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Feeding Problems

Definition:–
Feeding problem of infancy or early childhood is characterized by the failure of an infant or child under six years of age to eat enough food to gain weight and grow normally over a period of one month or more. The disorder can also be characterized by the loss of a significant amount of weight over one month. Feeding disorder is similar to failure to thrive, except that no medical or physiological condition can explain the low food intake or lack of growth.
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Infants and children with a feeding disorder fail to grow adequately, or even lose weight with no underlying medical explanation. They do not eat enough energy or nutrients to support growth and may be irritable or apathetic. Factors that contribute to development of a feeding disorder include lack of nurturing, failure to read the child’s hunger and satiety cues accurately, poverty, or parental mental illness. Successful treatment involves dietary, behavioral, social, and psychological intervention by a multidisciplinary

Feeding problems are common throughout childhood and affect both boys and girls.

Causes:–
The kind of feeding problem may depend on the age of the child.

Some new mothers take a while to get the hang of breastfeeding and may worry they’re not producing sufficient milk or their baby isn’t satisfied. But as long as the baby is gaining weight at the normal rate, there’s no need for concern.

Occasionally, early feeding problems are due to anatomical difficulties (for example, a severe cleft palate or oesophageal atresia) or more general illness, but these are usually quickly identified.

Minor infections, such as a cold, can interrupt established feeding patterns, but rarely for long.

Gastro-oesophageal reflux disease (GORD) can also make feeding difficult, affect weight gain and cause great stress for parents.

More serious conditions can interfere with the absorption of food and weight gain, including coeliac disease, cystic fibrosis, inflammatory bowel disease and food intolerance.

In toddlers and older children, emotional and social factors can cause feeding problems. Older children, especially girls, are more likely to develop eating disorders such as anorexia nervosa and bulimia.

Symptoms:–
The symptoms of feeding disorders can vary, but common symptoms include:

•Refusing food
•Lack of appetite
•Colic
•Crying before or after food
•Failing to gain weight normally
•Regurgitating or vomiting
•Diarrhoea
•Abdominal pain
•Constipation
•Behavioural problems

Diagnosis :–
Between 25% and 35% of normal children experience minor feeding problems. In infants born prematurely, 40% to 70% experience some type of feeding problem. For a child to be diagnosed with feeding disorder of infancy or early childhood, the disorder must be severe enough to affect growth for a significant period of time. Generally, growth failure is considered to be below the fifth percentile of weight and height.

Feeding disorder of infancy or early childhood is diagnosed if all four of the following criteria are present:

•Failure to eat adequately over one month or more, with resultant weight loss or failure to gain weight.
•Inadequate eating and lack of growth not explained by any general medical or physiological condition, such as gastrointestinal problems, nervous system abnormalities, or anatomical deformations.
•The feeding disorder cannot be better explained by lack of food or by another mental disorder, such as rumination disorder.
•The inadequate eating and weight loss or failure to gain weight occurs before the age of six years. If feeding behavior or weight gain improves when another person feeds and cares for the child, the existence of a true feeding disorder, rather than some underlying medical condition, is more likely.

Treatments :-
Successful treatment of feeding disorders requires a multidisciplinary team approach to assess the child’s needs and to provide recommendations and education to improve feeding skills, behavior, and nutrient intake. The multidisciplinary team for treatment of feeding disorders in childhood usually includes physicians specializing in problems of the gastrointestinal tract or of the ear, nose, and throat; a dietitian, a psychologist , a speech pathologist, and an occupational therapist. Support from social workers and physicians in related areas of medicine is also helpful.

An initial evaluation should focus on feeding history, including detailed information on type and timing of food intake, feeding position, meal duration, energy and nutrient intake, and behavioral and parental factors that influence the feeding experience. Actual observation of a feeding session can give valuable insight into the cause of the feeding disorder and appropriate treatments. A medical examination should also be conducted to rule out any potential medical problems or physical causes of the feeding disorder.

After a thorough history is taken and assessment completed, dietary and behavioral therapy is started. The goal of diet therapy is to gradually increase energy and nutrient intake as tolerated by the child to allow for catch up growth. Depending on the diet history, energy and nutrient content of the diet may be kept lower initially to avoid vomiting and diarrhea. As the infant or child is able to tolerate more food, energy and nutrient intake is gradually increased over a period of one to two weeks, or more. Eventually, the diet should provide about 50% more than normal nutritional needs of infants or children of similar age and size.

Behavioral therapy can help the parent and child overcome conditioned feeding problems and food aversions. Parents must be educated to recognize their child’s hunger and satiety cues accurately and to promote a pleasant, positive feeding environment. Changing the texture of foods, the pace and timing of feedings, the position of the body, and even feeding utensils can help the child overcome aversions to eating. If poverty, abuse, or parental mental illness contribute to the feeding disorder, these issues must also be addressed.

Prognosis :-
If left untreated, infants and children with feeding disorders can have permanent physical, mental, and behavioral damage. However, most children with feeding disorders show significant improvements after treatment, particularly if the child and parent receive intensive nutritional, psychological, and social intervention.

Prevention :-
Providing balanced, age-appropriate foods at regular intervals—for example, three meals and two or three snacks daily for toddlers—can help to establish healthy eating patterns. If a child is allowed to fill up on soft drinks, juice, chips, or other snacks prior to meals, appetite for other, more nutritious foods will decrease.

Positive infant and childhood feeding experiences require the child to communicate hunger and satiety effectively and the parent or caregiver to interpret these signals accurately. This set of events requires a nurturing environment and an attentive, caring adult. Efforts should be made to establish feeding as a positive, pleasant experience. Further, forcing a child to eat or punishing a child for not eating should be avoided.

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*Feeding Problems in Infants and Children…
*Problems feeding your baby?

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/feedingproblems2.shtml
http://www.minddisorders.com/Del-Fi/Feeding-disorder-of-infancy-or-early-childhood.html

http://www.brighttomorrowstoday.com/behavior-feeding-therapy.html

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Anorexia Nervosa: A serious eating disorder

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..click & see is a developmental period fraught with the physical and psychological changes that accompany the transition from childhood to adulthood. Teenagers must cope with the establishment of independence from parents, the creation of personal identity, the development of intimate relationships with members of the opposite sex, and the bodily changes that herald adulthood. Often, the key to self esteem lies in feelings about physical attractiveness. In our society, the high premium placed on thinness can create anxiety during this metamorphosis. Considering the myriad of social, academic, and parental pressures adolescents must face, it s no wonder some adolescents develop physical and psychological disturbances….click & see

A common manifestation of such disturbances is the development of an eating disorder. The incidence of the three common eating disorders    anorexia nervosa, bulimia, and obesity have increased in the last decade. Among women aged 15 to 30, incidence rates are roughly 30 percent for obesity, 10 percent for bulimia, and one percent for anorexia nervosa. Although the least common of these three eating disorders, anorexia nervosa carries the gravest medical and psychological consequences.

Anorexia nervosa is a serious condition wherein a person systematically restricts food intake to the point of extreme emaciation. In 1689, a physician first described a patient with this illness as “a skeleton wrapped up in skin.” Anorexia nervosa is also characterized by an irrational fear of becoming obese, denial of physical discomfort, excessive physical activity, and high self expectations. Although “anorexia” means lack of appetite, people with anorexia nervosa may actually be concealing a large appetite. In fact, they are morbidity preoccupied with food and fear losing control and falling victim to binge eating.

Alarmingly, the incidence of anorexia nervosa has doubled over the past two decades. Most anorectics are white and come from middle class or upper middle class families. Some 90 to 95 percent of those with anorexia nervosa are female.

Anorexia nervosa usually begins in adolescence. A typical case is a mildly overweight teenager who believes herself to be overweight. She reduces her weight by 5 to 10 pounds. Rather than stopping there, she finds it becomes easier and easier to lose weight. Whether this continued weight loss stems from a boost to her self esteem or from physiologic changes secondary to starvation is unclear. The weight loss is maintained by severe restriction of caloric intake or food restriction alternating with periods of binge eating that end in self-induced vomiting or purging with laxatives and diuretics (“water pills”).

Regardless of the method of attaining the weight loss, the danger is that further emaciation may progress unremittingly until death. The overall mortality rate has been reported to be between two and 15 percent. One reason the patient allows herself to pursue this macabre wasting course is attributed to a “body image disturbance.” Specifically, patients with anorexia nervosa deny they are too thin or that they experience any physical discomfort from their self-imposed starvation. In fact, they may insist they are still slightly overweight even when severely emaciated. Surprisingly, the parents may also deny the existence of a problem. Therefore, teenagers with anorexia nervosa often come to medical attention in a severe state of inanition. The physical and psychological consequences can be severe.

Of the psychological consequences, the most feared is suicide. Although the incidence of suicide among anorectics is relatively low (two to five percent), it is high compared to the general population. Other psychological problems, such as depression, obsessive-compulsive behavior, and difficult family relationships may persist even after weight gain.

The most common physical manifestations of anorexia nervosa in women are amenorrhea (absence of menstruation) and estrogen deficiency. The latter may contribute to osteoporosis (brittle bones). A host of other hormonal disturbances often accompany anorexia nervosa. Imbalance in body chemistry can also have dire consequences. For example, starvation, vomiting. laxative, and diuretic abuse can all cause dangerous lowered levels of potassium in the blood. Low potassium can cause disturbances in the heart s rhythm and even cardiac arrest, the leading cause of death in anorexia nervosa. Additionally, many anorectics also have abnormally slow heart rates and low blood pressure.

Disorders of the gastrointestinal tract, such as constipation, are common. Anorexia nervosa also predisposes patients to kidney stones. Because malnourishment impairs the immune system, patients are at an increased risk for infection.

In short, the consequences of anorexia nervosa are diverse and many are serious. But, what causes anorexia nervosa? No one knows for sure. This disease can vary along a broad spectrum of severity ar-id may have just as broad a spectrum of contributing causes. Theories incorporate sociocultural factors, occupational and recreational environments. psychological causes, and neurochemical abnormalities.

Western society may play an important role because of the emphasis placed on thinness, especially for women. In a society where one is held personally responsible for one s body type (“you are what you eat”), obesity is tantamount to failure. Other societal pressure such changes in the ecology of food and eating (eg. high calorie fast foods), alterations in family and community life, and nuclear threat have also been implicated as contributing to rising rates of anorexia nervosa.

Occupational and recreational environments that put women at risk for anorexia nervosa are those that stress thinness such as ballet and athletics. Both the strenuous physical training and the restricted calorie intake contribute to the development of the disease.

Anorexia nervosa used to be viewed as primarily a psychological disorder. Now, the many physical complications are given equal attention. However, normal psychological functioning is often impaired. Patterns of early developmental problems and disturbed family interactions, accompanied by depression are often noted. Patients often experience a paralyzing feeling of ineffectiveness. Weight loss may be a defense against such feelings, a way to gain control over one s self.

Current research is focusing on a search for abnormalities in the hormones and chemicals that transmit nervous impulses in the brain. Whether these disturbances are the underlying cause of anorexia nervosa or are a result of starvation remains to be seen.

While the definitive cause of anorexia nervosa is unknown, treatment will probably continue to be largely unsatisfactory. Denial of the illness by the teenager and family alike impede compliance with treatment.

Current treatments include nutritional rehabilitation, individual, group, and family psychotherapy, and occasionally, antidepressants. In severe cases, the teen is hospitalized to correct physical imbalances or to prevent possible suicide. Unfortunately, relapses are common.

Anorexia nervosa is a serious illness with grave consequences. It is disturbing to health care professionals that the incidence is rapidly rising. Hopefully, in the future, the exact cause of anorexia nervosa will be discovered allowing for better treatment.

Click to learn about Alternative medical treatment of Anorexia Nervosa

Click to learn about Homeopathic remedy of Anorexia Nervosa

Anorexia and Pregnancy
Source: www.kidsgrowth.com

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