Beyond "Picky Eating": Identification, Screening, and Referral for Pediatric Feeding Disorders in Primary Care

Pediatric feeding disorders (PFDs) affect 1 in 37 children under age 5 in the United States, representing a common yet frequently underrecognized condition in primary care. In 2019, a multidisciplinary expert panel established the first consensus definition of PFD, creating a standardized four-domain framework (medical, nutritional, feeding skill, and psychosocial) that has transformed clinical assessment and management. A recent 2025 consensus further clarified the relationship between PFD and avoidant/restrictive food intake disorder (ARFID), providing guidance on diagnostic overlap and differentiation. This continuing education article provides pediatric healthcare providers with current, evidence-based knowledge to screen, identify, and make appropriate referrals for children with PFDs. The article reviews the consensus definitions, epidemiology, validated screening tools, differential diagnosis, risk factors, assessment strategies, and referral guidelines. A case-based example illustrates the application of the four-domain framework in clinical practice. With appropriate early identification and intervention, most children with feeding difficulties can achieve improved nutritional status, oral-motor development, and positive mealtime experiences.