 feeding treatment on family functioning. As illustrated by Piazza and Carroll-Hernandez, research examining behavioural feeding treatment has consistently demonstrated its effectiveness with improving children’s oral feeding skills. Little is known, however, about the effects on family relationships as caregivers begin to transfer behavioural feeding strategies into the home setting. For example, how long do caregivers need to take stringent efforts to address their child’s feeding issues (i.e. when can caregivers stop or decrease their use of strict behavioural feeding strategies at meals and allow their child the freedom to eat independently without intervention)? How do such feeding interventions affect the identified child’s relationship with his or her siblings? Similarly, what impact does the caregiver’s use of behavioural feeding strategies with the targeted child have on the feeding patterns and mealtime interactions of other children in the family who do not have feeding or growth problems?
On a societal level, public policy and programs need to support efforts to promote healthy feeding and eating for children and families through primary, secondary and tertiary prevention of pediatric feeding disorders. Primary prevention efforts would involve halting the development of feeding disorders in children, particularly those known to be at highest risk for developing feeding problems, such as infants born at preterm and very low birth weight2-3 or families facing environmental and emotional stressors4-5. At a minimum, feeding programs need to partner with existing community programs that assume responsibility for reducing risk factors in the general population. For the specific case of feeding and growth, feeding programs need to collaborate with community programs that provide broad nutrition and early childhood intervention and support. In this manner, all children and caregivers, especially those at risk, can have access to education and programming designed to increase knowledge of healthy food choices and developmentally appropriate and positive eating behaviours. Most important, these primary intervention efforts need to be empirically tested to determine whether or not children and families benefit from such support and education in terms of a lowered rate of child feeding problems.
For children who are already experiencing feeding problems, secondary and tertiary prevention efforts need to focus on preventing (secondary) or controlling (tertiary) the negative and costly complications (e.g. naso-gastric or gastrostomy tube dependence) of the feeding problems. Given the complex causes of child feeding problems, children and families must have access to an interdisciplinary team of experts trained in the area of pediatric feeding assessment and treatment so that physiological as well as developmental and behavioural components can be assessed and addressed. The importance of interdisciplinary team care has been well described in the literature6-7. Unfortunately, such interdisciplinary assessment and treatment can be costly to provide and may not be available to all children and families, depending on where they live and the resources available. Therefore, to expand availability of services, health-care systems need to support the training of health-care providers to help them learn to identify feeding problems early as well as help them to understand and teach basic feeding and mealtime management strategies to caregivers of children with feeding and growth concerns. For children who require intensive feeding treatment, additional models of treatment need to be explored. Albeit effective, behavioural feeding treatment is highly individualized, labour-intensive and requires staff with specialized training to carry out the intervention8. Additional research needs to be conducted to determine whether the treatment of choice (i.e. intensive behavioural interventions) can be tailored for implementation within a group format, for example, rather than on an individual treatment basis to reduce health- care costs and 