Download - The Feeding Relationship
The Feeding Relationship
The feeding relationship
• Nourishing and nurturing
• Supports developmental tasks
Development of Feeding Behaviors
Age Reflexes Feeding Behavior
B-3 months Root, suck-swallow-breathe
Suckling pattern of feeding
4-6 months Fading root/bite reflex
Mature suck, brings objects to mouth, munching pattern
7-9 months Normal gag develops
Munching, rotary chewing, sits alone, holds bottle alone
10-12 months
Bites, brings food to mouth, drinks from cup, spoon feed
Stages of Development
• Homeostasis
• Attachment
• Separation and individuation
Stages
Age Infant 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 individualization
differentiation
behavioral organization and control
The Feeding Relationship
• The Relationship– Parent– Child
• Tasks– Parent– Child
Tasks
• Infant– time
– how much
– speed
– preferences
• Parent– food choices
– support
– nurturing
– structure and limits
– safety
Homeostasis
• Infant cycles through physical states
• Parent provides a safe and comfortable environment
• Reflex feeding transforms to self regulation of hunger
Attachment
• Emotional/social interactions
• Parent reciprocates/engages
• Infant’s emotional and physical needs reinforced
Separation
• Struggle for autonomy
• Parent supports autonomy and guides daily structure
• Emotional needs distinguished from physical needs
• Children do best with feeding when they have both control and support
Feeding
• “is a reciprocal process that depends on the abilities and characteristics of both the parent and the child…Once feeding starts, the parent and child work on the process with more or less flexibility and skill” Satter J Pediatr 117(2) 1990
• 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
Healthy Feeding Cycle
• 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
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
Feeding
• Delays in feeding skills
• feeding intolerance
• behavioral
• medical/physiological limitations
• other
Factors to consider
• Medical
• Developmental
• Temperament
• Psychosocial
• Nutritional Environmental
Factors
Medical
respiratory, cardiac, GI
Developmental
immature feeding skills, temperament, sensory integration, oral/motor
Factors
• Nutritional– Frequency, density, appropriate, balance, other
• Psychosocial– Anxiety, depression, stress, unmet
social.emotional needs, disarray– Self regulation, attachment, separation
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
Rommel et al
• Single identified problem
– 26.7% medical– 5.2 % oral/motor– 5.4% behavioral
Rommel et al
• Multifactorial– 48.5% oral/medical– 1.5% oral/behavioral– 5.2% medical behavioral
Rommel et al
• Medical/oral-motor – occurred more often <2 years of age
• Behavioral– occurred more often >2 years of age
Focus Group Parent Responsefrom Gaining and Growing Website
• “ I wasn’t afraid to bring home a baby that weighed only 3 pounds, but I was afraid to bring home a baby that wouldn’t eat”
Parent ResponseSurvey of Parents of Premature Group
• “ I felt I had to choose between growth and force feeding”
• “At 9 months, height/weight is proportionate, but we are still having to force feed”
• “I’ll have concerns until she is at 5% for everything”
• “even though my son had no difficulties with the mechanics of eating and no food issues, we had lots of questions, much anxiety, and too much stress…”
Jamie
• Born prematurely at 25 weeks GA
• Birthweight 800 grams
• Current age: 1 month corrected age
• Problems:– BPD
– Feeding difficulties
– Growth concerns: poor weight gain
Jackson
• Born at 32 weeks gestation
• Birth weight 1100 grams, small for gestational age
• Currently 15 months corrected age
• Problems:
– growth concerns: weight and length <5th %
– Speech and developmental delays
– Feeding Problems: gagging, food refusals, difficulty transitioning to solids