Infant Development, feeding skills, and relationships

1. Infant Development, feeding skills, and relationships

2. What factors influence food choices, eating behaviors, and acceptance?

3. Sociology of Food • Food Choices • Availability • Cost • Taste • Value • Marketing Forces • Health • Significance

4. Sociology of Food • Hunger • Social Status • Social Norms • Religion/Tradition • Nutrition/Health

5. Taste and Smell • Initial experiences of flavors occur prior to birth • Amniotic fluid flavors--- maternal diet • Breast milk odor/flavor-- maternal diet • Sweet preference (Lactose) • More frequent and stronger sucking behavior in response to sucrose • Ability to detect other flavors (ie salt) emerges later (~ 4 months)

6. Mechanisms of Appetite Regulation • Poorly and incompletely understood • Genetics • Pleasure-seeking and hedonic responses to feed intake are mediated by humoral substances (endorphins, dopamine, etc) • Interaction between hormones, nutrients, and neuronal signals with the CNS • Appetite stimulus: ghrelin • Appetite inhibition: CCK, leptin, GLP-1 etc) • GI volume sensitive feedback loops (ie distention)

7. The feeding relationship • Nourishing and nurturing • Supports developmental tasks • Learning • Relationship • Development • Emotion and temperament

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. Child associates hunger with need to eat Child communicates need Parent reads cues and provides Child communicates satiety Parent responds Positive experience gained Parent anticipates physical needs Healthy Feeding Cycle

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

13. Infant and Caregiver Interaction • Readability • Predictability • Responsiveness

14. Development • Oral- Motor development • Neurophysiologic development • Homeostasis • Attachment • Separation and individuation

15. Oral-motor development parallels psychosocial, neurophysiologic milestones of homeostasis, attachment, and separation/individuation

16. 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”

17. Development of Feeding Behavior

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

21. Stages

22. Homeostasis • Infant cycles through physical states • Parent provides a safe and comfortable environment • Reflex feeding transforms to self regulation of hunger

23. Attachment • Emotional/social interactions • Parent reciprocates/engages • Infant’s emotional and physical needs reinforced

24. Separation • Struggle for autonomy • Parent supports autonomy and guides daily structure • Emotional needs distinguished from physical needs

26. 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

27. 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

28. Play, Learning, Exploration

29. Feeding Difficulties

31. Feeding Difficulties • Complex problems caused by multiple factors within the lives of infants, children, and adults. • Medical/physical • Neurodevelopmental • Behavioral • Interact ional • Environmental • Psychosocial

32. Why Baby Won’t Eat • Case reports of FTT/inadequate intake without any identifiable etiology • Tolia, et al

33. 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

34. The Mother-Infant Feeding Relationship Across the First Year and the Development of Feeding Difficulties in Low-Risk Premature infants: Dalia Silberstein et al • Infancy 14(5) 501-525 2009

35. Silberstein • N= 76 • Mother-Infant Observation 2-3 days prior to hospital discharge, 4 months corrected age, and 1 year corrected age • Difficult vs non difficult feeders • Greater maternal gaze aversion, less adaptability, less affectionate touch during play interactions, more intrusive at 1 year

36. Factors to consider • Medical • Developmental • Temperament • Psychosocial • Nutritional • Environmental

37. Feeding • Delays in feeding skills • feeding intolerance • behavioral • medical/physiological limitations • other

38. Feeding DifficultiesRelated to maturity, medical and neurodevelopmental status • State control • endurance • suck-swallow-breath coordination • sleep-wake cycles • cues and demand behavior • temperament • patterns of oral-motor development

39. The Complexity of feeding problems in 700 infants and young children Presenting to a Tertiary Care Institution • Rommel et al: J Ped Gastro and Nutrition, July 2003 • Multidisciplinary Assessment catagorized feeding problems: • 86.1% medical • 61% oropharangeal dysfunction • 18.1% behavioral

40. Rommel et al • Medical/oral-motor • occurred more often <2 years of age • Behavioral • occurred more often >2 years of age

41. Rommel et al • Single identified problem • 26.7% medical • 5.2 % oral/motor • 5.4% behavioral

42. Rommel et al • Multifactorial • 48.5% oral/medical • 1.5% oral/behavioral • 5.2% medical behavioral