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Eating, more than any other bodily function, is drawn into the circle of the child's emotional life and is used as an outlet for libidinal and aggressive tendencies.
A. Freud, 1946
Anna Freud (1946), in her seminal account and classification of infantile feeding disturbances, first drew attention to the complexities and importance of the early feeding relationship. Freud elegantly described the need to consider organic, developmental, and neurotic issues that contribute to early feeding disturbances. She also anticipated contemporary perspectives on feeding disorders that place them on a continuum with organic and psychological contributing factors. Today, the American Academy of Pediatrics highlights the multifactorial nature of feeding pathology in its description of the development of feeding skills:
… it depends on the motor, emotional, and social maturation of the child as well as on the child's temperament and relationship with family members. (/cited in Snow, 1989, p. 125)
Irene Chatoor and her colleagues at the George Washington University School of Medicine have outlined a developmental classification of feeding disorders that incorporates the work of Stanley Greenspan as well as Margaret Mahler's concepts of separation-individuation (Chatoor et al., 1984). Chatoor's model integrates organic, developmental, and psychodynamic factors into a classification system of pediatric feeding disorders divided into three categories — homeostasis, attachment, and separation-individuation — based on the key developmental issue that the child is negotiating when the eating issues become manifest.