Info about Infants
Feeding and Other Disorders of Infancy or Early Childhood
Three Feeding Disorders are associated with various developmental stages. Those infants who at 3 to 12 months of age are identified for refusal to eat for at least 4 weeks with no apparent medical cause have significantly more problems in eating patterns, behavior, and growth, and are more susceptible to infection at 2 and 4 years of age. Gastrointestinal symptoms and fussy eating during early childhood correlated with anorectic behavior during adolescence, while problem behaviors during mealtime and pica early in life were associated with bulimia nervosa during the adolescent years.
• Diagnosis and Treatment
The diagnostic assessment of Feeding Disorders should include an assessment of the infant’s temperament characteristics; the infant’s medical, developmental, and feeding history; the caretaker’s psychological functioning and history, socioeconomic background, stressors, and social support system. The relationship of the infant with his or her primary caretakers during feeding and play is also crucial. Treatment begins with the first contact with the infant and his or her caregivers. The establishment of a therapeutic alliance with the caregivers is critical to any successful treatment. The diagnostic evaluation needs to identify the specific dynamics of each Feeding Disorder in order to develop a specific treatment plan. This is discussed in more detail for each Feeding Disorder.
• Pica
Pica refers to behaviorally and culturally inappropriate eating of non-nutritional substances for at least 4 weeks. Pica is a common but frequently missed problem. The onset of pica is usually during the toddler age, between 12 and 24 months. It is most often associated with poverty-related nutritional deficiencies and Mental Retardation. The assessment should include the history of the child’s development in general and feeding in particular.
• Diagnosis and Treatment
Special attention should be given to other oral activities that the child may use for self-soothing and relief of tension. In addition, the home environment and the parents’ relationship with each other, including how they nurture and supervise the child, should also be taken care of. In treating Pica, one must consider the various factors that appear to contribute to the development of Pica as well as its complications. It is important to treat the child medically while addressing the psychosocial needs of the child’s family as well. A psycho-educational treatment approach, in addition to teaching the mother the dangers of Pica, would also provide social support to help her become more available to her child.
• Rumination Disorder
Rumination Disorder is characterized by the repeated regurgitation and re-chewing of food occurring for at least 1 month with prior normal functioning. As in the case of Feeding Disorder of infancy and early childhood, these behaviors cannot be the result of a medical condition affecting the gastrointestinal tract. Similarly, this diagnosis is not made in the presence of Anorexia Nervosa or Bulimia Nervosa.
• Diagnosis and Treatment
Infants who ruminate come to the attention of professionals because of “frequent vomiting” and weight loss. Some infants ruminate primarily during the transition to sleep when left alone, and their ruminatory activity might not be readily observed. These infants are frequently found in a puddle of vomitus, which should raise suspicion of rumination. Other infants can be observed to posture with the back arched, to put the thumb or whole hand into the mouth, or to suck on the tongue rhythmically to initiate the regurgitation of food. Most of the regurgitated food is initially vomited, but gradually the infant appears to learn to hold more of the food in the mouth to re-chew and re-swallow. Besides surgical intervention to prevent reflux and the early use of mechanical restraints, treatment has been primarily behavioral or psychodynamic or a combination of both.