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Feeding Relationships

Feeding Relationships. New Mexico WIC Program in collaboration with New Mexico State University and Ellyn Satter Associates Esther Devall Shirley Jaquez Lisa Shields. Feeding is a Metaphor. For parent-child relationship. For family functioning. Levels of Intervention.

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Feeding Relationships

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

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

  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: What Child: What, When, & Where Infant: How Much & Whether Child: How Much & Whether

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