 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 feeding treatment on family functioning. As illustrated by Piazza and Carroll-Hernandez, research examining behavioural feeding treatment has consistently demonstrated its effectiveness with improving children’s oral feeding skills. Little is known, however, about the effects on family relationships as caregivers begin to transfer behavioural feeding strategies into the home setting. For example, how long do caregivers need to take stringent efforts to address their child’s feeding issues (i.e. when can caregivers stop or decrease their use of strict behavioural feeding strategies at meals and allow their child the freedom to eat independently without intervention)? How do such feeding interventions affect the identified child’s relationship with his or her siblings? Similarly, what impact does the caregiver’s use of behavioural feeding strategies with the targeted child have on the feeding patterns and mealtime interactions of other children in the family who do not have feeding or growth problems?
On a societal level, public policy and programs need to support efforts to promote healthy feeding and eating for children and families through primary, secondary and tertiary prevention of pediatric feeding disorders. Primary prevention efforts would involve halting the development of feeding disorders in children, particularly those known to be at highest risk for developing feeding problems, such as infants born at preterm and very low birth weight2-3 or families facing environmental and emotional stressors4-5. At a minimum, feeding programs need to partner with existing community programs that assume responsibility for reducing risk factors in the general population. For the specific case of feeding and growth, feeding programs need to collaborate with community programs that provide broad nutrition and early childhood intervention and support. In this manner, all children and caregivers, especially those at risk, can have access to education and programming designed to increase knowledge of healthy food choices 