Feeding and sleeping problems in infancy--a follow-up at early school age

Fatores associados aos tipos de dificuldades alimentares em crianças entre 0 e 10 anos de idade: um estudo retrospectivo em um centro de referência brasileiro

Objetivo: identificar fatores associados à prevalência dos diferentes tipos de dificuldades alimentares em crianças com idade entre 0 e 10 anos.Métodos: trata-se de um estudo observacional retrospectivo com dados de crianças de 0 a 10 anos diagnosticadas com alguma dificuldade alimentar, atendidas em um centro de referência localizado no município de São Paulo, SP, Brasil. A presença da dificuldade alimentar foi analisada de acordo com o diagnóstico multidisciplinar, o aparecimento da queixa, os dados sobre a gestação e a amamentação, o estilo parental, a presença de causas orgânicas e as complicações associadas. Os dados foram tabulados no programa Microsoft Excel e as análises estatísticas foram realizadas no programa IBM SPSS Statistics 21 através de frequências absolutas e relativas, média, desvio padrão, teste do qui-quadrado e Kruskall-Wallis com o teste de post-hoc de Dunn.Resultados: foram avaliados 166 pacientes com um predomínio do sexo masculino, em idade pré-escolar e nascidos a termo. O diagnóstico mais prevalente foi de seletividade alimentar, sem doenças orgânicas ou reações associadas. Os diagnósticos de dificuldade alimentar apresentaram associação estatisticamente significativa com idade, idade gestacional de nascimento, idade e fase da alimentação de aparecimento da queixa.Conclusões: os fatores que apresentaram associação com os diferentes tipos de dificuldade alimentar foram a idade, a idade gestacional de nascimento e a idade e fase da alimentação de aparecimento da queixa. O presente estudo permite iniciar um direcionamento mais específico de ações de orientação e de prevenção de dificuldade alimentar. Dessa forma, destaca-se a importância da realização de estudos desse cunho.

Problems of feeding, sleeping and excessive crying in infancy: a general population study

OBJECTIVE

To study regulatory problems (RPs) of feeding, sleeping and excessive crying in infancy, and explore the influence of maternal mental health problems and parent-child relationship problems.

DESIGN AND SETTING

Data were collected in the general child health surveillance delivered to infant families by community health nurses (CHNs). Information on CHNs' assessments and conclusions were obtained on 2598 infants and merged with data from national registers. Descriptive statistics and logistic regression models were used to study RPs in early and late infancy, and the influences due to child, family and parent-child relationship problems.

RESULTS

Combined RPs (C-RPs), defined as two or more simultaneous problems of feeding, sleeping or excessive crying, was identified in 2.9% and 8.6% of the population between age 2-6 and 8-11 months, respectively. Low maternal schooling and immigrant parents were associated with an increased risk of late C-RPs, but RPs in early infancy stand out as the main predictor of late C-RPs OR 3.4 (95% CI 1.8 to 6.6), and the effect of early maternal mental health problems and parent-child relationship problems seem to be mediated by early C-RPs.

CONCLUSIONS

Combined problems of feeding, sleeping or excessive crying may exist throughout infancy independently of exposures to maternal mental health problems and parent-child relationship problems. The results indicate that infants with RPs exceeding age 2 months need special attention, in clinical as well as community settings. Suggested intervention includes specific guidance to the parents to help them understand and regulate their infant's sensitivity and reactions.

Parents need support to find ways to optimise their own sleep without seeing their preterm infant's sleeping patterns as a problem

AIM

This study described how parents perceived their own sleep, and their infants', during neonatal intensive care unit (NICU) admission and after discharge. It also explored the infants' sleeping location at home.

METHODS

The study was conducted in the NICUs of two Swedish university hospitals. The parents of 86 infants - 86 mothers and 84 fathers - answered questionnaires during their infants' hospital stay, at discharge and at the infants' corrected ages of two, six and 12 months. The parents' own sleep was explored with the Insomnia Severity Index.

RESULTS

Mothers reported more severe insomnia than fathers during their infants' hospitalisation, and these higher insomnia severity scores were associated with more severe infant sleep problems at discharge (p = 0.027) and at two months (p = 0.006) and 12 months (p = 0.002) of corrected age. During the study period, 4%-10% of the parents reported severe or very severe infant sleeping problems. The bed-sharing rate was 75% after discharge and about 60% at the corrected age of 12 months.

CONCLUSION

Maternal insomnia during an infant's hospital stay was associated with later perceptions of sleep problems in their children. Parents need support to find solutions for optimal sleep without seeing their child's sleeping patterns as a problem.

Early Predictors of Eating Problems in Preadolescence-A Prospective Birth Cohort Study

PURPOSE

The epidemiology of childhood eating problems is far from being fully described. The present study aims to explore early predictors of eating behavior problems in preadolescence.

METHODS

The study sample comprised 1,939 children from the birth cohort study, the Copenhagen Child Cohort (CCC2000). Logistic regression models were used to investigate associations among infancy health, developmental and relational factors, maternal mental health problems, socioeconomic factors, parental reported eating behavior patterns in preschool age and eating behavior problems in preadolescence.

RESULTS

A number of factors expressing socioeconomic disadvantage across childhood were associated with an increased risk of eating behavior problems at age 11-12 years. In addition, overeating patterns at age 5-7 years predicted restrained eating in preadolescence (odds ratio [OR] = 2.77; 95% confidence interval [CI] = 1.13-6.77; p = .03), with overweight at age 11-12 years and low annual household income as strong explanatory factors (OR = 4.79; 95% CI = 2.81-8.17; p < .0001 and OR = 2.06; 95% CI = 1.19-3.58; p = .02, respectively). No significant associations between perinatal, early child- and relational factors, or maternal mental disorder and eating behavior problems in preadolescence were found.

CONCLUSIONS

Our results suggest that overeating at age 5-7 years is prospectively associated with restrained eating in preadolescence, with contemporaneous socioeconomic disadvantages and overweight as strong explanatory factors. Our findings might reflect successful public health interventions toward childhood obesity or might reflect a developmental course of problematic eating fluctuating between over- and undereating. Future studies should focus on the possible pathways from overeating to restrained eating and more severe eating pathology, including possible negative side effects of otherwise successful interventions aimed at reducing childhood obesity.

O papel do fonoaudiólogo no diagnóstico e tratamento multiprofissional da criança com dificuldade alimentar: uma nova visão

O presente artigo relata o caso clínico de paciente de dois anos e seis meses atendida por equipe multidisciplinar. A paciente apresentou dificuldades alimentares caracterizadas por recusa alimentar, tempo prolongado das refeições, defesa sensório-oral, reflexo de vômito anteriorizado e dificuldade mastigatória. Não se alimentava sozinha, nem participava das refeições em família. Apresentava refluxo gastroesofágico, alergia a proteína do leite de vaca e tosse seguida por vômito. Não apresentou comprometimento pondero-estatural. Foi utilizado o Programa de Refeição Compartilhada. Após acompanhamento médico, a conduta de trabalho foi definida e iniciada pelo trabalho sensório-oral, seguido do trabalho com a mastigação, associados ao trabalho de orientação familiar. A paciente passou a realizar as refeições com a família e participar das rotinas sociais de alimentação. O tempo de refeição foi reduzido e a recusa alimentar eliminada. Os aspectos sensório-motores-orais melhoraram significantemente. Após a alta e reavaliação em três meses, apresentou melhora no refluxo gastro-esofágico e a medicação foi suprimida. A nutricionista iniciou a introdução de derivados do leite, com boa aceitação por parte da paciente. O programa utilizado mostrou-se eficaz para o diagnóstico e tratamento da dificuldade alimentar apresentada pela paciente. A equipe multidisciplinar foi capaz de ter uma visão ampliada da dificuldade alimentar apresentada pela paciente, compreendendo as questões motoras, orais, orgânicas e nutricionais da alimentação da criança inseridas no seu contexto familiar.

Association between maternal depressive symptoms in the early post-natal period and responsiveness in feeding at child age 2 years

Maternal depression is a known risk factor for poor outcomes for children. Pathways to these poor outcomes relate to reduced maternal responsiveness or sensitivity to the child. Impaired responsiveness potentially impacts the feeding relationship and thus may be a risk factor for inappropriate feeding practices. The aim of this study was to examine the longitudinal relationships between self-reported maternal post-natal depressive symptoms at child age 4 months and feeding practices at child age 2 years in a community sample. Participants were Australian first-time mothers allocated to the control group of the NOURISH randomized controlled trial when infants were 4 months old. Complete data from 211 mothers (of 346 allocated) followed up when their children were 2 years of age (51% girls) were available for analysis. The relationship between Edinburgh Postnatal Depression Scale (EPDS) score (child age 4 months) and child feeding practices (child age 2 years) was tested using hierarchical linear regression analysis adjusted for maternal and child characteristics. Higher EPDS score was associated with less responsive feeding practices at child age 2 years: greater pressure [β = 0.18, 95% confidence interval (CI): 0.04-0.32, P = 0.01], restriction (β = 0.14, 95% CI: 0.001-0.28, P = 0.05), instrumental (β = 0.14, 95% CI: 0.005-0.27, P = 0.04) and emotional (β = 0.15, 95% CI: 0.01-0.29, P = 0.03) feeding practices (ΔR(2) values: 0.02-0.03, P < 0.05). This study provides evidence for the proposed link between maternal post-natal depressive symptoms and lower responsiveness in child feeding. These findings suggest that the provision of support to mothers experiencing some levels of depressive symptomatology in the early post-natal period may improve responsiveness in the child feeding relationship.

Interactions during feeding with mothers and their infants with symptoms of gastroesophageal reflux

OBJECTIVES

To examine whether maternal-child interaction during feedings was suboptimal in dyads in which the infant had gastroesophageal reflux disease (GERD) and to compare massage therapy to a nonmassage therapy sham treatment in improving the mother-child interaction in these dyads.

DESIGN

In this randomized, controlled pilot study, infants received massage therapy (n=18) or a nonmassage touch/holding sham treatment (n=18). Mothers, data collectors, and the investigator who scored the feeding observations were blinded to group assignment.

SETTINGS/LOCATION

Dyads were recruited from pediatric care providers in the Denver metropolitan area and online advertisements at the University of Colorado. Treatments were given in the home of the dyad.

PARTICIPANTS

Healthy infants, born at 38-42 weeks gestational age, were 5-10 weeks of age at enrollment; had a score of at least 16 on the Infant Gastroesophageal Reflux Questionnaire-Revised; and were diagnosed with GERD by their pediatric provider. Mothers were English speaking and at least 18 years of age.

INTERVENTIONS

Treatments were given for 30 minutes twice weekly for 6 weeks. A certified infant massage therapist administered massage, and a registered nurse or physical therapist experienced with infants administered the control treatment.

OUTCOME MEASURES

Maternal and infant scores on the Nursing Child Assessment of Feeding Scale (NCAFS).

RESULTS

NCAFS scores were significantly lower than national norms. Small to moderately sized effects showing improvement in the massage group relative to the nonmassage group were seen for Sensitivity to Cues, Social-Emotional Growth Fostering, Cognitive Growth Fostering, and Clarity of Cues (Cohen d) and ranged from 0.24 to 0.56.

CONCLUSIONS

Mothers and infants with GERD experience significantly worse interactions than those without GERD. Massage given twice weekly by a professional trended toward improved interaction during feeding. Daily maternal administration of massage may have a positive effect on the relationship.

Infant behaviors are predictive of functional somatic symptoms at ages 5-7 years: results from the Copenhagen Child Cohort CCC2000

OBJECTIVE

To investigate infancy predictors of impairing functional somatic symptoms (FSS) at child ages 5-7 years with a focus on problems with feeding, sleep, and tactile reactivity.

STUDY DESIGN

This study is part of a longitudinal birth cohort study, Copenhagen Child Cohort CCC2000. Child health, development, and functioning were assessed by community health nurses at 4 home visits from birth to age 10 months. FSS at ages 5-7 years were measured by the Soma Assessment Interview in 1327 children. Sociodemographic data and information on maternal psychiatric illness were obtained from the Danish National Registers.

RESULTS

Multiple logistic regression analysis controlled for maternal psychiatric illness and annual household income revealed that combined infancy regulatory problems (ie, at least 2 of 3 problems of feeding, sleeping, or tactile reactivity during the first 10 months of living) predicted impairing FSS at 5-7 years (aOR = 2.9, 95% CI: 1.3-6.6). Maternal psychiatric illness during the child's first year of living was also associated with later child FSS (aOR = 7.1, 95% CI: 1.8-27.8).

CONCLUSION

Regulatory problems may be an early marker of disturbed sensory reactivity in young children, which together with maternal psychiatric problems, point to possible early risk mechanisms of impairing FSS in childhood.

Prior sleep problems predict internalising problems later in life

BACKGROUND

One possible risk marker of later internalising symptoms is poor sleep, which is a problem for up to 40% of children. The present study investigated whether prior sleep problems could predict internalising symptoms over a period of 18 years of follow-up.

METHODS

The study sample included 1503 French young adults from the TEMPO cohort (mean age=28.8±3.6 years) whose parents participate in the GAZEL cohort study. All TEMPO participants previously took part in a study of children's mental health and behaviour in 1991 (mean age=10.3±3.6 years) and 1999 (mean age=18.8±3.6 years). Sleep problems and internalising symptoms (depression, anxiety, somatic complaints) were assessed three times (1991, 1999, 2009) using the Achenbach System of Empirically Based Assessment (ASEBA) questionnaire. The association between sleep problems in 1991 and trajectories of internalising problems from 1991 to 2009 was tested in a multinomial logistic regression framework, controlling for sex, age, baseline temperament, behavioural problems and stressful life events, as well as family income, and parental history of depression.

RESULTS

We identified four trajectories of internalising symptoms: high-persistent (2.5%), high-decreasing (11.4%), low-increasing (11.6%), and low-persistent (74.5%). After controlling for covariates, compared to participants who did not have sleep problems in 1991, those who did were 4.51 times (95% CI=1.54-13.19, P=.006) more likely to have high-persistent internalising symptoms and 3.69 times (95% CI=2.00-6.82, P<.001) more likely to have high-decreasing internalising symptoms over the 18-year follow-up.

LIMITATIONS

Sleep problems and internalising symptoms were based on self-report questions, results should be interpreted with due caution.

CONCLUSIONS

Sleep problems early in life are associated with an increased likelihood of internalising symptoms that persist from childhood to adulthood.

Feeding Problems of NICU and PICU Graduates: Perceptions of Parents and Providers

There is little known about family experiences with pediatric feeding problems after NICU or PICU discharge. The study purposes were to better understand the family experiences with and consequences of feeding problems among NICU and PICU graduates after they transitioned home. Using a qualitative, descriptive design, 15 parents and 10 health professionals completed in-depth interviews. Data were analyzed using qualitative content analysis. Analysis revealed that feeding problems greatly impacted families. Education and resources were considered important, but generally insufficient. Though some parent-provider partnerships were strong, many others were not, and at-times, partnerships were fraught with conflict, communication problems, and lack of collaboration. System barriers and financial concerns escalated parents' distress, affecting their emotional responses. Parents' perceptions of discrepancies between their family situation and those of "normal" families violated their expectations. Understanding the perspectives of parents and providers regarding feeding problems common among NICU and PICU graduates is essential to developing effective interventions.