Feeding Relationships

New Mexico WIC Programin 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

Primary Secondary Tertiary

Primary Intervention

Teach positive feeding.

Detect risk. Provide anticipatory guidance. Support parents.

Further Interventions

Secondary - WIC nutritionists with additional training.

Tertiary - referral to therapists in community.

Issues in Feeding Children

Food Selection. Feeding

Relationship.

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.

Regulation Process

INTERNAL

Hunger Appetite Satiety

EXTERNAL

Calories Food “Shoulds”

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.

Equation for a Good Diet

Well Balanced Meals & Snacks + Positive Eating Environment __________________________ = Well Nourished Child

Division of Responsibility

Parent: What Infant: How Much and

Whether

Parent: What, When, and Where

Toddler: How Much and Whether

Parent’s Tasks

Choose and prepare food.

Have regular meals and snacks.

Make eating time pleasant.

Provide mastery expectations.

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.

Developmental Stages

Homeostasis – Birth to 3 months. Attachment - 3 to 6 months. Separation-Individuation - 6 months to 3 years. Initiative - 3 to 5 years.

Developmental Stage

Homeostasis (Birth – 3 months)

Parent’s Tasks in Homeostasis

Calm and organize. Respond to infant cues.

Developmental Stage

Attachment (3 – 6 months)

Parent’s Tasks in Attachment

Maintain reciprocity.

Engage child.Modulate

arousal.

Developmental Stage

Separation–Individuation (6 months – 3 years)

Parent’s Tasks in Separation-Individuation

Provide opportunities to explore.

Support autonomy. Provide structure. Set limits.

Developmental Stage

Initiative (3 – 5 years)

Parent’s Tasks in Initiative

Make maturity demands.

Have realistic expectations.

Remain present and available.

Support without intruding.

Feeding Periods

Early Infancy - Nipple feeding.Late Infancy - Transition to solids.Toddler - Modified adult foods.

Eating Skills in Early Infancy

Roots for nipple.Sucks.Swallows.

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.

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.

Eating Skills in Toddler & Preschool Years

Chews.Moves food around in

mouth.No pause in side-to-side

transfer.Begins to use utensils.

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.

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.

Factors In Growth

Medical.Psychosocial.Feeding

Relationship.Nutritional.

Growth Patterns

Normative

ConsistentSmoothGradual changes

Divergent

UnpredictableUnevenDramatic changes

Feeding Relationships in WIC Clinics

Certification Risk factor.Nutrition goal.One-on-One counseling.

Nutrition EducationFacilitated discussions.

Additional CounselingPrimary or secondary intervention.

Concept Map of Feeding Relationships

Division of Responsibility

Child’s Responsibility Parent’s Responsibility

Infant: How Much & WhetherChild: How Much & Whether

Infant: WhatChild: What, When, & Where