INFANTILE ANOREXIA

1. INFANTILE ANOREXIA Adrienne Trennepohl NSCI 5373 Dr. Kennedy October 31, 2002 HAPPY HALLOWEEN!

2. What is Infantile Anorexia • Infantile Anorexia Nervosa is considered to be a severe feeding disorder, which usually arises during the toddler years. • Can also be found in the infant years of life as well as toddler age.

3. Overview… • There are many factors that are associated with Infantile Anorexia Nervosa, but much research has been conducted concerning the mother-to-infant interaction, and that much conflict arises between the two. • Therefore, this presentation focuses on the mother-to-infant interaction and the conflict they share.

4. Infantile Anorexia can be defined as a serious feeding disorder that develops during the infant’s transaction to spoon- and self-feeding stage, which can lead to acute & chronic malnutrition. This can endanger the infant’s overall development, Mal-adaptive interactional patterns between the mother &/or caregiver. Definition…

5. Specific Diagnostic Criteria… • The specific diagnostic criteria for this disorder are categorized in 4 areas: • Food Refusal for at least 1month- may involve primarily solid foods, which worsened or started during the transition to spoon to self-feeding

6. Diagnostic Criteria… 2.Acute &/or chronic malnutrition • Parental concern about the toddler’s eating expressed by coaxing the infant or toddler to eat more • Allowing distractions or play during feeding • Frequently feeding the infant or toddler at night • Expressing worry and frustration to the infant or toddler • Force feeding

7. Diagnostic Criteria… 4. Intense parent-to-toddler conflict, which is expressed by the toddler’s/infant’s food refusal and the parents or caregivers negative affect or comments about the toddler’s/infant’s refusal to eat.

8. Conflict: Mom vs. Infant • Infantile anorexia can by conceptualized as a relational disorder that arises when highly conflicutal feeding interactions disrupt the transition to self-feeding. • Ex: intense conflict during feeding can be stressful to mobilize the toddler’s sympathetic nervous system & suppress hunger sensations. (Chatoor 98)

9. Conflict & Feeding… • Also, infants may learn to associate intense emotions with feeding. • This feeling of emotion may mask the appropriate sensations of hunger and fullness. • Not responding to the toddler’s cues can undermine the toddler’s ability to differentiate between hunger and emotions. • Dyadic conflict interferes w/successful transition to self-feeding.

10. Dyadic Conflict… • Can arise if the parents or caregivers possess characteristics that limit capabilities of responding sensitively and contingently to their toddler’s or infant’s feeding behaviors. • Maternal responsiveness is influenced by one’s current environment, mother’s representations of past, & current relationships.

11. Distal Factors; #1Maternal Eating Attitudes • One important distal factor is Maternal Eating Attitudes. • Mother’s with eating disorders were more intrusive during their toddler’s mealtime as well as playtime. • Toddler’s weight - related to both the amount of conflict during mealtimes & the extent of the mother’s concern about her own body shape.

12. Maternal Eating Attitudes: • Mothers who have a great concern about their own weight and eating style also have a great difficulty managing feeding situations in their own child’s eating habits.

13. Maternal Eating Attitudes: • One study observed that anorexic mothersunderfeed their own children, therefore researchers hypothesized that maladaptive maternal eating attitudes are positively associated with conflicutal mother-to-toddler feeding interactions and the toddler’s malnutrition.

14. Distal Factor #2:Mother’s Perceptions of their earlier Attachment Relationships • Research suggests that adults with insecure attachment representations are less sensitive to the cues of their own children than adults with secure attachment representations. • Insecure Attachment- apparent during feeding interactions; parents must reduce toddler’s hunger (be nurturant) and set limits (child stays in high chair, etc.)

15. Distal Factor #2 • Mothers who have insecure representations of attachment relationships would have the most difficulty managing the feeding situations and would show the most conflict during feeding interactions.

16. Distal Factor #3Spousal Relationships • Studies show that distressed marriages are linked to maladaptive parenting. • Marital distress may negatively impact a mothers’ capacity to respond sensitively to their child’s cues. • This may lead to more problems and increase conflict with feeding interactions.

17. Interventions: • It is important to differentiate between the various feeding disorders because what might work in one situation, might not be as effective in another. • Treatment for infantile anorexia is to first reduce the infant to mother conflict interaction during feeding. • It is also key to target the parents in this situation. Help them to interact in a positive and relaxed setting as well as learn what the infant might be telling them.

18. Summary… • These factors play an important role between the mother and her infant child or toddler. • Conflict may arise if any of these factors are fluent in the household. • Studies postulate that maternal characteristics and perceptions of their toddler’s temperament are associated with infantile anorexia.

19. Summary… • 2 Critical Symptoms of Infantile Anorexia: 1. Feeding Conflict 2. Toddler’s Nutritional Status • Studies perceive that: 1. Toddler’s w/infantile anorexia are negative in mood, seek attention, & are more willful than “normal” toddlers.

20. Summary… • 2. Mothers of anorexic toddlers show insecure representations of attachment, marital conflict, & difficulty regulating their own eating • 3. Maternal perceptions of toddler temperament and maternal characteristics aid in mother-to-toddler conflict at feeding. • 4. Severity of conflict at feeding is related to severity of toddler’s malnutrition.

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22. References: • Chatoor, Irene., Diagnosing Infantile Anorexia: The Observation of Mother-to-Infant Interactions.,., Journal of the American Academy of Child and Adolescent Psychiatry., June 2000. • Chatoor, Irene., Maternal Characteristics and Toddler Temperament in Infantile Anorexia., Journal of the American Academy of Child and Adolescent Psychiatry., September, 1998. • Chatoor, Irene., Observation of Feeding in the Diagnosis of Posttraumatic Feeding Disorder of Infancy., Journal of the American Academy of Child and Adolescent Psychiatry., May, 2001.