title: Screening criteria for diagnosis of infantile feeding disorders as a cause of poor feeding or food refusal.
abstract: OBJECTIVE
  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).
  
  
  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.
authors.affiliation: Pediatric Gastroenterology and Nutrition Unit, Wolfson Medical Center, Tel Aviv University, Holon, Israel. alevine@wolfson.health.gov.il
authors.forename: Arie
authors.initials: A
authors.lastname: Levine
authors.forename: Lea
authors.initials: L
authors.lastname: Bachar
authors.forename: Zili
authors.initials: Z
authors.lastname: Tsangen
authors.forename: Avi
authors.initials: A
authors.lastname: Mizrachi
authors.forename: Anat
authors.initials: A
authors.lastname: Levy
authors.forename: Ilan
authors.initials: I
authors.lastname: Dalal
authors.forename: Lia
authors.initials: L
authors.lastname: Kornfeld
authors.forename: Yuval
authors.initials: Y
authors.lastname: Levy
authors.forename: Zvi
authors.initials: Z
authors.lastname: Zadik
authors.forename: Dan
authors.initials: D
authors.lastname: Turner
authors.forename: Mona
authors.initials: M
authors.lastname: Boaz
mesh_terms: D002652:Child Behavior; D002675:Child, Preschool; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005183:Failure to Thrive / Q000209:etiology; D005247:Feeding Behavior; D001068:Feeding and Eating Disorders / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D005683:Gagging; D006801:Humans; D007223:Infant; D018730:Infant Behavior; D057194:Intention to Treat Analysis; D007407:Interviews as Topic; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology