Infant Development, feeding
skills, and relationships
• What factors
influence food
choices, eating
behaviors, and
acceptance?
Sociology of Food
• Food Choices
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Availability
Cost
Taste
Value
Marketing Forces
Health
Significance
Sociology of Food
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Hunger
Social Status
Social Norms
Religion/Tradition
Nutrition/Health
Taste and Smell
• Initial experiences of flavors occur prior to
birth
• Amniotic fluid flavors--- maternal diet
• Breast milk odor/flavor-- maternal diet
• Sweet preference (Lactose)
– More frequent and stronger sucking behavior
in response to sucrose
– Ability to detect other flavors (ie salt) emerges
later (~ 4 months)
Mechanisms of Appetite Regulation
• Poorly and incompletely understood
• Genetics
• Pleasure-seeking and hedonic responses to feed intake
are mediated by humoral substances (endorphins,
dopamine, etc)
• Interaction between hormones, nutrients, and neuronal
signals with the CNS
• Appetite stimulus: ghrelin
• Appetite inhibition: CCK, leptin, GLP-1 etc)
• GI volume sensitive feedback loops (ie distention)
The feeding relationship
• Nourishing and
nurturing
• Supports
developmental tasks
• Learning
• Relationship
• Development
• Emotion and
temperament
Relationship
• Feeding is a
reciprocal process
that depends on the
abilities and
characteristics of
both caregiver and
infant/child
Relationship
• The feeding
relationship is both
dependent on and
supportive of infants
development and
temperament.
Relationship
• Children do best with
feeding when they
have both control and
support
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
Tasks
• Infant
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time
how much
speed
preferences
• Parent
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food choices
support
nurturing
structure and limits
safety
Infant and Caregiver Interaction
• Readability
• Predictability
• Responsiveness
Development
• Oral- Motor development
• Neurophysiologic development
• Homeostasis
• Attachment
• Separation and individuation
• Oral-motor development parallels
psychosocial, neurophysiologic milestones
of homeostasis, attachment, and
separation/individuation
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”
Development of Feeding Behavior
Age
Reflexes
Behavior
B-3 months
Root, suck-swallowbreath
Suckling pattern of
feeding
4-6 months
Fading root/bite reflex
Mature suck, brings
objects to mouth,
munching pattern
7-9 months
Normal gag
development
Munching, rotary
chewing, sits alone,
holds bottle alone
10-12 months
Bites, brings food to
mouth, drinks from
cup, spoon feeds
Age
(months)
Development
Feeding/oral sensorimotor
Birth to 4-6
Visual fixation and tracking,
learning to control body against
gravity, sitting with support near
6 months, rolling over, hand to
mouth
Nipple feeding, hand on bottle (2-4
months), maintains semiflexed posture
during feeding, promotion of infantparent interaction
6-9
Sitting independently for short
time, mouthing hand and toys,
extended reach with pincer
grasp, object permanence,
stranger anxiety, crawling skills
emerging
Feeding more upright position, spoon
feeding smooth purees, suckle pattern- suck, both hands hold bottle, finger
feeding introduced, vertical munching,
preference for parental feeding
9-12
Pulling to stand, cruising, first
steps by 12 months, some
independent spoon feeding,
refining pincer grasp
Cup drinking, eats lumpy/mashed foods,
finger feeding, chewing includes rotary
jaw action
12-18
Refining gross and fine motor
skills, independent walking,
climbing stairs, running,
grasping and releasing with
precision
Self feeding, grasps spoon with whole
hand, 2-handed cup holding, drinking
with 4-5 consecutive swallows, holding
and tipping cup
Stages of Development
• Homeostasis
• Attachment
• Separation and individuation
Stages
Age
Development
1-3 months Homeostasis
2-6 months Attachment
6-36
months
Separation and
individuation
* State regulation
* Neurophysiologic
stability
* “falling in love”
* Affective engagement
and interaction
* Differentiation
* Behavioral organization
and control
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
Stage
Homeostasis
Birth to 3
months
Cues for feeding: arousal, crying, rooting, sucking
Caregiver responds to cues ( leads to self regulation.
Infant quiets to voice
Hunger-satiety pattern develops
Infant smile promotes interation
Pleasurable feeding experience--greater environmental
interaction
Attachment:
3-6 months
“Falling in love”
↑ reciprocity
Consistent cues, anticipation of feeding. Social pauses vs
satiety of ? Burping, parents preferred feeder, attention seeking
behavior
Separation I
Individuation:
6-36 months
Responds to “no”, imitation, exploration play, follows simple
directions, self independent feeding emerges,
speech/language development,
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
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
Play, Learning, Exploration
Feeding Difficulties
Stage
Feeding difficulty
Homeostasis
Poor growth, stressfulunsatisfactory feeding, “colic”
Attachment
Vomiting, diarrhea, poor weight
gain, intensely conflicted or
disengaged interactions
Separation-Individuation
Food refusals
Feeding Difficulties
• Complex problems
caused by multiple
factors within the lives
of infants, children,
and adults.
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Medical/physical
Neurodevelopmental
Behavioral
Interact ional
Environmental
Psychosocial
Why Baby Won’t Eat
• Case reports of
FTT/inadequate
intake without
any identifiable
etiology
– Tolia, et al
• 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
• The Mother-Infant Feeding Relationship
Across the First Year and the
Development of Feeding Difficulties in
Low-Risk Premature infants: Dalia
Silberstein et al
– Infancy 14(5) 501-525 2009
Silberstein
• N= 76
• Mother-Infant Observation 2-3 days prior
to hospital discharge, 4 months corrected
age, and 1 year corrected age
• Difficult vs non difficult feeders
– Greater maternal gaze aversion, less
adaptability, less affectionate touch during
play interactions, more intrusive at 1 year
Factors to consider
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Medical
Developmental
Temperament
Psychosocial
Nutritional
Environmental
Feeding
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Delays in feeding skills
feeding intolerance
behavioral
medical/physiological limitations
other
Feeding Difficulties
Related to maturity, medical and
neurodevelopmental status
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State control
endurance
suck-swallow-breath coordination
sleep-wake cycles
cues and demand behavior
temperament
patterns of oral-motor development
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
• Medical/oral-motor
– occurred more often <2 years of age
• Behavioral
– occurred more often >2 years of age
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
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Infant Development, feeding skills, and relationships