Methods for the analysis of feeding behaviour in infancy: Sucklings

Co-regulation of movements during infant feeding

The process by which infants move from liquid feeding to caregiver-assisted spoon feeding of semi-solid food is quite a dramatic transition. In previous studies, we observed that in the weeks after the introduction to solid food, mother-infant dyads showed increased co-regulation and synchronization of their respective feeding behaviors (e.g. offering food, accepting/refusing, timing). Learning this new way of feeding and eating requires that infants coordinate their position and movements with the complementary position and movements of the caregiver. The present study augments the category-based analysis of this co-regulation by the analysis of coupling in the dyads based on automatically extracted movement data. Previously collected video data from 10 mother-infant dyads were re-analyzed for the purpose of this study. Movement trajectories of mother's hand and infant's face were obtained by applying an automatic movement detection algorithm (TLD, Kalal et al., 2012; for applications to mother-infant interactions see López Pérez et al., 2017). Coordination was assessed by the method of Diagonal Cross Recurrence Profiles (DCRP), which expresses the degree of synchronization at different time lags. Profiles for each dyad from two different occasions --with one visit in the first week of solid feeding and one approximately 4-5 weeks later-- were compared. The results showed that, on average, most synchronization occurred in the first visit at lag 0. In the second visit there was an average delay in synchronization of about 1 s, with leading behavior starting from the infant. This suggests that the coordination was initially closely synchronized and became somewhat looser over time. Possibly, infants have begun to anticipate and guide the feeding movements enacted by the mother. However, our findings underline the idiosyncratic and complex nature of co-regulation of movements during the introduction of solid food. Whereas some dyads showed signs of increased organization, others seemed to disorganize, re-organize, or showed no organization at all. Many (interacting) factors --both individual and contextual-- may be responsible for the observed differences between dyads. Further research is needed to understand why specific synchronization pathways emerge and whether and how these might relate both to later feeding and eating and to the emergent patterns of participation.

A complex dynamical systems approach to the development of feeding problems in early childhood

Though it is commonly agreed upon that the development of feeding problems in early childhood is a complex process, much of the research on these problems has a component-oriented focus, and very little attention is paid to the mechanisms that lead to these kinds of problems in individual children. The aim of this theoretical paper is to interpret the development of feeding problems in early childhood from a complex dynamical systems viewpoint. In addition to its focus on self-organization and nonlinearity, this approach defines several central properties of development: soft-assembly, embodiment, iterativity, the emergence of higher-order properties, and intra-individual variability. In this paper, I argue that each of these properties is highly relevant for understanding feeding problems and discuss the implications of this for both clinical practice and research purposes.

Special Considerations for the Pediatric Population Relating to a Swallow Screen Versus Clinical Swallow or Instrumental Evaluation

Careful consideration should be taken to determine how a swallow screen could be implemented in the pediatric population. A variety of factors to be considered include: age, developmental level, feeding experience of the child, diagnosis, the status of the child's dysphagia, and the setting where the patient is treated. A swallow screen might be feasible in specific situations in the pediatric population to identify aspiration risk in those with a change in normal swallow status. Yet, more research is needed to improve the accurate identification for the pediatric population of aspiration risk and other signs of dysphagia that warrant an instrumental assessment. While risk for aspiration is a concern in this population, it is not the only concern due to the dynamic changes in feeding and swallowing performance that occur throughout childhood. These dynamic changes require a thorough clinical observation that neither a swallow screening nor instrumental assessment can provide the clinician. Thus, the clinical swallow evaluation (CSE) remains the most comprehensive tool available to assess oral feeding skill development and function, as well as, to identify risk factors for not only aspiration, but for other aspects of dysphagia, which may warrant an instrumental assessment.

Feeding skill performance in premature infants during the first year

BACKGROUND

Little is known about premature infants' feeding skill development and the contribution to it of biologic and environmental conditions.

AIMS

Explore the level and variation in feeding skill performance through the first post-term year and examine the contribution to performance of infant neonatal condition and rate of weight gain per day, maternal feeding behavior, and its interaction with neonatal condition.

STUDY DESIGN AND SUBJECTS

In this longitudinal, descriptive study, data sources included observed and videotaped in-home feeding for 45 infants <1250 g birth weight and their mothers (age > or =17 years).

OUTCOME MEASURE

Feeding skill performance (fdgskill): total number of expected skills at 1, 4, 8, and 12 months, post-term age (PTA).

RESULTS

Feeding skill performance varied widely among infants at all four assessments. At 8 and 12 months, fdgskill indicated, for a minority of infants, delay and lack of opportunity to engage in skills associated with new foods and new feeding modalities. Neonatal medical condition contributed significantly to fdgskill at 1 and 4 months, but in the predicted (negative) direction only at four months. Rate of weight gain per day contributed significantly to fdgskill at 1 and 8 months, but in the predicted direction (positive) only at one month. Maternal feeding behavior did not contribute to fdgskill, nor did it interact with infant neonatal conditions to affect fdgskill.

CONCLUSIONS

Although infant neonatal medical status and rate of weight gain per day, before or within the span of time between assessments, accounted for some variance in feeding skill performance within the first three assessments (1, 4, and 8 months), much remains to be explained, including neuro- and oral-motor capacities to manage new foods and feeding modalities and opportunities to practice feeding skills during the last half of the first year.

Repetitive exposures to a surrogate nipple providing nutritive and non-nutritive fluids: effects on suckling behavior of the newborn rat

Responsiveness to a surrogate nipple providing water, 0.1% saccharin, 10% sucrose, pedialyte, or milk was tested in naïve-to-suckling newborn rats during six 10-min exposures, one every 1.5 h over a 7.5 h period. Across a succession of exposures, newborn rats repeatedly attached to and ingested milk from a surrogate nipple, yielding significant body weight gain and increased concentration of blood plasma glucose. Initially, pups ingested considerable amounts of saccharin and sucrose, but then dramatically decreased their consumption of these fluids across the experimental sessions. Intake of milk was significantly higher than that of all other substances. Blood glucose concentration in pups treated with water, saccharin, sucrose, and pedialyte did not differ significantly from that of non-treated pups. The present data suggest a potential contribution of a fluid's palatability and nutritive value in the persistence and efficacy of diet intake for neonatal rats in the context of suckling behavior.