dividual education that fosters caregiver mealtime management and increases awareness of healthy eating behaviour. These interventions are equally important for children who are underweight or overweight.
While Black’s paper provides direction for multilevel interventions to promote the development of healthy eating behaviours for all children spanning the entire weight continuum, Piazza and Carroll-Hernandez focus their review of the research solely on children who are underweight and/or fail to thrive. Similar to Ramsay’s and Black’s reviews, the authors note the complex causes of pediatric feeding disorders, which can include both biological and environmental factors that are further exacerbated by caregiver management. Demonstrating the effectiveness of intensive, interdisciplinary day-treatment services that are primarily behaviourally-based, the authors provide empirical support for behavioural feeding treatment through outcomes-based data. In their own work, the authors document the fact that children with long-standing feeding problems, many of whom required supplemental feedings via naso-gastric or gastrostomy tubes, were able to meet 70% or greater of their oral feeding goals in the treatment program, with 100% of cases being able to transfer treatment to the home and community. Follow-up data up to 24 months post-discharge from the treatment program reveal that 85% of children continued to make progress toward age-typical feeding.
Implications for Development and Policy
In combination, these three papers illustrate the complexity of feeding development and the mechanisms by which feeding problems emerge in young children. Clearly, pediatric feeding disorders do not have a single origin, but involve several interacting components that result in atypical feeding patterns that ultimately affect the child, family and society as a whole. Outcomes-based data is critical to understanding the most effective strategies to use when addressing feeding problems in children, and the authors have provided compelling data to support the use of intensive behavioural interventions to advance feeding development in children with chronic feeding and growth problems.
Much more research, however, needs to be conducted within the contexts of the child and family. On the individual child level, very little data has been published regarding the medical, psychological and social longitudinal outcomes of children who were considered “failure to thrive” as infants and have participated in intensive feeding treatment. The physical health, weight, growth and feeding status of this population of children remain unclear, with the exception of results obtained from follow-up studies conducted only up to two years post-treatment. It is not clear, for example, whether children who receive feeding treatment continue to appear significantly dissimilar in their height and weight in comparison to their healthy peers as they grow up, or whether they cease to appear appreciably different in body size and simply have small statures or thin body frames. Previous research reveals that, for low birth weight infants, inhibited growth and development may be a permanent characteristic1. Questions also remain regarding whether or not low-weight status children are more, less or just as physically healthy as children who are 90% to 100% of ideal body weight. Therefore, it is important to understand at which point(s) in the child’s development it is appropriate to be more or less concerned with poor growth or weight status. In addition, previously undetected medical, psychological or developmental issues may reveal themselves with maturation for which a specific, characteristic pattern of feeding problems may have been the first indication of an emerging diagnosable problem. Obtaining clarification of these issues may help to determine health-care providers’ choice, course and intensity of treatment for a young child with feeding problems.
Additional research also needs to be conducted within the context of the family, especially with regard to the effects of