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Infant Development, feeding skills, and relationships. What factors influence food choices, eating behaviors, and acceptance?. Sociology of Food. Food Choices Availability Cost Taste Value Marketing Forces Health Significance. Sociology of Food. Hunger Social Status Social Norms

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sociology of food
Sociology of Food
  • Food Choices
    • Availability
    • Cost
    • Taste
    • Value
    • Marketing Forces
    • Health
    • Significance
sociology of food4
Sociology of Food
  • Hunger
  • Social Status
  • Social Norms
  • Religion/Tradition
  • Nutrition/Health
taste and smell
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
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
The feeding relationship
  • Nourishing and nurturing
  • Supports developmental tasks
  • Learning
      • Relationship
      • Development
      • Emotion and temperament
relationship
Relationship
  • Feeding is a reciprocal process that depends on the abilities and characteristics of both caregiver and infant/child
relationship9
Relationship
  • The feeding relationship is both dependent on and supportive of infants development and temperament.
relationship10
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

Healthy Feeding Cycle
tasks
Infant

time

how much

speed

preferences

Parent

food choices

support

nurturing

structure and limits

safety

Tasks
infant and caregiver interaction
Infant and Caregiver Interaction
  • Readability
  • Predictability
  • Responsiveness
development
Development
  • Oral- Motor development
  • Neurophysiologic development
      • Homeostasis
      • Attachment
      • Separation and individuation
slide15
Oral-motor development parallels psychosocial, neurophysiologic milestones of homeostasis, attachment, and separation/individuation
development of infant feeding skills
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”
stages of development
Stages of Development
  • Homeostasis
  • Attachment
  • Separation and individuation
homeostasis
Homeostasis
  • Infant cycles through physical states
  • Parent provides a safe and comfortable environment
  • Reflex feeding transforms to self regulation of hunger
attachment
Attachment
  • Emotional/social interactions
  • Parent reciprocates/engages
  • Infant’s emotional and physical needs reinforced
separation
Separation
  • Struggle for autonomy
  • Parent supports autonomy and guides daily structure
  • Emotional needs distinguished from physical needs
emotion temperament
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
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
feeding difficulties31
Feeding Difficulties
  • Complex problems caused by multiple factors within the lives of infants, children, and adults.
    • Medical/physical
    • Neurodevelopmental
    • Behavioral
    • Interact ional
    • Environmental
    • Psychosocial
why baby won t eat
Why Baby Won’t Eat
  • Case reports of FTT/inadequate intake without any identifiable etiology
        • Tolia, et al
slide33
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
slide34
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
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
Factors to consider
  • Medical
  • Developmental
  • Temperament
  • Psychosocial
  • Nutritional
  • Environmental
feeding
Feeding
  • Delays in feeding skills
  • feeding intolerance
  • behavioral
  • medical/physiological limitations
  • other
feeding difficulties related to maturity medical and neurodevelopmental status
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
slide39
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
Rommel et al
  • Medical/oral-motor
    • occurred more often <2 years of age
  • Behavioral
    • occurred more often >2 years of age
rommel et al41
Rommel et al
  • Single identified problem
    • 26.7% medical
    • 5.2 % oral/motor
    • 5.4% behavioral
rommel et al42
Rommel et al
  • Multifactorial
    • 48.5% oral/medical
    • 1.5% oral/behavioral
    • 5.2% medical behavioral