1. Feeding Skill, Appetite and Feeding Behaviours of Infants and Young Children and Their Impact on Growth and Psychosocial Development – Maria Ramsay, PhD
2. Helping Children Develop Healthy Eating Habits – Maureen M. Black, PhD
3. Assessment and Treatment of Pediatric Feeding Disorders – Cathleen C. Piazza, PhD and Tammy A. Carroll-Hernandez, PhD
Feeding disorders commonly occur in the pediatric population, typically affecting developing children as well as children with development delays and medical conditions. Feeding disorders are multi-factored and can emerge from a broad range of causes, including physical abnormalities, neurodevelopmental disorders, appetite regulation problems, metabolic diseases, sensory defects and learned behaviours. Encompassing a wide range, feeding problems vary from picky eating, which may not have an imminent impact on the physical health of the child, to total refusal to eat, which can place the child at risk for nutritional compromise. Given the consequences for growth, cognitive development and physical health for the child with chronic feeding problems, understanding how problematic feeding skills and mealtime interactions develop as well as discerning effective strategies by which to intervene are critical to promoting the long- term health of children. Ramsay, Black, Piazza and Carroll-Hernandez wonderfully review previous research and highlight their own work, which underscores the importance of considering multiple interacting factors when understanding, assessing and treating pediatric feeding problems.
Research and Conclusions
In her overview of feeding and growth in children, Ramsay describes the evolution of feeding skills from a developmental perspective. She illustrates the typical early developmental course of feeding in young children, initially driven by internal cues of hunger and functional oral motor skills, but also modulated by temperament and parent feeding styles. Recognizing the complexity of understanding feeding skills acquisition, Ramsay mentions several other influences, including societal expectations and maternal and family characteristics for child weight and type of food eaten, that contribute to the development of negative feeding patterns and poor growth in the child. Clearly, as evidenced by Ramsay’s thoughtful review, child feeding problems extend beyond the child’s specific characteristics and reflect the influence of several external or environmental factors simultaneously affecting the young child at multiple levels. Therefore, discerning the specific contributors to a young child’s feeding impairment is challenging, given that problematic feeding patterns may be the result of physiologic or functional feeding problems (e.g. limited hunger, poor sucking) but can later become conditioned through learned association with external or environmental cues (e.g. parent feeding practices and beliefs). As Ramsay notes, all of these factors can have a detrimental impact on a child’s feeding behaviours, mealtime interactions and growth.
Echoing Ramsay’s comments, Black further illustrates the impact of the child-caregiver interaction on the development of child feeding patterns and mealtime behaviours. The child’s contributions to subsequent feeding problems may include inconsistent or disruptive communication of verbal and nonverbal cues regarding hunger and satiety. In turn, caregivers may have difficulty recognizing or interpreting their child’s feeding cues, which can lead to mealtime conflicts. Black reviews several strategies by which caregivers can promote the feeding process, such as modelling positive eating behaviours, establishing consistent and predictable mealtime routines and emphasizing the value of offering nutritionally balanced foods within a positive mealtime atmosphere. Black, however, underscores the importance of the need for multilevel interventions to promote healthy feeding patterns in children, including environmental changes in which restaurants need to include nutritious, yet appealing, food choices for children, and family and in