FEEDSETUP: feeding difficulties spectrum evaluation and treatment up-to-date proposal

OBJECTIVE: To organize current knowledge and propose a comprehensive, treatment-focused classification system, called FEDSETUP, that guides clinicians through a stepwise, multidisciplinary approach to pediatric feeding difficulties, emphasizing intervention intensity matched to clinical need and severity. SOURCES: Development of the FEEDSETUP framework was grounded in a systematic approach to evidence synthesis, following PRISMA principles adapted for narrative framework development. Given the multidimensional nature of pediatric feeding difficulties-spanning medical, nutritional, behavioral, and developmental domains-a structured PICO framework was employed to guide literature identification and selection. SUMMARY OF THE FINDINGS: FEEDSETUP integrates a systematic initial assessment encompassing medical history, dietary evaluation, physical examination, and anthropometry. It categorizes feeding difficulties into distinct yet overlapping domains, including underlying organic disease, typical neophobia, micronutrient deficiency, difficulty concentrating on food, food phobia, and food selectivity. The framework prioritizes primary healthcare as the first line of intervention, with clear criteria for escalation to specialized multidisciplinary teams for more complex or severe cases, including those with Autism Spectrum Disorder comorbidity or Avoidant/Restrictive Food Intake Disorder. CONCLUSIONS: FEEDSETUP offers a comprehensive, integrated, and treatment-oriented approach to pediatric feeding difficulties, moving beyond diagnosis-centric models to provide a structured pathway for effective and individualized care across the spectrum of severity. The algorithm provides a practical, evidence-based roadmap for clinicians to ensure timely identification of associated behavioral, nutritional, and organic abnormalities. It facilitates interdisciplinary assessment, reduces diagnostic delays, and promotes coordinated care by matching intervention intensity to clinical presentation, thereby avoiding both under-treatment and over-medicalization.