Nonorganic failure to thrive: a theoretical approach

Eating behavior disorders in Chilean infants

Eating behavior disorders (EBD) are often observed in children. Most of the related research, however, has been performed in developed countries. In countries like Chile, characterization of food disorders during the first years of life is unknown.

OBJECTIVE

The goal of the current study is to characterize the EBD of Chilean children during the first 2 years of life.

METHODS

We studied 67 children (mean age = 5.4 months; range = 4-24 months). The study group (SG; according to criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders) consisted of 34 children with EBD whose mothers spontaneously consulted for difficulties for feeding and the control group (CG) included 33 healthy children. A structured recall was applied to their mothers.

RESULTS

EBD onset was observed more frequently during the first semester of life and was associated with new foods. The children in the SG presented with lower birth weight (SG: 3,000 +/- 500 g; CG: 3,400 +/- 500 g; p < .001), weight/length (-0.4 +/- 1.0 vs. 0.8 +/- 1.1; p = .0001), and length/age z scores (-0.7 +/- 1.0 vs. -0.1 +/- 0.8; p = .007) than children in the CG. Early weaning before 4 months of age was more frequently found in the SG (44.1% vs. 12.1%; p = .04). The logistic regression showed as variables those associated with EBD, that is, birth weight and maternal history of EDB during her infancy (chi(2), p = .0003). Mothers of children in the SG felt that their maternal role was more difficult and less satisfactory than mothers of children in the CG (chi(2), p = .03).

DISCUSSION

EBDs in Chilean infants are observed during the first months of life and are associated with a lower birth weight, shortened exclusive breast-feeding, maternal history of EBD during their infancy, and lower physical growth. Mothers of children with EBD frequently feel that their maternal role is difficult and unsatisfactory.

Improving Preschoolers' self-regulation of energy intake

BACKGROUND

Children exhibit individual differences in their ability to self-regulate energy intake. Feeding strategies that focus on external signals, like the time of day or amount of food left on a plate, tend to diminish children's ability to respond to internal cues of hunger and fullness.

OBJECTIVES

We investigated whether children could be taught to focus on internal cues of hunger and satiety, and consequently improve their self-regulation of energy intake. We explored whether parents' eating behaviors and adiposity were related to their children's self-regulation skills and adiposity.

DESIGN

In a pretest and posttest design, preschoolers participated in single-meal protocols to assess their individual ability to self-regulate food intake. During a 6-week intervention period, children took part in individual and group activities designed to help them recognize internal cues. Parents completed questionnaires regarding adult dietary restraint and disinhibition.

RESULTS

At baseline, we found a large individual variability in children's regulation: some children overate, some regulated accurately, and others underate. At baseline, children's eating related to their adiposity and to mothers' disinhibition: heavier children and children whose mothers' reported difficulty controlling food intake showed less evidence of self-regulation. Both overeaters and undereaters responded to the intervention, improving their ability to self-regulate, and children's eating was no longer significantly related to mother's eating.

CONCLUSIONS

Children's disregulated energy intake is related to mothers' weight status and mothers' perceived control over eating. Cues can be provided that help children to focus on internal signals and improve their ability to self-regulate energy intake.