1. Feeding Relationships New Mexico WIC Program in collaboration with New Mexico State University and Ellyn Satter Associates  Esther Devall  Shirley Jaquez  Lisa Shields

2. Feeding is a Metaphor  For parent-child relationship.  For family functioning.

3. Levels of Intervention  Primary  Secondary  Tertiary

4. Primary Intervention  Teach positive feeding.  Detect risk.  Provide anticipatory guidance.  Support parents.

5. Further Interventions  Secondary - WIC nutritionists with additional training.  Tertiary - referral to therapists in community.

6. Issues in Feeding Children  Food Selection.  Feeding Relationship.

7. The Issue in Feeding Children is Trust Children are internally regulated.  Require trust to regulate.  Ignoring their needs interferes with internal regulation.  Ignoring their needs undermines their self- esteem.

8. Regulation Process INTERNAL  Hunger  Appetite  Satiety EXTERNAL  Calories  Food  “Shoulds”

9. Children Are Erratic With Eating  Food acceptance varies.  Accept/reject food unpredictably.  The amount they eat varies.  They don’t eat a square meal.  They eat what tastes good.

10. Equation for a Good Diet Well Balanced Meals & Snacks + Positive Eating Environment __________________________ = Well Nourished Child

11. Division of Responsibility  Parent: What  Infant: How Much and Whether  Parent: What, When, and Where  Toddler: How Much and Whether

12. Parent’s Tasks  Choose and prepare food.  Have regular meals and snacks.  Make eating time pleasant.  Provide mastery expectations.

13. Children’s Eating Capabilities  Children will eat when hungry.  They know how much to eat.  They will eat a variety of foods.  They will grow predictably.  They will mature with eating.

14. Developmental Stages  Homeostasis – Birth to 3 months.  Attachment - 3 to 6 months.  Separation-Individuation - 6 months to 3 years.  Initiative - 3 to 5 years.

15. Developmental Stage  Homeostasis (Birth – 3 months)

16. Parent’s Tasks in Homeostasis  Calm and organize.  Respond to infant cues.

17. Developmental Stage  Attachment (3 – 6 months)

18. Parent’s Tasks in Attachment  Maintain reciprocity.  Engage child.  Modulate arousal.

19. Developmental Stage  Separation–Individuation (6 months – 3 years)

20. Parent’s Tasks in Separation-Individuation  Provide opportunities to explore.  Support autonomy.  Provide structure.  Set limits.

21. Developmental Stage  Initiative (3 – 5 years)

22. Parent’s Tasks in Initiative  Make maturity demands.  Have realistic expectations.  Remain present and available.  Support without intruding.

23. Feeding Periods  Early Infancy - Nipple feeding.  Late Infancy - Transition to solids.  Toddler - Modified adult foods.

24. Eating Skills in Early Infancy  Roots for nipple.  Sucks.  Swallows.

25. Eating Skills in Middle Infancy  Begins sitting.  Follows food with eyes.  Lips close over spoon.  Moves semi-solids to back of tongue.  Swallows semi-solids.

26. Eating Skills in Late Infancy  Tongue moves food to side of mouth.  Positions food In mouth.  Delays swallow.  Munches.  Palms food.  Scrapes food into mouth.

27. Eating Skills in Toddler & Preschool Years  Chews.  Moves food around in mouth.  No pause in side-to-side transfer.  Begins to use utensils.

28. Child Characteristics That Risk Feeding  Difficult temperament.  “At risk” or very small.  Eats very large or very small amounts.  Illness.  Prematurely born.  Physical or cognitive limitations.  Requires a modified diet.

29. Parent Characteristics That Risk Feeding  Over-active, too stimulating.  Under-active, not engaging.  Chaotic or disorganized.  Rigid or over-controlling.  Over-concerned about child’s food selection or weight.  Under-concerned about child’s food selection or weight.  Has a particular agenda for growth.

30. Factors In Growth  Medical.  Psychosocial.  Feeding Relationship.  Nutritional.

31. Growth Patterns  Normative  Consistent  Smooth  Gradual changes Divergent  Unpredictable  Uneven  Dramatic changes

32. Feeding Relationships in WIC Clinics  Certification  Risk factor.  Nutrition goal.  One-on-One counseling.  Nutrition Education  Facilitated discussions.  Additional Counseling  Primary or secondary intervention.

33. Concept Map of Feeding Relationships Division of Responsibility Child’s Responsibility Parent’s Responsibility Infant:How Much & Whether Child:How Much & Whether Infant:What Child:What, When, & Where