Pediatric Feeding Disorder and the Rome V Criteria: Advancing the Clinical Framework for Pediatric Feeding Assessment

The 2019 consensus definition of Pediatric Feeding Disorder (PFD) has provided a framework for the conceptualization of pediatric feeding problems. Rather than viewing feeding difficulties through a single disciplinary lens, PFD is defined as impaired oral intake that is not age-appropriate and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction. This framework emphasizes that feeding disorders are inherently multifactorial and often require coordinated assessment and intervention across disciplines.

The PFD definition has been widely adopted because it provides a common language for describing complex feeding disorders while facilitating interdisciplinary care. Importantly, the framework recognizes that dysfunction in one domain frequently influences the others, underscoring the need for comprehensive evaluation rather than discipline-specific management. However, many children with PFD start feeding intervention with a single discipline approach. This may be partly due to access issues to interdisciplinary feeding teams, therefore adapting this definition into a functional clinical care model continues to evolve.

The recently published Rome V criteria further expands this framework by formally incorporating functional pediatric feeding disorders within the spectrum of pediatric disorders of gut–brain interaction (DGBIs). Rome V expands beyond symptom-based gastrointestinal diagnoses by recognizing that gastrointestinal physiology, sensory processing, motility, pain, and the gut–brain axis may directly contribute to impaired feeding. The updated criteria encourages clinicians to systematically evaluate gastrointestinal symptoms alongside oral sensorimotor function, nutritional status, developmental abilities, and psychosocial influences.

For clinicians working with children with feeding disorders, these complementary frameworks reinforce the importance of interdisciplinary assessment. The PFD definition provides the overarching functional diagnosis, while the Rome V criteria help identify specific gastrointestinal mechanisms that may contribute to feeding dysfunction. Together, they support more precise phenotyping of children with feeding disorders, facilitate targeted intervention planning, and promote greater consistency across clinical care and research.

As our understanding of pediatric feeding disorders continues to evolve, integrating the PFD framework with the Rome V diagnostic criteria offers an opportunity to improve diagnostic accuracy, strengthen interdisciplinary collaboration, and ultimately enhance outcomes for children and families.

Question for clinicians and providers:

1. Do you provide feeding therapy individually or on a team?
2. If you work individually, do you have resources in your community for care in all of the PFD domains?
3. Do you have access to a feeding team or are your clients accessing care from different specialists in stand alone appointments?

Question for caregivers:

1. Does your child receive care for feeding from one provider or a team of specialists?

Email answers to these questions to pediatricfeedingnews@gmail.com

Key references:

• Goday, P. S., Huh, S. Y., Silverman, A., Lukens, C. T., Dodrill, P., Cohen, S. S., Delaney, A. L., Feuling, M. B., Noel, R. J., Gisel, E., Kenzer, A., Kessler, D. B., Kraus de Camargo, O., Browne, J., & Phalen, J. A. (2019). Pediatric Feeding Disorder: Consensus Definition and Conceptual Framework. Journal of pediatric gastroenterology and nutrition, 68(1), 124–129.
• Rosen, R., et al. (2026). Rome V pediatric upper gastrointestinal disorders of gut-brain interaction. Gastroenterology. 170:1347-1366.