Feeding Disorders of Infants and Toddlers: A Follow-up to the Treatment of Infantile Anorexia

Feeding disorders of infants and toddlers have become more prevalent as diagnostic criteria and assessment are specialized, yet few longitudinal studies have been conducted to investigate the effectiveness of treatment. Infantile Anorexia (IA) is a specific feeding disorder that often emerges between 6 months and 3 years of age, characterized by the child’s refusal to eat adequate amounts of food, an inability to regulate hunger and fullness, distractibility and a greater interest in the environment than eating, and significant growth deficiency. Between 2000 and 2005, a treatment study for children diagnosed with IA focused on the internal regulation of eating according to hunger and fullness. The goals of the study consisted of helping parents understand their child, implement feeding guidelines to set up regular mealtimes, and address limit-setting for the child’s oppositional behaviors during mealtime. Currently, a follow-up study is being conducted to examine the long-term effect of the treatment of IA, investigating the children’s eating behavior, anxiety and externalizing behavior, cognitive development, and the parents’ stress and psychopathology. This research examines the assessment and treatment of Infantile Anorexia, and the current follow-up study that will provide crucial insight to the effectiveness of treatment and the development of these children. Introduction Feeding disorders in children have become more prevalent as diagnostic criteria and assessment are specialized. Diagnostic criteria for Feeding Disorders of Infancy or Early Childhood was added to DSM-IV and proved to be a significant step forward in diagnosing this disorder in children. In DSM-IV the American Psychiatric Association (APA, 2010) characterizes the disorder as a feeding disturbance with onset before 6 years of age, marked by failure to eat adequately with failure to gain weight or significant weight loss for at least one month. Diagnostic criteria also state that the disorder is not due to a medical condition and cannot be accounted for by another mental disorder. There has been growing awareness of the significance of feeding disorders in infants and toddlers, and research in this area has been expanding. Feeding disorders can be described as oral stage issues that may be based on sensory or motor development (Kleinman, 2009). Feeding disorders affect up to 25% of normally developing infants and up to 35% of infants with developmental handicaps (Benoit, 2000). Some symptoms indicating a feeding disorder relate directly to feeding skills and the infant’s behavior during feeding, such as “partial to total food refusal, quick loss of interest, oral motor, oral sensory and oropharyngeal difficulties, vomiting, inability to graduate to textured foods, gagging, coughing, ingestion of nonnutritive substances [pica], and tantrums” (Benoit, 2000, p. 340). Other common difficulties in feeding include “‘eating too little,’ restricted food preferences, delays in self-feeding, objectionable mealtime behaviors, and bizarre food habits” (Chatoor, 2002, p. 163). These feeding problems can become severe, with insufficient weight gain caused by refusal to eat and vomiting. These severe feeding problems occur in 1% to 2% of infants younger than one year of age, and 70% of these infants continue to have feeding problems 4 to 6 years later (Chatoor, 2002). Feeding disorders of infancy and early childhood significantly influence the child’s cognitive development, behavior, and of course physical development. The consequences of inadequate food intake are evident in the child’s growth. The child does not gain sufficient weight, and their height growth also slows down as chronic malnutrition develops. The child’s head circumference may continue to grow, so the child may appear proportionate in the body, but the head appears too large. However, before puberty the children do have a chance to catch up in growth if they begin to eat better (Chatoor, 2002). Insufficient caloric intake associated with feeding problems can also affect cognitive development. Chatoor et al. (2004) conducted a study investigating a specific feeding disorder she labels Infantile Anorexia and cognitive development, and found that children in the healthy eater group displayed significantly higher scores on the Mental Development Index than children with Infantile Anorexia. However the results also showed that psychosocial factors such as SES, maternal education, and interactional conflict were stronger predictors of the Mental Development Index score than nutritional status. Certain risk factors for the development of feeding disorders have been identified. Feeding problems do not discriminate by socio-economic status. Feeding disorders have shown to occur in all socio-economic groups (Wright, 2005). But family stressors can diminish a parent’s capacity to support their child and respond to them appropriately. Some of these stressors include racism, a lack of support following relationship disintegration, and poverty (Batchelor, 2008). Additionally, studies show that children are more likely to experience early feeding problems if they have a difficult or fussy temperament in infancy (Ammaniti et al.,