Eating behaviour in childhood

Question 1

Weaning

Answer 1

happens when milk cannot satisfy infant, provide nutrients and motor skills are sufficiently developed (requires complex oral motor skills, delayed transition may miss developmental period causing problems as these skills also used in language development)

Question 2

Issues with weaning

Answer 2

can cause problems if children given solids too early
anxiety about choking or aspiration (accidental ingestion of foods/fluids into lungs) can delay
gag reflex common in transition period, adaptive to prevent choking but can cause panic
mothers report anxiety/difficulties and seeking advice suggests gap in provision of information (Infant feeding survey 2010)

Question 3

Knowing what to eat

Answer 3

non-edible substances distinguished through sensory qualities of food, anticipated consequences and cultural beliefs
caregivers have important role to help unlearn associations between foods and negative consequences

Question 4

Pica

Answer 4

condition where people eat non-foods

Question 5

Accepting new foods

Answer 5

10-20 tastes needed before ‘liking’ new food but fewer exposure needed over weaning period (Birch et al 1968)
can still accept novel food when older as continued cognitive development influences further accpetance

Question 6

Food preferences

Answer 6

children prefer sweet/familiar foods as give greater post-ingestive feedback, dislike bitter as can suggest poisonous foods (evolutionary) and less post-ingestive feedback

Question 7

Infants self-regulation

Answer 7

infants are good at self-regulating how much to eat, 2-5 year olds have better compensation than adults (eat more if had low energy snack and vice versa) (Birch & Dysher 1986)
eating in absence of hunger increases from 5-9 years (Birch et al 2003)
2-3 year olds eat roughly same amount when different portion sizes offered but 4-6 year olds may overeat (Rolls et al 2000)

Question 8

Approaches to weaning

Answer 8

traditional - caregiver spoon feeds puree -> small lumps -> larger lumps -> solids
baby-led - self-feeds solid finger foods, no puree or infant specific foods

Question 9

Impact of baby-led weaning

Answer 9

increased liking for carbs and more underweight, sweet foods most preferred and more obese in SP, suggests BLW promotes healthy food preferences and protections against obesity (Townsend & Pitchford 2012)
BLW follow post-ingestive feedback and learn carbs are more satiating
caregiver needs a varied diet
rarely ready before 6 months so may consume less food, more milk and have nutritional deficiencies

Question 10

Impacts of spoon-feeding

Answer 10

most pre-made baby foods made of fruit so mostly sweet
learn preference for these and can’t regulate portions
prolonged duration of smooth foods delays development of oral skills (Mason et al 2005)
less exposure to different textures to so more food refusal later (Northstone et al 2001)
later introduction of lumpy solids associated with higher risk of parent-reported feeding problems (Babik et al 2021)

Question 11

Inappropriate feeding

Answer 11

relatively common, driven by inappropriate beliefs, generational influences, confusion over guidelines
more common in mothers with depression/obesity, low SES families, non BF infants (Wasser et al 2011)

Question 12

Impacts of inappropriate feeding

Answer 12

associated with activity level/distress and issues in child temperament?
associated with higher daily intake of over 100kcal and higher weight-for-length ratio (Thompson & Bentley 2013)

Question 13

Feeding problem behaviour

Answer 13

Child - food refusal, rejecting bitter tastes, preference for unhealthy food
caregiver - pressure to eat, food as reward/to soothe
authoritative parenting style associated with healthiest eating habits (Ventura & Birch 2008) but unclear of direction
poor diet in childhood predicts poor diet in adulthood (Craigie et al 2011) and development of preventable diseases (obesity, cancer, heart disease) (Nicklas & Hayes 2008)

Question 14

Food refusal

Answer 14

caused by neophobia, developing cognition, developmentally predictable (common phase in children)

Question 15

Pressure to eat

Answer 15

predicts picky eating in adults (Batsell et al 2002), can reduce intake (Galloway et al 2006) due to negative associations or increase intake (Orrell-Valente et al 2007) as overrides internal fullness cues
associated with increased neophobia (Fisher et al 2002) and lower fruit/veg intake (Galloway et al 2005)
elicits negative comments and reduced willingness to consume pressured foods (negative long-term consequences) (Galloway et al 2005)
may be children refuse to exert control over environment as eating is one of few ways they can have control

Question 16

Food as a reward

Answer 16

using disliked foods makes them even less desirable (Birch et al 1984)
may make healthy foods less liked and unhealthy more liked, associated with higher BMI, negative child temperament and lower parenting self-efficacy (Stifter et al 2011)
non-food incentives can increase child’s consumption (Baer et al 1987) and reduces emotional loading on reward foods

Question 17

Food to soothe

Answer 17

can encourage children to eat in absence of hunger, particularly in negative mood conditions, suggests emotional eating as young as 3 (Blissett et al 2010)

Question 18

Restriction

Answer 18

denying access to desired foods
children restricted age 5 may eat more in absence of hunger aged 7-9 (Birch et al 2003)
effective restriction should be covert, moderating portions, alongside teaching about nutrition

Question 19

How to effectively increase intake

Answer 19

consumption of disliked/refused vegetable can be increased via 14-day programme of offering incentives and praise plus parental modelling (Holley et al 2015)
fun not fuss with food programme - found decrease in problem eating scores after education in nutrition and techniques such as verbal instruction, role modelling and positive reinforcement, suggests single-session intervention can improve eating behaviour (Fraser et al 2004)

Question 20

Nursing problems (infancy)

Answer 20

colic - screaming for 3 hours+, 3 days+. 3 weeks+ (causes could be hormones in gut, reaction to cows milk protein, excessive gas in abdomen, lactose malabsorption
breastfeeding - difficulties latching, sore/cracked nipples, mastitis (breast infection), tongue-tie (tongue still attached to bottom of mouth preventing latching)

Question 21

Weaning problems (infancy)

Answer 21

problems accepting solids
delay past 7 month ‘critical period’
oral motor dysfunction
anxieties around aspiration/chocking

Question 22

Growth faltering (failure to thrive)

Answer 22

50% persist up to 6 years
may be caused by problems with food provision, taking in food or absorbing calories from food

Question 23

Impacts of growth faltering

Answer 23

brain development, infections, lower IQ, heart disease, emotional development, psychological distress, emotional family distress, anxiety in parents
can lead to later eating disorders
pica - more likely to develop bulimia, picky eating more likely to develop anorexia (Marchi & Cohen 1990)

Question 24

Childhood problems

Answer 24

growth faltering or child feeding problems

Question 25

Problems in puberty

Answer 25

eating disorders or adult-onset obesity

Question 26

Prevalence of feeding problems

Answer 26

25-45% infants/toddlers experience feeding problems (Sdravou et al 2021)
higher for children with developmental disabilities (70-90%)

Question 27

ARFID definition

Answer 27

avoidant/restrictive food intake disorder
problematic eating habits sig enough to cause weight loss or failure to gain appropriate weight,
presents with avoidance of certain foods/categories resulting in limited variety diet, frequently rely on high processed foods so have deficiencies in vitamins/minerals (Brigham et al 2018)
avoidance reduces anxiety momentarily but reinforces over time
typically escalates with age if left untreated

Question 28

ARFID symptoms

Answer 28

acute malnutrition: fatigue, dizziness
long-standing malnutrition: abdominal pain, constipation, cold intolerance, amenorrhea, dry skin, hair loss (Mammel & Ornstein 2017)
more than ‘picky eating’, can impact physical health (weight) and psychological wellbeing (growth, development, daily functioning)

Question 29

ARFID and autism

Answer 29

sensitivities associated with autism can cause limited food repertoire, sensory preferences, rigid rules around mealtimes (Crane et al 2009)
likely to be highly prevalent and impactful amongst children with ASD (Bourne et al 2022)
can impair psychosocial functioning if individual has to eat alone and avoids social situations (Williams & Hnedy 2014)

Question 30

Causes of ARFID

Answer 30

may be biological basis underlying sensory sensitivity, trait anxiety and low homeostatic/hedonic appetites (Thomas et al 2017)
cause unknown but may be due to sensory-based avoidance/restriction, concerns about consequences of eating (sick/choking - learned or anxiety), low interest in eating (low hunger signals)

Question 31

ARFID signs and risk factors

Answer 31

few acceptable foods, sticking to similar characteristics, avoiding veg, protein, fruit, skips one or more food groups, nutrient deficiencies, poor weight gain, emotional/stressed around food, negative impact on social behaviour
risk factors - severe picky eating, anxiety disorders, autism, ADHD, intellectual disabilities

Question 32

Good responses to food issues

Answer 32

support, understand, intervene, no blame
multidisciplinary approaches and multi-level - including parents, wider family, school
interventions tailored to child and family

Question 33

Neophobia

Answer 33

personality trait, measured by food neophobia scale, associated with general neophobia and trait anxiety (Pliner & Hobden 1992)
negatively associated with sensation seeking in adults (Pliner & Loewen 1997)
children become less neophobis with ages, levels related to emotionality and negative reactions to food, sig correlation between mothers’ and children’s scores (but reported by mothers’ so may be bias) (Pliner & Loewen 1997)