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

DevelopmentalSocialCulturalNutritionalPublic 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

StagesAge 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

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

Age Reflexes Oral, Fine, Gross Motor Development1-3months

Rooting and suckand swallowreflexes arepresent at birth

Head control is poorSecures milk with suckling pattern, the tongue projectingduring a swallowBy the end of the third month, head control is developed

4-6months

Rooting reflexfadesBite reflex fades

Changes from a suckling pattern to a mature suck withliquidsSucking strength increasesMunching pattern beginsGrasps with a palmer graspGrasps, brings objects to mouth and bites them

7-9months

Gag reflex is lessstrong as chewingof solids beginsand normal gag isdevelopingChoking reflexcan be inhibited

Munching movements begin when solid foods are eatenRotary chewing beginsSits aloneHas power of voluntary release and resecuralHolds bottle aloneDevelops an inferior pincer grasp

10-12months

Bites nipples, spoons, and crunchy foodsGrasps bottle and foods and brings them to the mouthCan drink from a cup that is heldTongue is used to lick food morsels off the lower lipFinger feeds with a refined pincer grasp

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

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

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 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