Feeding disorders in children commonly are seen in both the primary care and pediatric gastroenterology setting. There is no good epidemiologic data about the prevalence of pediatric feeding disorders in children in the United States. Thus, the authors of this study used de-identified data from the Truven Health Analytics MarketScan Commercial Claims and Encounters Database (Ann Arbor, Michigan) for patients with private insurance as well as Arizona and Wisconsin Medicaid data for patients with Medicaid covering the time period from 2009 to 2014. Children between 2 months and 18 years were included in the study, and the authors used 25 International Classification of Diseases (ICD)-9 and ICD-10 codes to identify potential study subjects as there is no specific “feeding disorder” diagnosis code for children. Children who had been diagnosed with one of these codes and not with an eating disorder were included. The authors evaluated all such patients for comorbid conditions, the presence of malnutrition/ failure to thrive, and the presence of a gastrostomy tube. Children were identified as having a complex chronic condition (CCC) based on known ICD codes if they had a medical condition expected to last least 12 months and had at least one organ system involvement which could require pediatric subspecialty care and potential hospitalization.
The presence of feeding disorders increased in all databases during the time period with significantly more children covered by Medicaid having feeding disorders (Arizona, 16.97 per 1000 child-years; 95% CI, 16.84-17.10 and Wisconsin, 21.43 per 1000 child-years; 95% CI, 21.27-21.60) compared to children covered with private insurance (9.38 per 1000 child-years; 95% CI, 9.35-9.40). A lower prevalence of feeding disorders was present in older patients (defined as 12-18 years old), and more males had feeding disorders compared to females throughout the study. Specific patients with CCC (including children with respiratory, gastrointestinal, miscellaneous technology dependency, prematurity/neonatal risk, and organ transplantation) had higher rates of feeding disorders, and the prevalence of feeding disorders in children with a CCC increased throughout the study despite no increase in the number of children with a feeding disorder and without a CCC. Although the prevalence of malnutrition in children with a feeding disorder decreased in all databases throughout the study, children with an associated CCC had a higher prevalence of a malnutrition. The prevalence of gastrostomy tubes decreased in this population throughout the study period, and most children who had both a feeding disorder and a gastrostomy tube also had an associated CCC.
This study demonstrates that pediatric feeding disorders are increasing in children in the United States, and this disorder is commonly associated with the presence of a CCC. Thus, we need early intervention as well as improved long-term treatment options for this population as well as better accuracy in ICD coding in order to track and to care for these children over time.
Kovacic K, Rein L, Szabo A, Kommareddy S, Bhagavatula P, Goday P. Pediatric feeding disorder: a nationwide prevalence study. Journal of Pediatrics 2021; 228: 126-131.