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INTRODUCTION
This article will outline a conceptual framework for understanding feeding disturbances which can begin in children before 3 years of age. Recognizing feeding disturbances will enable the pediatrician to diagnose and better treat various types of failure to thrive (FTT) and growth disorders in infants and young children.
Pediatric disorders such as failure to thrive, which occur during the first 2 years of life, carry with them significant developmental risks. Too frequently early intervention and treatment of the psychological and emotional aspects of the pediatric illness are given second priority because of the urgent press of the medical situation. At times children who have substantial developmental problems as well as emotional difficulties are not assessed and treated until nursery school age. Unfortunately, by the age of 3, the time of optimal therapeutic leverage may have passed.
Failure to thrive was first recognized as a phenomenon associated with poverty and institutional care of infants and children.1 There followed a gradual appreciation of the many organic diseases in which failure to thrive can be the presenting feature. These two perspectives led to a diagnostic division of the disorder into organic failure to thrive and non-organic failure to thrive.2'4
The authors agree with Homer and Ludwig5 who suggest that a third category of failure to thrive patients exists. These patients present a combination of organic and non-organic factors in the etiology of the growth disturbance. Respectful of the range of factors which can result in growth failure and the need to consider all relevant organic, psychological and social factors, we have begun to de-emphasize the classical dichotomy in failure to thrive.6,7 One shared feature which is impressive in both organic and non-organic failure to thrive is the frequency of feeding problems. The variety of feeding problems and the specificity of certain feeding difficulties at specific ages have led us to look at failure to thrive from a developmental point of view.
A MULTIFACTORIAL FRAMEWORK FOR UNDERSTANDING FEEDING DISORDERS
The frame of reference for this article comes from at least three sources: 1) the awareness of the multiple organic as well as inorganic factors which need to be considered in the assessment and diagnosis of FTT, 2) the growing knowledge of the contribution that the interaction between mother...