Nutritional Disorders Telehealth Network Project
An adequate diet which has sufficient caloric content and balanced nutritional composition and is developmentally appropriate. Poor or inappropriate dietary content can have indirect effects on appetite, and a developmentally inappropriate diet can affect the child’s ability to eat. Behavioral goals typically are to increase the patients’ intake of nutritious foods with the additional goals of decreasing intake of non-nutritious foods and increasing levels of physical activity in the context of disorders of overnutrition .
The ability to eat has significant anatomical and physiological dimensions, and both obvious and subtle problems of physical competence can contribute to childhood feeding disorders. Specifically, structural, anatomical, or neuromuscular dysfunction can complicate the ability to be physically active, resulting in excess weight or obesity.
The motivation to eat is a complex construct, which is determined by an exceedingly intricate interaction of many biological and environmental factors. Some are physiological and metabolic, some are related to the timing and size of meals, and some are related to the properties of food. Cultural and social factors affect the appeal of food, as do learning and conditioning. Behavioral goals are typically to promote meal schedules which increase or diminish appetite to reach the therapeutic objective.
Feeding problems can be symptomatic of a wide variety of acute, recurrent, or chronic illnesses. Therefore, the possibility of underlying disease or organ dysfunction must always be considered when feeding problems are evaluated and treated.
Parent-child interaction can be a significant factor in feeding problems. Problems can develop when the adult caregiver fails to recognize, misinterprets, or ignores cues that represent efforts to communicate nutritional needs. As children take more responsibility for feeding, caregivers may mismanage the feeding relationship by differentially attending to fussiness rather than to appropriate feeding habits. Both child and caregiver variables may contribute to feeding interaction problems.
Children who are persistently “fussy” or “difficult”, overly passive, children with attention-deficit/hyperactivity disorder, the child with autism, and the child with sensory impairments might present with feeding challenges even when other conditions are optimal. Child constitution problems interact with parent characteristics, and whether feeding becomes problematic may depend on the “goodness of fit” between caregiver and child.
Parenting competence has many dimensions: intellectual competence, child care and parenting skills, nutrition knowledge, and psychological status are among those most relevant to nutrition.
Contextual factors can contribute to the genesis or maintenance of nutrition problems. Systemic factors are aspects of the broader “ecological” context that may affect feeding interactions. Family variables such as marital conflict and financial or health problems are sources of stress that can undermine parental competence in child care. Systemic factors also may have an impact on feeding patterns outside of the home environments; for example, when children are supervised by others or in multiple environments, inconsistencies in feeding practices can create or exacerbate problems, and socioeconomic variables can affect all aspects of family functioning and child welfare.