難(Pediatric Feeding Disorders, PFDs²)定義仍在發展中，若以現行的診斷分類，可能只有迴避/節制型攝食症(ARFID)，為臨床小兒職能治療師在面對自閉症兒童進食困難時經常會介入的，這部分主題太大了，下次寫。

總之，如果接下來我寫的文章，可能都會是我個人經驗和看書下的一面之談，沒有實證大家不要太介意xddd 如果我有參考任何資料，我也都會附在底下給大家的！

心得x討論

我好驚訝原來典型兒童餵食困難的比例這麼高！有遇到的苦主也要一起取暖的嗎？

另外，我也很驚訝原來餵食困難是這麼新的研究領域，隨便找都可以找到2020年之後的文獻一堆

我很好奇

平常也有在做feeding的治療師們平常都看什麼資料學習呢?
如果你是家長，遇到孩子進食困難但不是口腔生理功能異常，會怎麼辦呢?
曾經有人回我，那種小孩是不是沒被打過 (威~

還是其實家裡都會有個智慧的阿嬤，讓大家知道當年都這麼帶孩子的~

-純屬示意圖-

‒ 我是一樣有點挑食的OT Erin，分享臨床與吃飯有關的小趣事

The start of feeding occupational therapy – feeding disorder

Occupation Means Daily Life—And My Favorite One Is Eating!

As an occupational therapist, my greatest sense of achievement comes from witnessing the moment a child willingly eats because of a strategy I implemented.

But I often wonder—why is something as instinctive as eating so difficult for some children? Why does mealtime feel like such a struggle instead of a happy experience?

Feeding Problems

According to research¹, 25–40% of typically developing children experience feeding problems. These issues can be categorized as follows:

Picky Eating / Fussy Eating
Ex: Refusing vegetables, preferring food at a specific temperature, or only eating meals prepared by their mother.
Food Refusal
Ex: Refusing to eat outside the home or rejecting food entirely.
Selective Eating / Food Selectivity
Ex: Only eating crackers and fried food while refusing rice or any white-colored food.
Dietary Restrictions
Ex: Only drinking milk from a bottle, limited oral motor skills restricting food to pureed textures, or inadequate water intake.
Other Behavioral Issues
Ex: Never sitting down for a meal, showing extreme distress like crying or tantrums during mealtime.

(Note: The classification names are based on research, while the examples come from my clinical experience.)

Clinical Diagnosis

According to the DSM-5, feeding and eating disorders are categorized into six major types. However, my search for related literature, found that the definition of Pediatric Feeding Disorders (PFDs) is still evolving.

Based on the current classification, Avoidant/Restrictive Food Intake Disorder (ARFID) is the most commonly diagnosed condition in children with autism experiencing feeding difficulties.

This is a huge topic, so I’ll save it for another post!

Thoughts & Discussion

I was shocked to learn that the percentage of feeding difficulties in typical children is so high! Are there any parents or professionals here who have struggled with this too? Let’s support each other!

I was also surprised to find out that feeding difficulties are such a new research field—there are tons of papers published after 2020.

I’m curious:

For therapists working with feeding issues, what resources do you usually rely on for learning?
For parents, if your child has feeding difficulties but no oral-motor dysfunction, how do you handle it?
Once, someone responded to me, “A kid like that probably just hasn’t been disciplined properly!” (Yikes… 😅)
Or maybe every family has that wise grandma who insists, “Back in my day, this is how we handled it!”

‒ I’m Erin, an OT who’s also a picky eater! Sharing fun clinical stories related to mealtime.

║文獻參考Reference

Sdravou, K., Fotoulaki, M., Emmanouilidou-Fotoulaki, E., Andreoulakis, E., Makris, G., Sotiriadou, F., & Printza, A. (2021). Feeding problems in typically developing young children, a Population-Based study. Children, 8(5), 388.
Goday, P. S., Huh, S. Y., Silverman, A., Lukens, C. T., Dodrill, P., Cohen, S. S., Delaney, A. L., Feuling, M. B., Noel, R. J., Gisel, E., Kenzer, A., Kessler, D. B., De Camargo, O. K., Browne, J., & Phalen, J. A. (2018). Pediatric feeding disorder. Journal of Pediatric Gastroenterology and Nutrition, 68(1), 124–129.