1. Development, Feeding Skills and Relationships

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

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

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

5. Feeding Practices and Transitions
Developmental
Social
Cultural
Nutritional
Public Health

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

7. The feeding relationship in infancy
Nourishing and nurturing
Supports developemental tasks

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

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

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

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

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

13. Development Neurophysiologic Oral Motor Homeostasis Attachment
Separation and individuation
Oral Motor

14. Stages of Development Homeostasis Attachment
Separation and individuation

15. Stages Age Development 1-3 months Homeostasis * State regulation
* Neurophysiologic stability
2-6 months
Attachment
* “falling in love”
* Affective engagement and interaction
6-36 months
Separation and individuation
* Differentiation
* Behavioral organization and control

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

17. Infant and Caregiver Interaction
Readability
Predictability
Responsiveness

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

19. 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

20. Temperament

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

22. 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

23. Play, Learning, Exploration

25. Feeding behavior of infants Gessell A, Ilg FL

26. 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

27. 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”

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

29. 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

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

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

34. The End

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

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

37. 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)

38. 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.

39. 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”

40. 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

41. 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)

42. Sam Healthy Wt 75th %ile, Length 90th %ile, OFC 75-90th %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