The new Paediatric Feeding Disorder (PFD) Diagnosis

This news is big… well in the world of feeding therapy, it is huge!

As of October 1st, 2021 the International Classification of Disease (ICD-10) recognized Paediatric Feeding Disorder (PFD) as an international diagnosis. For years we have worked under a PFD ‘definition’ without ever an official diagnosis, so as you can imagine, this is very exciting news. 

So what does this diagnosis mean? 

The diagnosis is broken down into a few key areas that can define PFD (Information from Feeding Matters,


  • labored breathing with and without feeding
  • color changes in lips or face when eating or drinking
  • sweating when eating or drinking
  • gurgle or squeaking sounds with and without feeding
  • reoccurring upper respiratory infections
  • crying, arching, coughing, grimacing when eating or drinking
  • suspected food allergies
  • multiple formula changes
  • Vomiting
  • never seems hungry
  • physical discomfort when eating or drinking

There are a range of medical conditions and complications that also contribute (eg: reflux, constipation, etc) 


  • unable to eat or drink enough to grow or stay hydrated
  • insufficient or too rapid of a change in weight or height
  • lack of a certain nutrient, i.e., iron, calcium
  • need for nutritional supplements
  • reliance on a particular food for nutrition
  • need for enteral feeds for nutrition-NG, GT, TPN
  • constipation
  • limited dietary diversity for age
  • too few fruits and/or vegetables
  • limited or no protein source
  • too few foods eaten on a regular basis

Feeding Skill:

Suitable for all ages

  • labored, noisy breathing or gasping
  • coughing, choking, gagging, or retching
  • gurgles or wet breaths
  • loud and/or hard swallows or gulping
  • unable to eat or drink enough for optimal growth
  • excessively short mealtimes (< 5 minutes)
  • excessively long mealtimes (> 30 minutes)
  • need for thickened liquids
  • need for special food or modified food texture
  • need for special strategies, positioning, or equipment

Feeding Skill specific to a CHILD (12 months of age or older)

  • grazing between scheduled mealtimes
  • refusal to eat, drink or swallow
  • certain food textures
  • needs a distraction to eat such as screen time
  • needs excessive praise/threats/bribes to eat
  • difficulty chewing age-appropriate foods
  • unable to eat in new or unfamiliar situations


  • unable to come to or stay with the family at meals
  • refusal to eat what is offered or to eat at all
  • disruptive mealtime behaviors
  • unable to eat with others present at mealtimes
  • child exhibits stress, worry, or fear during meals
  • caregiver stress, worry, or fear when feeding a child
  • presence of bribes, threats, yelling at mealtimes
  • need for distraction and/or rewards for eating
  • unpleasant mealtime interactions between caregiver and child

As an Occupational Therapist working in Feeding Therapy, I am able to diagnosis a child with PFD. As much as we try to avoid ‘labeling’ children with a diagnosis, it can be a very helpful way of further understanding the challenges the child is presenting with but also to seek additional help and support. The aim of providing this diagnosis is to allow a child to access funding in order to further access feeding therapy. If you would like to discuss this further, please get in touch or read more about it from the Feeding Matters website.

Rebecca Barnard

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