Mealtime Communication Patterns of Infants from 2 to 24 Months of Age

Young Children’s Learning about Hunger and Satiety through the Lens of the Norms of Those Who Feed Them

This article focuses on parental perceptions of signs of hunger and satiety in children under 4 years of age and their effects on feeding practices, in a sample of parents of children with typical development. Discourse analysis shows the close relationships between social food norms, nutritional norms, medicalized child care norms, and educational norms in adults’ determination of children’s appetites according to their perceived needs and psychomotor development. The results also indicate how these norms are expressed according to social position, parental experience and context. More broadly, this article addresses top-down education—from adults to children—in food socialization, and points to the varying attention paid to the signals given by the child. It thus highlights some of the processes by which biological, psychological and social factors interact in socializing children to food.

An infant-led approach to complementary feeding is positively associated with language development

The timing and strategy with which parents first introduce their infants to solid foods may be an important predictor of subsequent developmental outcomes. Recent years have seen a decline in the prevalence of traditional parent‐led feeding of soft, puréed food and a rise in the prevalence of infant‐led complementary feeding. Although there has been some research espousing the benefits of infant‐led complementary feeding for improving food fussiness and self‐regulation, there has been little exploration of this approach that may impact on other developmental outcomes in children. The current study explores whether aspects of the infant‐led approach, specifically the child eating unaided and consuming finger foods and eating with the family, are related to child language outcomes. One hundred thirty one parents of children aged 8–24 months completed questionnaires about their approach to complementary feeding, their current feeding practices, their child's experiences with family foods and child language comprehension/production. The findings suggest that an approach to complementary feeding which promotes infant autonomy in feeding (i.e., eating finger foods rather than puréed foods) and consuming more family foods is related to more advanced child language production and comprehension. Specifically, the prevalence of eating family foods mediated the relationship between eating unaided at the onset of the complementary feeding period and later language outcomes. This study is the first to find a significant relationship between different approaches to introducing solid foods and child language outcomes and these findings highlight the potential for different complementary feeding approaches to influence behaviour beyond mealtimes.

Communicating hunger and satiation in the first 2 years of life: a systematic review

Responsive feeding has been identified as important in preventing overconsumption by infants. However, this is predicated on an assumption that parents recognise and respond to infant feeding cues. Despite this, relatively little is understood about how infants engage parental feeding responses. Therefore, the aim of this systematic review was to identify what is known about infant communication of hunger and satiation and what issues impact on the expression and perception of these states. A search of Medline, CINAHL, Web of Science, PsycINFO, Science Direct and Maternal and Infant care produced 27 papers. Eligibility criteria included peer reviewed qualitative and/or quantitative publications on feeding behaviours, hunger, and satiation/satiety cues of typically developing children in the first 2 years of life. Papers published between 1966 and 2013 were included in the review. The review revealed that feeding cues and behaviours are shaped by numerous issues, such as infants' physical attributes, individual psychological factors and environmental factors. Meanwhile, infant characteristics, external cues and mothers' own characteristics affect how feeding cues are perceived. The existing literature provides insights into many aspects of hunger and satiation in infancy; however, there are significant gaps in our knowledge. There is a lack of validated tools for measuring hunger and satiation, a need to understand how different infant characteristics impact on feeding behaviour and a need to extricate the respective contributions of infant and maternal characteristics to perceptions of hunger and satiation. Further research is also recommended to differentiate between feeding driven by liking and that driven by hunger.

Early problematic eating behaviours are associated with lower fruit and vegetable intake and less dietary variety at 4–5 years of age. A prospective analysis of three European birth cohorts

Problematic eating behaviours during early childhood could be mediators of poor dietary habits. This study aims to prospectively relate early eating behaviours with fruit and vegetable (F&V) intake and a healthy diet variety score of children aged between 4 and 5 years. Eating behaviours were assessed in three European birth cohorts (Generation XXI from Portugal, ALSPAC from the UK and EDEN from France) at 4–6, 12–15, 24 and 48–54 months of age, based on the child’s feeding difficulties, mother’s perception of child’s poor eating (eating small quantities at each meal, not eating enough or needing to be stimulated to eat), food refusal and difficulties in the establishment of daily food routines. Daily servings of F&V (>1 v. ≤1 serving/d, except in Generation XXI: >3 v. ≤3) and the Healthy Plate Variety Score (categorised by the median score of each sample) were calculated using FFQ. Associations were tested by logistic regressions adjusted for maternal age, education, smoking during pregnancy, any breast-feeding and the child’s z-score BMI at 4–5 years of age. Children with more feeding difficulties, poor eating, food refusal/neophobia and difficulties in establishing a daily routine at 12–15, 24 and 48–54 months of age had in general lower F&V intake at 4–5 years of age. The association with vegetables was slightly stronger than with fruits. These early feeding problems were also inversely associated with the variety score at 4–5 years of age, particularly when eating behaviours were reported after 12–15 months of age. A better understanding of these early feeding difficulties may help define strategies to increase the dietary quality in children.

Perfil da prática da amamentação em grupo de mães adolescentes

OBJETIVOS: Caracterizar o aleitamento materno entre mães adolescentes; identificar as experiências anteriores da amamentação; identificar eventos/situações que consideram como obstáculo na amamentação atual. MÉTODOS: Estudo exploratório desenvolvido em maternidade de baixo risco de Ribeirão Preto-SP. Foram entrevistadas 80 puérperas adolescentes. Aplicou-se um formulário em três momentos (alta hospitalar, consulta nos 10º a 15º dias pós-parto e busca via telefone, após um mês). Utilizou-se a estatística descritiva. RESULTADOS: Houve redução gradativa de aleitamento materno exclusivo. Em experiência anterior, 38,5% das adolescentes amamentaram mais de seis meses. Na experiência atual, consideraram problemas: os traumas mamilares e a dificuldade de sucção do bebê e demonstraram estar instrumentalizadas para amamentar. CONCLUSÕES: A mãe adolescente requer atenção sem rótulos pré-concebidos de incapacidade para cuidar do filho, guardando as especificidades da adolescência.

Prevalence of picky eaters among infants and toddlers and their caregivers’ decisions about offering a new food

OBJECTIVES

To determine the prevalence of infants and toddlers who were considered picky eaters, the predictors of picky eater status and its association with energy and nutrient intakes, food group use, and the number of times that caregivers offered a new food before deciding their child disliked it.

DESIGN

Cross-sectional survey of households with infants and toddlers (ages four to 24 months) was conducted.

SUBJECTS/SETTING

National random sample of 3,022 infants and toddlers.

METHODS

Data included caregiver's socioeconomic and demographic information, infants' and toddlers' food intake (24-hour recall), ethnicity, and caregivers' reports of specified times that new foods were offered before deciding the child disliked it.

STATISTICAL ANALYSES

For picky and nonpicky eaters, t tests were used to determine significant mean differences in energy and nutrient intakes. Logistic regression was used to predict picky eater status, and chi(2) tests were used for differences in the specified number of times that new foods were offered.

RESULTS

The percentage of children identified as picky eaters by their caregivers increased from 19% to 50% from four to 24 months. Picky eaters were reported at all ages for both sexes, all ethnicities, and all ranges of household incomes. On a day, both picky and nonpicky eaters met or exceeded current age-appropriate energy and dietary recommendations. Older children were more likely to be picky. Those in the higher weight-for-age percentiles were less likely to be picky. The highest number of times that caregivers offered a new food before deciding the child disliked it was three to five.

APPLICATIONS/CONCLUSIONS

Dietetics professionals need to be aware that caregivers who perceive their child as a picky eater are evident across gender, ethnicity, and household incomes. When offering a new food, mothers need to provide many more repeated exposures (eg, eight to 15 times) to enhance acceptance of that food than they currently do.

Feeding behaviors and other motor development in healthy children (2-24 months)

OBJECTIVES

To monitor infant's gross, fine and oral motor development patterns related to feeding.

DESIGN

An incomplete block design was used with 57 to 60 (sample = 98) mothers interviewed when their children were 2, 3, 4, 6, 8, 10, 12, 16 and 24 months (within +/- 5 days of birth date). Each mother had 5 to 6 interviews.

SETTING

Selected developmental feeding behaviors were monitored using in-home interviews conducted by trained interviewers (n = 2). At each interview, mothers reported the child's age when behaviors first occurred, and anthropometric measurements were performed.

SUBJECTS

Subjects were healthy white children who lived mostly in homes with educated two-parent families of upper socioeconomic status.

RESULTS

Mean behavioral ages were within normal ranges reported in the literature, whereas individuals exhibited a wide diversity in reported ages. Examples of gross motor skills (age in months, +/- SD) included sitting without help (5.50+/-2.08) and crawling (8.00+/-1.55). Mean ages for self-feeding fine motor skills showed children reaching for a spoon when hungry (5.47+/-1.44), using fingers to rake food toward self (8.87+/-2.58) and using fingers to self-feed soft foods (13.52+/-2.83). Oral behaviors included children opening their mouth when food approached (4.46+/-1.37), eating food with tiny lumps (8.70+/-2.03) and chewing and swallowing firmer foods without choking (12.17+/-2.28).

CONCLUSIONS

Mean ages for feeding behaviors occurred within expected age ranges associated with normal development. However, mothers reported that individual children exhibited a wide age range for achieving these behaviors. Our results should be considered in counseling mothers about infant feeding practices.

Pediatric feeding disorders

Pediatric feeding disorders are common: 25% of children are reported to present with some form of feeding disorder. This number increases to 80% in developmentally delayed children. Consequences of feeding disorders can be severe, including growth failure, susceptibility to chronic illness, and even death. Feeding disorders occur in children who are healthy, who have gastrointestinal disorders, and in those with special needs. Most feeding disorders have underlying organic causes. However, overwhelming evidence indicates that abnormal feeding patterns are not solely due to organic impairment. As such, feeding disorders should be conceptualized on a continuum between psycho-social and organic factors. Disordered feeding in a child is seldom limited to the child alone; it also is a family problem. Assessment and treatment are best conducted by an interdisciplinary team of professionals. At minimum, the team should include a gastroenterologist, nutritionist, behavioral psychologist, and occupational and/or speech therapist. Intervention should be comprehensive and include treatment of the medical condition, behavioral modification to alter the child's inappropriate learned feeding patterns, and parent education and training in appropriate parenting and feeding skills. A majority of feeding problems can be resolved or greatly improved through medical, oromotor, and behavioral therapy. Behavioral feeding strategies have been applied successfully even in organically mediated feeding disorders. To avoid iatrogenic feeding problems, initial attempts to achieve nutritional goals in malnourished children should be via the oral route. The need for exclusive tube feedings should be minimized.

Fruit juice intake is not related to children's growth

BACKGROUND

Excessive fruit juice intake (>12 ounces/day) has been reported to be associated with short stature and obesity in preschool children.

OBJECTIVE

To confirm whether excess fruit juice intake was associated with short stature and obesity in preschool children, we assessed growth parameters and fruit juice intake in 105 white children, ages 24 to 36 months.

METHODOLOGY

Mothers were interviewed twice by a registered dietitian when children were age 24, 28, or 32 months (interview 1) and when children were age 28, 32, or 36 months (interview 2); interviews were assigned randomly. At each interview mothers provided 3 days of dietary data (one 24-hour recall and a 2-day food record) and the registered dietitian weighed the child and measured his/her height. Dietary data were analyzed using Nutritionist IV software. Each child's body mass index (wt/ht2) and ponderal index (wt/ht3) were calculated for each interview. Growth parameters of children consuming <12 ounces/day 100% fruit juice were compared with those consuming >/=12 ounces/day using the Student's t test, chi2, Fisher's exact test, and mixed model repeated measures analyses (PROC MIXED).

RESULTS

Results consistently indicated no statistically significant differences in children's height, body mass index, or ponderal index related to fruit juice intake. Intakes of soda pop were negatively related to intakes of milk and fruit juice although intakes of milk and fruit juice were not related.

CONCLUSIONS

The consistent lack of relationship between children's fruit juice intake and growth parameters in our study does not support previous recommendations to limit the intake of 100% fruit juice to <12 ounces/day.