A team of Australian scientists will seek to pinpoint the best course of treatment for young problem eaters in a bid to reverse an unprecedented surge in the number of malnourished children who require medical intervention for food refusal.
Many typically developing children and up to 85 per cent of children with disabilities are now presenting with moderate to severe feeding difficulties, warranting nutritional supplements, intensive work with speech therapists to help develop oral motor skills like chewing, and even tube feeding.
Specialist doctors say the increase is being partly driven by the improved survival of high-risk children, such as premature babies, who are at increased risk of continuing developmental delays, as well as by changing lifestyles leading to junk food diets and lack of family time at the dinner table.
The Children's Nutrition Research Centre at the University of Queensland is now recruiting 300 children to its trial of feeding intervention strategies used by feeding disorder clinics in hospitals around the country.
Dr Pamela Dodrill, the centre's research fellow, said the Healthy Eating Learning Program would be the world's first randomised controlled trial to attempt to assess which of the child- or parent-focused strategies did best to improve a child's overall nutritional status.
The study would compare the clinical benefits and cost effectiveness of three kinds of feeding interventions: nutritional advice and counselling, behavioural strategies to coax children to eat using rewards, or exercises to improve biting and chewing skills and tolerance of textures. It would also assess the value of once-a-week therapy sessions compared to intensive blocks of therapy of three times a day for five days.
Dr Dodrill said it was vital to catch feeding problems and treat them before they escalated. Research in Britain had concluded that feeding difficulties in infants and toddlers were a predictor of a range of adult diseases including diabetes, some cancers, cardiovascular disease and stroke. Establishing feeding patterns in the first 12 months was also important in the bonding process between mother and child.
Unfortunately, Dr Dodrill said, the parents of poor feeders are often given poor advice from health professionals to get weight onto their child in any way they can and to focus on easy to swallow high-energy junk foods such as those high in fats and carbohydrates. That focus on weight, and not nutrition, often resulted in children gaining fat but did not address their malnutrition and denied the child the opportunity to learn skills to eat healthy fresh foods.
In the absence of evidence-based research, parents have been turning to unevaluated feeding programs offered outside of Australia - at a cost of about $30,000 per program - which often used coercive feeding methods.
These overseas clinics may be successful in getting children to gain weight in the short term and wean them off tube feeding, but often fail to improve the long-term health outcomes for the child, Dr Dodrill said.
But Karelle Logan, who took her son to Austria to wean him off a stomach tube and get him to feed orally, welcomed the appraisal as long overdue.
She said doctors in Australia were too quick to focus on her child's weight and that usually led to a slippery slope of intervention, tube feeding and possibly ''tube dependency''.
''What happens is the child doesn't know what it is like to be hungry or thirsty so they have no natural desire to eat,'' Ms Logan said.