Development, Feeding Skills and Relationships

What factors influence food choices, eating behaviors, and acceptance?

Sociology of Food Hunger Social Status Social Norms Religion/Tradition Nutrition/Health

Sociology of Food Food Choices –Availability –Cost –Taste –Value –Marketing Forces –Health –Significance

Feeding Practices and Transitions Developmental Social Cultural Nutritional Public Health

Foods for infants and young children Nurturing Nourishing Learning Relationship Development Emotion and temperament

The feeding relationship in infancy Nourishing and nurturing Supports developemental tasks

Relationship Feeding is a reciprocal process that depends on the abilities and characteristics of both caregiver and infant/child

Relationship The feeding relationship is both dependent on and supportive of infants development and temperament.

Relationship Children do best with feeding when they have both control and support

Maternal-Infant Feeding dyad Indicates hunger (I) Presents milk (M) Consumes milk by suckling (I) Indicates satiety, stops suckling (I) Ends feeding (M)

Tasks Infant –time –how much –speed –preferences Parent –food choices –support –nurturing –structure and limits –safety

Development Neurophysiologic –Homeostasis –Attachment –Separation and individuation Oral Motor

Stages of Development Homeostasis Attachment Separation and individuation

Stages AgeDevelopment 1-3 monthsHomeostasis* State regulation * Neurophysiologic stability 2-6 monthsAttachment* “falling in love” * Affective engagement and interaction 6-36 months Separation and individuation * Differentiation * Behavioral organization and control

Nurturing Supportive and responsive –Homeostasis –Attachment –Separation and individuation –Security –Well-being –Temperament –Needs –other

Infant and Caregiver Interaction Readability Predictability Responsiveness

Feeding Problems Homeostasis –Colic, poor growth, stressful unsatisfactory feedings Attachment –Vomiting, diarrhea, poor growth, disengaged or intensely conflicted feeding interactions Individuation –Food refusal

Problems established early in feeding persist into later life and generalize into other areas Ainsworth and Bell –feeding interactions in early months were replicated in play interactions after 1st year

Temperament

Emotion/Temperament Temperament theory categorizes enduring personality styles based on activity, adaptability, intensity, mood, persistence, distractibility, regularity, responsivity, approach/withdraw from novelty Chess and Thomas 1970

Temperament Easy: approaches novelty, positive mood, adaptable, regular, active, low intensity Slow to warm: withdraws from novelty, low mood, low activity, moderate to low intensity, cautious Difficult: withdrawing, low adaptability, high intensity, low regularity, negative mood

Play, Learning, Exploration

Feeding behavior of infants Gessell A, Ilg FL

Developmental Changes Oral cavity enlarges and tongue fills up less Tongue grows differentially at the tip and attains motility in the larger oral cavity. Elongated tongue can be protruded to receive and pass solids between the gum pads and erupting teeth for mastication. Mature feeding is characterized by separate movements of the lip, tongue, and gum pads or teeth

Development of Infant Feeding Skills Birth –tongue is disproportionately large in comparison with the lower jaw: fills the oral cavity –lower jaw is moved back relative to the upper jaw, which protrudes over the lower by approximately 2 mm. –tongue tip lies between the upper and lower jaws. –"fat pad" in each of the cheeks: serves as prop for the muscles in the cheek, maintaining rigidity of the cheeks during suckling. –feeding pattern described as “suckling”

Analytical framework for the Start Healthy Guidelines for Complementary foods (JADA, 2004)

How? Establish healthy feeding relationship –Recognize child’s developmental abilities –Balance child’s need for assistance with encouragement of self feeding –Allow the child to initiate and guide feeding interactions –Respond early and appropriately to hunger and satiety cues

Analytical framework for the Start Healthy Guidelines for Complementary foods (JADA, 2004)

Provide guidance consistent with family/child’s –Development –Temperament –Preferences –Culture –Nutritional needs

The End

Case: Quinn 6 weeks old Breastfed from birth Readmitted at two days for dehydration –formula supplementation, lactation consult –Breastfeeding successfully established “fussy, irritable, ? Colic”

Quinn Family constellation: –Mother (33 yrs): works as an architect for large firm. On 3 month family leave –Father (35 yrs): Psychologist –Quinn is first child (IVF)

Quinn Mother is concerned about Quinn’s “fussy, colicky” behavior, development, and sleep –? Allergy, not enough milk, should she avoid certain foods. Has asked her pediatrician several times if there is a medical problem. –? Foods she can eat to help Quinn’s IQ and development, did early formula “hurt” Quinn –Would like Quinn to develop good sleep habits and has read conflicting information on whether Quinn should sleep in same bed, same room, or away from parents.

Quinn Quinn is fed on demand, at least 12 times a day. Seems to feed best in the evening between 7PM and 5AM (3-4 times) Indicates hunger clearly, but can “escalate and be hard to settle down” During day, demands frequently, nurses one side, 3-5 minutes, then refuses other side, although may not appear “comforted”

Case: Sam 10 months old male. 2 older siblings (4 yrs and 2 yrs). Mother works as a cashier at a grocery store. Father is in the navy, and is often away from home. Sam and his siblings are cared for by maternal grandmother during the day

Sam Feeding history: –Formula fed from birth. As a newborn, was demand fed but by six weeks was schedule fed (q4 hours) –Given first solids at 2 months (rice cereal) “to sleep through the night” –By 6 months offered 3 meals/day (cereal, fruit/vegetables, meat) (stage 1 foods)

Sam Healthy Wt 75 th %ile, Length 90 th %ile, OFC th %ile 24 oz formula (“2 bottles during day, one at naptime, and one at bedtime” Table foods with siblings: –Breakfast: eggs, cereal, or pancakes, juice –Lunch: hot dogs or macaroni and cheese or sandwich, fruit, cup of milk –Dinner: family dinner: meat or casserole, vegetable, and “a starch”, cup of milk