Development, Feeding Skills and Relationships

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

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

14. Stages of Development • Homeostasis • Attachment • Separation and individuation

15. Stages

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 • 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 • 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