Causes are most commonly related to:

• medical conditions, for example prematurity, gastroenterological problems

• oromotor delay or dysfunction, for example neurological difficulties (2.9

• behavioural management and social learning problems

• emotional difficulties in the parents, for example maternal depression, social isolation, household disorganization. (21)

A prolonged experience of vomiting or the repeated pairing of pain and nausea with feeding during the first year of life can establish strong avoidance conditioning in the infant, leading to severe food refusal. Repeated experiences of choking or gagging on food due to immature or distorted oromotor co-ordination will also result in avoidance conditioning. Parents who are unable to set boundaries on their child's behaviour may maintain their child's severe selective eating pattern, avoidance of textured food, excessive drinking patterns, or disruptive table behaviour. Parents who have their own mental health problems may be unable to support their child emotionally or be neglectful, or they may be emotionally volatile, excessively punitive, and restrictive in their own feeding practices. (15>

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