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FEEDING PROBLEMS INCHILDREN-”ROLE OF CLINICAL       PSYCHOLOGY”             Ms. SMARANIKA                TRIPATHY         ...
Feeding difficulties•Feeding difficulties may potentiallyinterfere with the parent-child feedingrelationship•Children who ...
Contributing Factors• Organic, developmental,  psychological, and  behavioral issues• Family dynamics• Social and cultural...
Addressing feeding problems                        Picky                        eating Feeding                 Feeding    ...
Poor appetiteThe food:• Quantity appropriate?• Developmentally  appropriate?• Nutritionally balanced?• Influenced by cultu...
Poor appetiteThe child:• Evident appetite?• Difficult temperament?• Sensory difficulties?• Oral-motor dysfunction?• Acute ...
Food(contributing to feeding problems and             poor appetite )•   Nature of the child•   Food likes and dislikes•  ...
Poor appetiteThe feeders:• Creating an appropriate feeding  environment?• Sensitive to the childs hunger and  satiety cues...
The feeder• Method/time of feeding• Interaction with the child• Poor judgment about child’s  hunger• Dissatisfaction about...
The feeder-Role of care giver or Ayahs• Age/experience• Nature (sympathetic/not  sympathetic)• Wrong method of feeding• La...
Family and cultural influence• Type of  family(joint/nuclear)• Traditions• Economic status• Poor living  conditions
Media influence• Role models(promoting zero  figure)• Taboos and stigma• More propaganda on junk  food (Mc Donald/Pizza Hu...
Prevalence• Estimates in physically normal children   – 50% to 60% for parent-reported feeding difficulty   – 25% to 35% f...
Issues of Concern• Chronic aversion with socially  stigmatizing meal behavior• Some children do have growth  limitations• ...
Parent-child relations• Maternal education• Parent-child conflict during  feeding• Parent intrusiveness during  play• Pare...
Type of feeding difficulties•   Fear of Eating•   Highly Selective Intake•   Vigorous Child•   Organic Disease•   Apathy• ...
Features demonstrated in feeding                   difficulties• Child may cry at the sight of food or the bottle or resis...
Features demonstrated in feeding                 difficulties• Child is easily distracted from feeding; may be  difficult ...
systematic approach to the identification and management of feeding difficulties•   Acknowledge•   Investigate•   Identify...
Assessment of              Feeding Behavior• Background history • History of prenatal,                       birth, hospit...
Assessment of             Feeding Behavior• Background history   • Cooperates with setup                       • Sits appr...
Assessment of             Feeding Behavior• Background          •   Refuses to sit in chair  history             •   Cries...
Assessment of             Feeding Behavior• Background history   • Eye contact with child                       • Position...
Assessmet of             Feeding Behavior• Background history   • Reminds child to swallow                         complet...
Chronic Underlying Pathology(organic)• Dysphasia• In coordinate swallowing suggested  by cough, choking, or recurrent  pne...
Non-organic pathology        Psychological disorders/conditions•   Fear of feeding•   Poor appetite•    child who is funda...
General complaints(outcomes)• Feeding problem in both poor and rich.• ‘My child eats nothing’,• ‘My child eats like a bird...
General complaints(outcomes)• Child is the usual winner.• Worst is forcing food after  restraining child.• Spits or vomits...
Addressing eating disorders-           role of clinical psychologist• More than just eating disorders  – it is psychologic...
Addressing eating disordersAn initial evaluation should focus:• feeding history- detailed  information on type and timing ...
Treatments and interventions• Behavioral therapy can help the  parent and child overcome  conditioned feeding problems and...
Addressing eating disorders•   Cognitive behavioral therapy :(CBT)–   Acceptance and commitment therapy–   Dialectical beh...
How to tackle?           Rule out serious illness• Prevention is easier than  treatment.• Avoid over indulgence not  payin...
How to tackle?• “Intelligent neglect”.• More attention and pleasure  when eats.• Ignore when does not eat or  fiddles.• Se...
How to tackle?• The whole family to participate in  training including grand parents.• It is a behavior disorder.• No loss...
How to tackle?• Meals with more eye appeal,  shapes/size.• Let him help in preparing meal.• Never bribe for a few more spo...
Refuses vegetables• Serve and eat a variety of vegetables.  Parents eating habits influence the  children• Prepare vegetab...
Refuses milk• Drink milk yourself along  with child• Substitute e.g. curd, butter,  cheese etc.• Serve in small colorful g...
ConclusionWhen I was growing up, I wouldhear people say, "You can lead ahorse to water but you cant makehim drink." That s...
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Understanding Food and Feeding difficulties

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this presentation talks about the basic difficulties a mother faces for feeding a child .
its more about the feeder and the food

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Transcript of "Understanding Food and Feeding difficulties "

  1. 1. FEEDING PROBLEMS INCHILDREN-”ROLE OF CLINICAL PSYCHOLOGY” Ms. SMARANIKA TRIPATHY CLINICAL PSYCHOLOGIST
  2. 2. Feeding difficulties•Feeding difficulties may potentiallyinterfere with the parent-child feedingrelationship•Children who accept very few foodsmay be at risk for nutrient deficiencies•Feeding difficulties have the potentialto compromise nutrition, growth, andcognitive development•Causes vary widely and feedingdifficulties require tailored therapy toaddress this variation
  3. 3. Contributing Factors• Organic, developmental, psychological, and behavioral issues• Family dynamics• Social and cultural influences
  4. 4. Addressing feeding problems Picky eating Feeding Feeding disordersproblems Feeding difficulties
  5. 5. Poor appetiteThe food:• Quantity appropriate?• Developmentally appropriate?• Nutritionally balanced?• Influenced by cultural norms?
  6. 6. Poor appetiteThe child:• Evident appetite?• Difficult temperament?• Sensory difficulties?• Oral-motor dysfunction?• Acute or chronic illness?
  7. 7. Food(contributing to feeding problems and poor appetite )• Nature of the child• Food likes and dislikes• Preferring outside food• Very choosy• Improper presentation• Food timing• Type of food• Preoccupation during meal time
  8. 8. Poor appetiteThe feeders:• Creating an appropriate feeding environment?• Sensitive to the childs hunger and satiety cues?• Overly controlling or too uninvolved?• Misinformed about nutrition?• Working mother• Mood/attitude/health• Preoccupation during meal time• Knowledge about food and nutrition
  9. 9. The feeder• Method/time of feeding• Interaction with the child• Poor judgment about child’s hunger• Dissatisfaction about child’s appetite• Weight and growth concern• Influenced by others• Fear (falling sick/being compared/criticized)• Proper time interval• Un tasted food• Misconceptions about food(egg/bitter gaurd /neem leaves)• No. of children
  10. 10. The feeder-Role of care giver or Ayahs• Age/experience• Nature (sympathetic/not sympathetic)• Wrong method of feeding• Lack of knowledge and interaction• Patience and irritability• Monotonous and repeated meals• Food served (too hot/too cold)• No innovation or improvisation in food
  11. 11. Family and cultural influence• Type of family(joint/nuclear)• Traditions• Economic status• Poor living conditions
  12. 12. Media influence• Role models(promoting zero figure)• Taboos and stigma• More propaganda on junk food (Mc Donald/Pizza Hurt )• Conceptualizing “fit and fine”• Turning vegetarians• Importance on “X-factor/body image and personality)• Following food which is popular
  13. 13. Prevalence• Estimates in physically normal children – 50% to 60% for parent-reported feeding difficulty – 25% to 35% for specific difficulties (e.g., food refusal, selective eating) – 1% to 2% for severe and prolonged difficulties• Estimates in children with neurological and developmental disorders/delays – > 80% in some studies – Swallowing disorders are especially common
  14. 14. Issues of Concern• Chronic aversion with socially stigmatizing meal behavior• Some children do have growth limitations• Some have suboptimal consumption of nutrients• Serious organic and nonorganic causes exist• Impaired parent-child interactions indicated by touching behavior
  15. 15. Parent-child relations• Maternal education• Parent-child conflict during feeding• Parent intrusiveness during play• Parental pressure to eat appears to increase feeding resistance• feeding resistance associated decelerating weight gain
  16. 16. Type of feeding difficulties• Fear of Eating• Highly Selective Intake• Vigorous Child• Organic Disease• Apathy• Concerned parents
  17. 17. Features demonstrated in feeding difficulties• Child may cry at the sight of food or the bottle or resist feeding by crying, arching, or refusing to open his/her mouth• May occur in a child who has experienced a frightening feeding experience (e.g., choking) or in a child who has been tube fed• consistently refuses specific foods because of taste, texture, smell, or appearance.• Child may become visibly anxious if asked to eat aversive foods• Additional sensory difficulties are often present; e.g., the child may be upset by loud noises or the sensation of sand or grass under his/her feet• Child is more interested in playing and interacting with people than in feeding• Child may take only 1 or 2 bites and be finished with eating
  18. 18. Features demonstrated in feeding difficulties• Child is easily distracted from feeding; may be difficult to keep at table or in high chair during meals• Limited verbal and nonverbal communication (e.g., smiling, babbling, eye contact) between child and caregiver• Possible evidence of neglect and/or signs of abuse• Child is small but achieving satisfactory growth based on mid-parental height• Excessive parental concern may lead to coercive feeding methods that adversely affect the child
  19. 19. systematic approach to the identification and management of feeding difficulties• Acknowledge• Investigate• Identify• Manage
  20. 20. Assessment of Feeding Behavior• Background history • History of prenatal, birth, hospitalizations• Observation and • Early feeding history Assessment of Child’s Feeding • Developmental Behavior milestones • Temperament• Assessment of • Regulation: sleeping, Caregiver Feeding soothing, toileting Behavior • Previous evaluations
  21. 21. Assessment of Feeding Behavior• Background history • Cooperates with setup • Sits appropriately• Observation and • + interaction with feeder (e.g., Assessment of smiles, claps) Child’s Feeding • positive comments about food • Opens mouth, anticipates food Behavior • Feeds self• Assessment of • Responds to prompts to Caregiver Feeding continue • Requests food Behavior
  22. 22. Assessment of Feeding Behavior• Background • Refuses to sit in chair history • Cries • Spits food out of mouth• Observation and • Gags, vomits Assessment of • Verbally says “no “ to food Child’s Feeding • Moves head away from spoon Behavior • Refuses to open mouth •• Assessment of Puts hands in front of mouth • Throws food or utensils Caregiver Feeding • Gags before food is introduced Behavior
  23. 23. Assessment of Feeding Behavior• Background history • Eye contact with child • Positions child appropriately• Observation and • Presents appropriate food, Assessment of utensils Child’s Feeding • Prompts child verbally and non- Behavior verbally • Pays attention to child during• Assessment of meal Caregiver Feeding • Models appropriate eating Behavior
  24. 24. Assessmet of Feeding Behavior• Background history • Reminds child to swallow completely• Observation and • Paces child at reasonable pace Assessment of • Interacts positively during meals Child’s Feeding • Praises child for appropriate Behavior behavior• Assessment of • Sets limits on throwing food, leaving table Caregiver Feeding • Persists Behavior
  25. 25. Chronic Underlying Pathology(organic)• Dysphasia• In coordinate swallowing suggested by cough, choking, or recurrent pneumonia/chest phenomena• Failure to thrive• Feeding interrupted by pain• Regurgitation/chronic vomiting• Diarrhea or blood in stool• Neurodevelopment abnormalities• Atopic and eczema• Chronic cardio respiratory disease• Signs of neglect
  26. 26. Non-organic pathology Psychological disorders/conditions• Fear of feeding• Poor appetite• child who is fundamentally vigorous• child who is apathetic and withdrawn• parental misperception• Colic that interferes with feeding (< 3 months of age)• Developmental delays• MR and PDD• ADHD(attention deficit and hyper active)• Problem behavior• Autism• Somatoform disorder
  27. 27. General complaints(outcomes)• Feeding problem in both poor and rich.• ‘My child eats nothing’,• ‘My child eats like a bird’• ‘I have tried everything’• Meal times are virtual mini-wars• Child is coaxed, cajoled, forced, bribed• Story, showing a picture book, T.V.,• Mother chasing the child with plate• The whole family revolves around child• Meal time becomes unpleasant, emotionally surcharged and stressful• Morale of the child is high while the family is gloomy.
  28. 28. General complaints(outcomes)• Child is the usual winner.• Worst is forcing food after restraining child.• Spits or vomits.• Low growth rate• Loss of appetite• Physical illness/constipation• Fear/phobia• Irritability/excessive crying• Is there any food supplements
  29. 29. Addressing eating disorders- role of clinical psychologist• More than just eating disorders – it is psychological• Consult with dietitian, psychologist or medical doctor to come up with an effective treatment plan• Parents should give comfort and support during treatment• Give love, compassion, appreciation and quality time
  30. 30. Addressing eating disordersAn initial evaluation should focus:• feeding history- detailed information on type and timing of food intake• feeding position• meal duration• energy and nutrient intake• behavioral and parental factors
  31. 31. Treatments and interventions• Behavioral therapy can help the parent and child overcome conditioned feeding problems and food aversions.• Parents must be educated to recognize their childs hunger and satiety cues accurately and to promote a pleasant, positive feeding environment.• Changing the texture of foods• the pace and timing of feedings• the position of the body• even feeding utensils• forcing a child to eat or punishing a child for not eating should be avoided
  32. 32. Addressing eating disorders• Cognitive behavioral therapy :(CBT)– Acceptance and commitment therapy– Dialectical behavior therapy– Cognitive Remediation Therapy• Family therapy• Behavioral therapy : focuses on gaining control and changing unwanted behaviors.• Interpersonal psychotherapy :(IPT)• Music Therapy :• Recreation Therapy• Art therapy
  33. 33. How to tackle? Rule out serious illness• Prevention is easier than treatment.• Avoid over indulgence not paying excessive attention and concern to child’s food.• Honor the likes and dislikes.• Offer variety to break monotony.• Best way is “not to try”• Relaxed attitude at meal time.• Enjoy.
  34. 34. How to tackle?• “Intelligent neglect”.• More attention and pleasure when eats.• Ignore when does not eat or fiddles.• Self feed, even if creates mess.• Most like to eat when others are eating.• After reasonable time remove plate quietly without any concern or anxiety.• Negative statement may help
  35. 35. How to tackle?• The whole family to participate in training including grand parents.• It is a behavior disorder.• No loss of appetite or ‘sluggish liver’• No role of tonics and appetizers. Placebo? Iron/multivitamin.• Understand the family dynamics of fussiness. Needs change in attitude and approach in feeding the child.• May take long time - Patience.• Do not talk of his food habits in front of him• Do not lecture or find faults during mealtime.• Give less than what he normally takes.
  36. 36. How to tackle?• Meals with more eye appeal, shapes/size.• Let him help in preparing meal.• Never bribe for a few more spoons• In the beginning do not offer food which child does not like.• Cut down between meal snacks/drinks• Look at the bigger picture• Adopt a relaxed and common sense approach without any sense of frustration.• Be aware of other influences such as peer pressure and advertising• Individualize the approach
  37. 37. Refuses vegetables• Serve and eat a variety of vegetables. Parents eating habits influence the children• Prepare vegetable to retain its eye appeal and vitamins.• Many like to eat raw.• Vegetable shapes. Carrot coins, flowers• Add cheese, sauce etc• Gradually reintroduce vegetables• Mix with paranthas, pizzas.• Make soup.• Extra fruits.• Visit farms and gardens.• Help him to plant seeds, watch them grow into something to eat.
  38. 38. Refuses milk• Drink milk yourself along with child• Substitute e.g. curd, butter, cheese etc.• Serve in small colorful glass which child can hold.• Straw can be used.• Small quantity to be served frequently• No problem even if does not take.
  39. 39. ConclusionWhen I was growing up, I wouldhear people say, "You can lead ahorse to water but you cant makehim drink." That saying remindsme of childrens eating habits. Youcan slave for hours in the kitchen,use your finest place settings,even dine by candlelight but ifyour child isnt hungry or doesntlike the cuisine, you cant, usingreasonable methods, make themeat it.
  40. 40. Thank You

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