Irene Chatoor

Feeding disorders in infants and toddlers: diagnosis and treatment☆

Each of the six feeding disorders described presents with specific symptoms, has a different origin, and responds to different interventions. Consequently, it is important to establish an accurate diagnosis and use the appropriate intervention for the specific feeding disorder. As the study by Benoit et al [7] demonstrates, an intervention that may be helpful for one feeding disorder can be completely ineffective for another.

Maternal Characteristics and Toddler Temperament in Infantile Anorexia

OBJECTIVEnTo explore the association between specific maternal characteristics, maternal perceptions of toddler temperament, and infantile anorexia.nnnMETHODnThree groups of toddlers (aged 12-37 months) participated in this study: toddlers with infantile anorexia (n = 34), picky eaters (n = 34), and healthy eaters (n = 34). Mothers completed questionnaires that assessed their own eating attitudes, marital satisfaction, and their toddlers temperament, and an interview that explored their attachment representations. Mothers and toddlers were videotaped during a feeding session, and toddlers were weighed and measured.nnnRESULTSnTemperament ratings differentiated between infantile anorexics and healthy eaters (p < .0001), with infantile anorexics receiving higher difficulty, irregularity, negativity, dependence, and unstoppable ratings. Mothers of anorexics showed greater attachment insecurity than mothers of healthy eaters (p < .05), but they demonstrated neither overt eating pathology nor less marital satisfaction than the other groups. Thirty-nine percent of variance in feeding conflict was explained by toddlers diagnoses, temperament ratings, and maternal characteristics. Twenty-one percent of variance in toddlers weights was explained by temperament ratings and feeding conflict.nnnCONCLUSIONnMaternal characteristics and perceptions of their toddlers temperament characteristics should be addressed in treatment for infantile anorexia.

Observation of Feeding in the Diagnosis of Posttraumatic Feeding Disorder of Infancy

OBJECTIVESnTo delineate diagnostic criteria for posttraumatic feeding disorder (PTFD) of infancy and to differentiate PTFD from infantile anorexia (IA) via observation of feeding interactions.nnnMETHODnThree groups of infants (aged 6-32 months) participated: PTFD (n = 30), IA (n = 30), and healthy eater controls (n = 30). The three groups were matched with regard to age, gender, ethnicity, and socioeconomic status. Child psychiatrists used infants medical and feeding histories and observed 20-minute mother-infant feeding interactions to determine diagnoses and group placement. Feeding interactions were also videotaped, and two raters assessed infants resistance to feeding situations and to swallowing, as well as specific qualities of mother-infant feeding interactions.nnnRESULTSnOverall, the clinical groups (PTFD and IA) demonstrated more problematic feeding interactions than did the control group. However, the PTFD group exhibited more resistance during feeding interactions than did the other two groups. In particular, the PTFD group displayed the most resistance to swallowing food.nnnCONCLUSIONSnInfants medical and feeding histories, as well as observations of feeding, are important to making the diagnosis of PTFD and differentiating it from other feeding disorders. Implications for treatment of PTFD are discussed.

The role of non-specific factors in treatment outcome of psychotherapy studies

Non-specific factors refer to dimensions that are shared by most psychotherapies and include the therapeutic alliance, the therapist’s competence and adherence to the treatment protocols whereas specific factors refer to the specific techniques and interventions that characterize particular psychotherapies. Review of the literature on non-specific treatment factors reveals that the therapeutic alliance and therapist competence may vary among patients and therapists, and that the therapeutic alliance also varies among treatment modalities. All three non-specific treatment factors, therapeutic alliance, therapist competence and adherence to the specific treatment modality, contribute significantly to treatment outcome and may account for more of the variance in outcome than specific treatment approach. Consequently, these factors need to be considered in the design of psychotherapy studies. In this paper we use the treatment study of infantile anorexia as an example of how to integrate these non-specific factors in the study design and the data analysis of treatment outcome in a psychotherapy study.

Maternal psychopathology and child risk factors in infantile anorexia.

OBJECTIVEnThis study examines a transactional and multirisk model for Infantile Anorexia (IA) and investigates the contributions of the parent, the child, and dyadic interactional variables related to this feeding disorder.nnnMETHODnThe sample consisted of 371 mother-child pairs (children aged 6-36 months), of which 187 pairs of mothers and normally developing children (ND-group), and 184 mothers and IA children. All dyads were videotaped during feeding; mothers completed questionnaires assessing their psychological profiles and eating attitudes, as well as their childrens temperament and emotional/ behavioral functioning.nnnRESULTSnAnalyses revealed that the IA-group showed higher scores in symptomatic characteristics both of the mother and of the child, and dysfunctional interactions during feeding as compared with the ND-group. Further analyses revealed that both child and maternal characteristics are significant predictors of dyadic interactional conflict.nnnDISCUSSIONnResults confirm that a multidimensional assessment is critical in the evaluation of IA.

Feeding disorders of infancy: A longitudinal study to middle childhood

OBJECTIVEnTo evaluate over time feeding behavior and emotional-behavioral functioning in a sample of children diagnosed with Infantile Anorexia (IA) and a group of typically developing children; and to investigate the relationship between maternal psychological functioning and the childrens feeding patterns and emotional-behavioral functioning.nnnMETHODnSeventy-two children diagnosed with IA and 70 children in the control group were prospectively evaluated through several measures at two, five, and eight years of age.nnnRESULTSnOur findings revealed partial improvement in the nutritional status of the children with IA. However, they continued to show ongoing eating problems and, in addition, anxiety/depression and withdrawal, as well as rule-breaking behaviors and social problems. There were significant correlations between the childrens eating problems and their emotional difficulties and their mothers increased emotional distress and disturbed eating attitudes.nnnDISCUSSIONnOur longitudinal study points out that the natural course of untreated IA is characterized by the persistence of difficulties in eating behavior and emotional-behavioral adjustment in both, the children and their mothers.

Two-year-old twins refuse to eat : a multidisciplinary approach to diagnosis and treatment

This round table addresses the diagnosis and treatment of feeding disorders and failure to thrive. It describes a family-centered approach by a multidisciplinary feeding disorders team, beginning with the screening evaluation by the team coordinator at intake, through the evaluations by various team members, the team meeting with the parents, the development of a treatment plan, to a 1-year follow-up after treatment. Both twins refused to eat textured food and were found to have a posttraumatic feeding disorder secondary to repeated gagging and choking on cereal and lumpy baby food. However, only one twin was engaged in a battle with the parents over eating and developed infantile anorexia associated with failure to thrive. The differential diagnosis and the specific treatment plans of these two feeding disorders characterized by food refusal are discussed.

Infantile Anorexia Growth and Nutrient Intake in 62 Cases

Eating disorders among young children are not well characterized. Diet and growth data were collected from toddlers (1-3 years old) at the time of diagnosis of infantile anorexia (IA) and up to 1 y...