Food Refusal / Feeding Problems

Infantile anorexia or food refusal is a feeding disorder that has its onset around six to nine months of age (Chatoor et al 1989; Chatoor et al 2004). It is characterized by extreme food refusal and apparent lack of appetite, leading to failure to thrive (or poor weight gain) (Chatoor et al 1989; Chatoor et al 2004).

Infantile anorexia therefore carries significant developmental risks for the child, including growth deficits, which can be particularly dangerous for a growing baby (Chatoor et al 1989; Chatoor et al 2004).

Food refusal & CMPA

What causes food refusal in infants?

There are many reasons why infants can be finicky about food and feeding. It is suggested that food/feed refusal could be related to teething, or if the baby is tired, if they are being overfed or if they have an underlying illness, causing pain. It may also be the result of an aversion to, or a traumatic event associated with, the ingestion of a certain food for example an allergic reaction (Steinberg C. 2007).

Could it be a symptom of Cow’s Milk Protein Allergy?

Infantile anorexia or food refusal has been associated with cow’s milk protein allergy (CMPA) (Steinberg C. 2007).

However, the majority of infants with CMPA have at least two symptoms affecting at least two different organ systems (Lifschitz C. and Szajewska H 2015; Høst & Halken 1990; Høst et al 1994).

Therefore, it is important to consider the individual child as well as the magnitude of their symptoms. The Cow’s Milk Related Symptom Score (CoMiSS®) could be useful to understand what other symptoms the patient manifests to understand if the risk of CMPA(Vandenplas et al 2015;Vandenplas et al 2022).