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
Tasks

• Infant
• time
• how much
• speed
• preferences

• Parent
• food choices
• support
• nurturing
• structure and limits
• safety

13
Development

• Neurophysiologic
• Homeostasis
• Attachment
• Separation and individuation
• Oral Motor

14
Stages of Development

• Homeostasis
• Attachment
• Separation and individuation

15
Stages
Age 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
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
24
(No Transcript)
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 childs developmental abilities
• Balance childs 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)
31
(No Transcript)
32
(No Transcript)
33

• Provide guidance consistent with family/childs
• Development
• Temperament
• Preferences
• Culture
• Nutritional needs

34
The End
35

• Provide guidance consistent with family/childs
• 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 Quinns 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 Quinns 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