Eating behaviour in childhood week/lecture 4/5 Flashcards
what is weaning?
Weaning/complementary feeding:
- Major developmental change
○ Milk to solids
○ Sucking to chewing and biting
○ Dependent to independent
when are infants weaned?
- Milk energy supply cannot satisfy infant or provide nutrients
- Motor skills are developed sufficiently
- Major variability
○ Thailand: 15% some solids at 2 weeks
○ UK: 3% some solids at 6 weeks
weaning guidelines
- WHO (2001) recommends weaning at 6 months (because by this point babies can sit and hold themselves and their heads up and reaching behaviours have begun)
- UK department of health adopted this in 2003
reality of weaning in the UK
○ 30% introduced solids by 4 months
○ 75% introduced solids by 5 months
○ 94% introduced solids by 6 months
§ 2010 infant feeding survey, DoH, 2013
many start weaning earlier due to
○ Belief that baby is hungry
○ To encourage better sleep patterns
○ Following routine used with older offspring
oral motor skills and weaning
- Necessary for weaning
- Highly complex: swallowing = 31 muscle pairs (take time to develop/mature enough)
- Delayed transition to solids - miss this developmental period –> problems
- Anxieties about choking can delay transition
- Aspiration can result (if solid feeding is too late): Accidental ingestion of food or fluids into the lungs
gag reflex
- Adaptive; prevents choking
- Common in the transition period
- Not serious; but caregivers can panic
○ Gagging; retch and make a lot of noise
○ Choking; will be silent - Can become hypersensitive:
○ Learned from negative experience; e.g. choking
○ Generalises to all foods, even sight of food
○ Professional help required to ‘unlearn’ response
food choice: distinguish between non-edible substances by
○ Sensory qualities of food
○ Anticipated consequences of eating food
§ E.g. poisoning
○ Cultural beliefs
§ Disgust
§ Disease
- Pica (eating non-foods)
pica
eating non-foods
neophobia
fear of the new
- New and previously liked foods
- Decreases with age
○ 69% 2yo refuse to taste new foods
○ 29% 3yo
○ <1% 5yo
- 10-20 tastes needed before may ‘like’ food
- Exposure during weaning sets foundation
- BF and exposure (BF supports exposure and familiarity with flavour profiles)
critical period in weaning
- Fewer exposures needed over weaning period
○ Birch et al., (1998): 1 exposure = 50% increase in intake in 4-7 month olds- More exposures needed after weaning
- But not critical period because…
○ Older child/adult will accept novel food eventually
○ Continued cognitive development influences further acceptance
○ Information in healthiness, for example, an influence intake
food preferences in childhood
- Children prefer
○ Sweeter tastes
○ Familiar foods
○ Greater post-indigestive feedback- Children dislike
○ Bitter tastes
○ Tastes associated with illness or treatment (e.g. cancer)
○ Less post-indigestive feedback
- Children dislike
how much to eat?
- Infants and young children very good at self-regulation
- Early models based on homeostatic principles
- Motivated to maintain absence of hunger
- Eat until homeostasis is restored
- Birch and Dysher (1986)
○ 2-5yo children
○ High or low energy preload snack; 40kcal vs 150kcal
○ Lunchtime energy intake measured - Compensation very accurate
- More accurate than adults
- Birch et al., (2003)
○ Eating in the absence if hunger (EAH) increases from 5-9 years - Rolls et al., (2000)
○ Macaroni cheese offered in different portion sizes
○ 2-3 year olds eat approximately same
○ 4-6 yo eat +60% if portion size doubled
types of weaning
traditional and baby-led
traditional weaning
○ Caregiver spoon feeding
○ Pureed –> small lumps –> larger lumps –> solids
○ Semi-prescribed order of introduction
○ May include baby jars
○ Caregivers select meals
baby-led weaning
○ Self-feeding solid finger foods
○ No purees or infant specific foods
○ Same foods as family
○ More able to influence own food choice
weaning method and child weight gain
- Townsend and Pitchford (2012)
○ Compared 52 spoon-fed (SF) and 54 baby-led-weaned (BLW) infants
○ Found:
§ Higher incidence of overweight/obesity in SF group
§ Higher incidence of underweight in BLW group
§ Significantly increased liking for carbs in BLW group
§ Carbs most preferred food of BLW group, sweet foods most preferred food of SF group
why is there a correlation between weaning method and child weight gain?
- Type of food given:
○ SF given sweet foods more often e.g., pork and apple
○ SF learned preference for sweet foods likely influences
preferences and unhealthy food choices in future
○ BLW: Post-ingestive feedback – when choose own foods, learn that carbs are more satiating = preference- Caregiver feeding practices
○ SF infants more likely to be pressured to eat; dictated by external cues (e.g., food left in the jar)
○ General differences in familial attitudes towards food
○ NB: findings cross-sectional
- Caregiver feeding practices
problems with BLW
- Only effective if caregivers haver varied diet
○ Evidence some parents/caregivers don’t have appropriate diets; high in salt, sugar, saturated fat, yet low in energy density and folate (Rowan & Harris, 2012)- Rarely ready to self-feed before 6 months
○ If guidelines change to recommend earlier weaning, then BLW not as appropriate - Some evidence BLW infants consume less food and more milk
○ Could lead to nutritional deficiencies
- Rarely ready to self-feed before 6 months
problems with SF weaning
- Prolonged duration of smooth foods – delays development of oral skills (Mason et al., 2005)
- Less exposure to different textures = more food refusal later on (Northstone et al., 2001)
○ Best predictor of eating chopped carrots in 12- month-old is experiences with carrots in variety of forms / textures (Blossfeld et al., 2007) - Effect of exposure to textures does not transfer from processed baby food to homemade meals (Birch et al., 1998)
- Less exposure to different textures = more food refusal later on (Northstone et al., 2001)
how common is inappropriate feeding?
relatively common
what is inapprpriate feeding driven by?
- Driven by inappropriate beliefs
○ Benefits to sleep
○ Belief hunger is main cause of distress- Some generational influences
○ Parents/grandparents - Confusion over guidelines
- Some generational influences
risk factors for inappropriate feeding
- Wasser et al., (2011)
○ More common in certain populations
§ Mothers with depression, obesity
§ Low SES family
§ Non-breast-fed infants
○ Links to child temperament
§ Positive association between inappropriate feeding and both ‘activity level’ and ‘distress to limitations’
§ But, may be mediated by parent self-efficacy (Anzman-Frasca et al., 2013)
how does inappropriate feeding link to obesity?
- Thompson and bentley (2013) - US study
○ 217 low SES, first-time mums in US Infant Care and Risk of Obesity Study
○ 78% of infants received age-inappropriate solids and liquids at 3 months old
○ 10% given fruit juice from 2 months of age
○ 25% drinking soft drinks by 18 months; 10 x higher than breast milk consumption!
○ Associated with higher mean daily intake of over 100 kcal and higher weight-for-length ratio- Ong et al. (2006) - UK study
○ Each 100-kcal excess per day at 4 months =
§ 46% increased odds of overweight at 3 years
§ 25% increased odds of overweight at 5 years
○ Why?
§ Clear excess in energy and protein
§ Changes in hypothalamus
□ Rat studies (Bouret, 2012)
§ Learned preferences
- Ong et al. (2006) - UK study
what anxieties are there around weaning?
- Infant Feeding Survey (2010) found 11% UK mothers of 1-year-olds reported experiencing difficulties with weaning
○ Portion size and eating enough
○ Dealing with food rejection
○ Offering enough variety
○ Seeking helpful advice- Clear gap in provision of weaning information and support to parents/caregivers
where can people get help around weaning?
Child feeding guide - website, app, online training:
- Commercialisation of research knowledge
- Free for parents/caregivers
- Training courses for childcare staff and health professionals
what are the 2 places where there are common feeding problems?
childrens behaviour
caregivers behaviour
common feeding problems in childrens behaviour
- Food refusal
- Rejection of bitter tastes
- Unhealthy food preferences
- Many common difficulties reflect natural developmental stages or learned behaviour
common feeding problems in caregivers behaviour
- Pressure to eat
- Food as a reward
- Food to soothe
- Restriction
- Caregivers often rely on unfavourable practices that can undermine healthy eating behaviours
what is food refusal characterised by?
- Refusing new of previously liked foods
2. Rejection of bitter tastes - especially vegetables
3. Can generalise to same texture, colours, etc
why does food refusal occur?
○ Neophobia/developing cognition/developmentally predictable
common caregiver responses to food refusal
○ Pressure to eat
○ Food as a reward
what does pressure to eat predict?
- Predicts ‘picky’ eating in adults (Batsell et al., 2002)
○ “Bad memories of school dinners still affect the eating habits of many adults, a survey suggests” (BBC poll of 2,000 Good Food Magazine readers)
how does pressure to eat come about?
coercion and bribing
concerns of pressure to eat
- Often out of concern
○ Linked to lower child weight (Ruzicka et al., 2021)
○ Unrealistic portion sizes?
Ruzicka et al. (2021).
study as evidence for pressure to eat reduces intake
- Galloway et al. (2006)
○ N = 27 preschoolers (3-5 yrs)
○ 2 conditions
§ Pressured to eat soup (“finish your soup please”)
§ Control
○ Parental questionnaire about whether they used pressure to eat
○ Pressure condition
§ Did not eat more soup
§ More negative comments about soup
evidence that pressure to eat increases intake
- Orell-Valente et al., (2007)
○ 142 families of kindergartners (52% females)
○ Observed at dinnertime using a focused-narrative observational system
○ 85% parents tried to get children to eat more
○ 83% of children ate more than they might otherwise
○ 38% ate moderately to substantially more
why might pressure to eat lead to decreased intake?
○ Fear response
○ Less liking, negative associations
why might pressure to eat lead to increased intake?
○ Fear response
○ Over-ride internal fullness
study for food as a reward
- “you’re not having ice cream until you’ve eaten your peas”
○ e.g., Birch et al. (1984). Eating as the ‘means’ activity in a contingency: effects on young children’s food preferences. Child Development, 55, 432–439.
why might foods become less liked when a reward is offered?
negative associations
why might foods become more liked when a reward is offered?
prize
desired
studies as food to soothe
- Stifter et al., (2011)
○ 43 male infants/toddlers (3-34 months)
○ Questionnaires on use of food to soothe, parent feeding practices, parenting self-efficacy, child temperament
○ Weight and length taken- Blissett, Haycraft and Farrow (2010)
○ 25 children aged 3-5-years
○ Ate lunch to satiety
○ Allocated to control or negative mood condition
○ Children whose mothers used food to regulate emotions ate more cookies in the absence of hunger regardless of condition
○ Children whose mothers used food to regulate emotions ate more chocolate in the negative mood condition than in the control condition
○ Shows they have already learnt to deal with emotions using food
- Blissett, Haycraft and Farrow (2010)
use of food to soothe is associated with
○ Higher child BMI
○ More negative child temperament
○ Lower parenting self-efficacy
what does the use of non-reward foods lead to?
increased liking
can incentives work?
- Incentives can be effective at
○ Altering children’s food choices (Orrell-Valente et al., 2007)
○ Increasing children’s consumption of foods (Baer et al., 1987)- Significant, sustained increases in liking in children praised for repeated tasting of a vegetable over 12 days (Cooke et al., 2011)
Holley, Haycraft and Farrow (2015)
- 115 parent/child pairs recruited from toddler groups
- 2.5- to 4-year-olds
- Each child assigned a target disliked vegetable based on parent rankings verified with a taste test
- Experimental group parents: offered child target vegetable outside of a mealtime for 14 consecutive days
- Control group: no offerings, just baseline and follow-up 5 minute free-eating test
- Holley, Haycraft & Farrow (2015). ‘Why don’t you try it again?’ A comparison of parent led, home based interventions aimed at increasing children’s consumption of a disliked vegetable. Appetite, 87, 215-222.
results:
- Children’s consumption of a disliked / refused vegetable can be increased via a 14-day programme of offering and tasting with incentives and praise, plus parental modelling
- Although parental modelling may impact acceptance when combined with incentives, it does not seem to be sufficient as a solo method to achieve tastings
- Just seeing a parent eating it and saying it was nice wasn’t effective enough, they needed an incentive
what is restriction characterised by?
- Restricting access to desired foods/drinks
- Often high-calorie “treat” foods
why does restriction occur?
○ Response to child weight / health concerns
Driven by child innate preferences
common caregiver responses to restriction - types of restriction
○ Overt restriction (restriction that the child is aware of “can I have another one?” “No you can’t”
○ Inconsistent restriction (one day they get sweets after pudding, another day they don’t - gets confusing
studies for over restriction
- Fisher and Birch (1999) 3-5y/o
○ Two snacks in daycare
§ Snack 1 available for full duration of snack time
§ Snack 2 only available for a limited duration
○ Snack 2
§ “I want it!”
§ Clapping when available
§ Pounding fists on table when access no longer available
§ Consumed more when available - Birch et al. (2003). Learning to overeat: maternal use of restrictive feeding practices promotes girls’ eating in the absence of hunger. Am J Clinical Nutrition, 78(2), 215-20.
○ 197girls: tested at 5, 7 and 9 years
○ Girls eat lunch until full
○ Free access food/toy
○ Found restriction at 5 led to eating in the absence of hunger at 7 and 9
§ Especially if overweight
why does restriction lead to increased intake?
prize
desired
want something cant have
how does a caregiver restrict in a good way?
covertly
factors motivating caregiver control
- Concern about child weight
- Demographic factors
- Sex of child/parent
