The Feeding Relationship

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The Feeding Relationship

  1. 1. The Feeding Relationship
  2. 2. The feeding relationship • Nourishing and nurturing • Supports developmental tasks
  3. 3. 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
  4. 4. Stages of Development • Homeostasis • Attachment • Separation and individuation
  5. 5. 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
  6. 6. The Feeding Relationship • The Relationship – Parent – Child • Tasks – Parent – Child
  7. 7. Tasks • Infant – time – how much – speed – preferences • Parent – food choices – support – nurturing – structure and limits – safety
  8. 8. Homeostasis • Infant cycles through physical states • Parent provides a safe and comfortable environment • Reflex feeding transforms to self regulation of hunger
  9. 9. Attachment • Emotional/social interactions • Parent reciprocates/engages • Infant’s emotional and physical needs reinforced
  10. 10. Separation • Struggle for autonomy • Parent supports autonomy and guides daily structure • Emotional needs distinguished from physical needs
  11. 11. • Children do best with feeding when they have both control and support
  12. 12. 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
  13. 13. • 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
  14. 14. 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
  15. 15. Feeding Difficulties Related 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
  16. 16. Feeding • Delays in feeding skills • feeding intolerance • behavioral • medical/physiological limitations • other
  17. 17. Factors to consider • Medical • Developmental • Temperament • Psychosocial • Nutritional Environmental
  18. 18. Factors Medical respiratory, cardiac, GI Developmental immature feeding skills, temperament, sensory integration, oral/motor
  19. 19. Factors • Nutritional – Frequency, density, appropriate, balance, other • Psychosocial – Anxiety, depression, stress, unmet social.emotional needs, disarray – Self regulation, attachment, separation
  20. 20. 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
  21. 21. Rommel et al • Single identified problem – 26.7% medical – 5.2 % oral/motor – 5.4% behavioral
  22. 22. Rommel et al • Multifactorial – 48.5% oral/medical – 1.5% oral/behavioral – 5.2% medical behavioral
  23. 23. Rommel et al • Medical/oral-motor – occurred more often <2 years of age • Behavioral – occurred more often >2 years of age
  24. 24. Focus Group Parent Response from 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”
  25. 25. Parent Response Survey 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…”
  26. 26. 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
  27. 27. 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

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