Tag Archives: DSM-IV Codes

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.

You may click to see :

*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

Eating Disorder

Definition:
An eating disorder is a compulsion to eat, or avoid eating, that negatively affects both one’s physical and mental health. Eating disorders are all encompassing. They affect every part of the person’s life. According to the authors of Surviving an Eating Disorder, “feelings about work, school, relationships, day-to-day activities and one’s experience of emotional well being are determined by what has or has not been eaten or by a number on a scale.” Anorexia nervosa and bulimia nervosa are the most common eating disorders generally recognized by medical classification schemes, with a significant diagnostic overlap between the two. Together, they affect an estimated 5-7% of females in the United States during their lifetimes. There is a third type of eating disorder currently being investigated and defined – Binge Eating Disorder. This is a chronic condition that occurs when an individual consumes huge amounts of food during a brief period of time and feels totally out of control and unable to stop their eating. It can lead to serious health conditions such as morbid obesity, diabetes, hypertension, and cardiovascular disease. ANAD, or the National Association of Anorexia Nervosa and Associated Disorders is a non profit organization aimed at fighting these disorders. They work primarily in areas such as research, educating the public and running a hotline which is dedicated to referring those afflicted by disorders to support groups, therapists, or inpatient/outpatient clinics.

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Eating disorders often are long-term illnesses that may require long-term treatment. In addition, eating disorders frequently occur with other mental disorders such as depression, substance abuse, and anxiety disorders (NIMH, 2002). The earlier these disorders are diagnosed and treated, the better the chances are for full recovery.

Who Is At Risk?
Eating disorders,many people believe, occur mainly among young white females. This is not the case. While eating disorders do mainly affect women between the ages of 12 and 35, other groups are also at risk of developing eating disorders. Eating disorders affect all ethnic and racial groups and while the specific nature of the problem and the risk factors may vary, no population is exempt. Younger and younger children seem to be at risk of developing eating disorders. While most children who develop eating disorders are between 11 and 13, studies have shown that 80% of 3rd through 6th graders are dissatisfied with their bodies or their weight and by age 9 somewhere between 30 and 40% of girls have already been on a diet. Between ages 10 and 16, the statistic jumps to 80%. Many eating disorder experts attribute this behavior to the effects of cultural expectations. Stress is also considered to be a factor in the development of eating disorders. According to Abigail Natenshon, a psychotherapist specializing in eating disorders, children as young as 5 show signs of stress related eating disorders. This includes compulsively exercising and running to burn off calories. Natanshon notes that as children reach puberty younger and younger, they are less equipped to understand the changes in their bodies. They understand the message of the media to be “thin” and try to fit in without comprehending the effects on their bodies. While eating disorders affect younger and younger children, not only girls but also boys suffer from eating disorders. Boys who participate in sports where weight is an issue and often boys who experience issues regarding sexual identity are at risk of developing eating disorders.

Anorexia nervosa :……..CLICK & SEE

Anorexia nervosa is deliberate and sustained weight loss driven by a fear of becoming overweight and a distorted body image. It is not to be confused with anorexia, which is its symptomatic general loss of appetite or disinterest in food. DSM-IV characterizes anorexia nervosa as:

* An abnormally low body weight (the suggested guideline = 85% of normal for age and height, or BMI = 17.5).
* For postmenarcheal females, amenorrhea (the absence of three consecutive menstrual cycles).
* An intense fear gaining weight or becoming fat and a preoccupation with body weight and shape.

Most anorexics become so as adolescents, with 76% reporting onset of the disorder between the ages of 11 and 20.The mortality rate for those diagnosed with anorexia nervosa is approximately 6%—the highest of any mental illness—with roughly half of those due to suicide.There is a third type of eating disorder currently being investigated – Binge Eating Disorder. People who suffer from this disorder experience chronic episodes where they consume huge amounts of food in a very brief period. They experience feelings of being out of control. Unlike bulimia nervosa, they do not purge. Binge eating can lead to serious health risks such as morbid obesity, diabetes, hypertension, and an increased likelihood of cardiovascular disease.

Anorexics are commonly perfectionists, driven to succeed; yet they set unattainable standards of performance for themselves. When they fail to meet these standards, they look for a part of their lives they can control; food and weight become that “control” for them. Low self-esteem and constant self-criticism cause anorexics to constantly fear losing control, and even consuming a small amount of food could be considered a loss of control.

Bulimia nervosa………..CLICK & SEE
Bulimia nervosa is a cyclical and recurring pattern of binge eating (uncontrolled bursts of overeating) followed by guilt, self-recrimination and overcompensatory behaviour such as crash dieting, overexercising and purging to compensate for the excessive caloric intake.

Bulimics often have “binge food,” which is the food they typically consume during binges. Some describe their binge episodes as a physical high they feel, numbing out, going into auto-pilot, losing all control, immediate comfort, etc. The reasoning or triggers behind a binge may serve different purposes for different people. This binge episode leads the individual to feel guilt, shame, embarrassment, and complete failure. Bulimics try to regain control of themselves and the situation by purging the food–making up for their mistake. This leads to feeling famished and empty again, and therefore, another uncontrollable binge, followed by feeling powerless, and the vicious binge/purge cycle continues. Bulimics have extreme eating and exercising habits, instead of demonstrating moderation. This compulsive behavior is often echoed in similar destructive behavior such as sexual promiscuity, pathological lying, and shoplifting. Some bulimics not only struggle with the eating disorder, but these other harmful behaviors as well.

Binge-eating disorder……..CLICK & SEE
People with this recently recognized disorder have frequent episodes of compulsive overeating, but unlike those with bulimia, they do not purge their bodies of food (NIMH, 2002). During these food binges, they often eat alone and very quickly, regardless of whether they feel hungry or full. They often feel shame or guilt over their actions. Unlike anorexia and bulimia, binge-eating disorder occurs almost as often in men as in women (National Eating Disorders Association, 2002).

Causes:

Environmental

The media may be a significant influence on eating disorders through its impact on values, norms, and image standards accepted by modern society.  Both society’s exposure to media and eating disorders have grown immensely over the past decade. Researchers and clinicians are concerned about the relationship between these two phenomena and finding ways to reduce the negative influence thin-ideal media has on women’s body perception and susceptibility to eating disorders. The dieting industry makes billions of dollars each year by consumers continually buying products in an effort to be the ideal weight. Hollywood displays an unrealistic standard of beauty that makes the public feel incredibly inadequate and dissatisfied and forces people to strive for an unattainable appearance.  This takes an enormous toll on one’s self-esteem and can easily lead to dieting behaviors, disordered eating, body shame, and ultimately an eating disorder.

Biological

Patients with severe obsessive compulsive disorder, depression or bulimia patients were all found to have abnormally low serotonin levels. Neurotransmitters such as serotonin, dopamine and norepinephrine are secreted by the intestines and central nervous system during digestion.

Researchers have also found low cholecystokinin levels in bulimics. Cholecystokinin is a hormone that causes one to feel full and decreases eating. Low levels of this hormone are likely to cause a lack of satiative feedback when eating, which can lead to overeating. Another explanation researchers found for overeating is abnormalities in the neuromodulator peptides, neuropeptide Y and peptide YY. Both of these peptides increase eating and work with another peptide called leptin. Leptin is released by fat cells and is known to decrease eating. Research found the majority of people who overate produced normal amounts of leptin but they might have complications with the blood-brain barrier preventing an optimal amount to reach the brain.

Cortisol is a hormone released by the adrenal cortex which promotes blood sugar and increases metabolism.High levels of cortisol were found in people with eating disorders. This imbalance may be caused by a problem in or around the hypothalamus. A study in London at Maudsley Hospital found that anorexics were found to have a large variation of serotonin receptors and a high level of serotonin.

Many of these chemicals and hormones are associated with the hypothalamus in the brain. Damage to the hypothalamus can result in abnormalities in temperature regulation, eating, drinking, sexual behavior, fighting, and activity level.

While scientists have determined that there are possible biochemical or biological causes leading to eating disorders because certain chemicals which control hunger, appetite or digestions are out of balance, experts such as Dr. Edward J. Cumella, executive director of the Remuda Treatment Programs, states that there are three components to eating disorders: 1. The genetic component; 2. The unique environmental factors, such as personal experiences; and 3) The shared environmental factors, such as culture. According to Dr. Cumella, “Some people are born with a predisposition to having an eating disorder and there are genetic markers that can push a person in the direction of anorexia or bulimia…but it does not guarantee that a person will automatically suffer from an eating disorder. The environment – a person’s life experience – still has to pull the trigger.”

Developmental etiology

Research from a family systems perspective indicates that eating disorders stem from both the adolescent’s difficulty in separating from over-controlling parents, and disturbed patterns of communication. When parents are critical and unaffectionate, their children are more prone to becoming self-destructive and self-critical, and have difficulty developing the skills to engage in self-care giving behaviors. Such developmental failures in early relationships with others, particularly maternal empathy, impairs the development of an internal sense of self and leads to an over-dependence on the environment. When coping strategies have not been developed in the family system, food and drugs serve as a substitute.

Trauma
Eating disorders should also be understood in the context of experienced trauma, with many eating problems beginning as survival strategies rather than vanity or obsession with appearance. According to sociologist Becky Thompson, eating disorders stemming from women of varying socio-economic status, sexual orientation and race, and finds that eating disorders and a disconnected relationship with ones body is commonly a response to environmental stresses, including sexual, physical, and emotional abuse, racism, and poverty. This reality is further detrimental for women of color and other minority women, since they are forced to live in a culture that embraces a narrowly defined conception of beauty: “people furthest from the dominant ideal of beauty, specifically women of color, may suffer the psychological effects of low self-esteem, poor body image, and eating disorders.

Gender wise:
“Frequent dieting and trying to look like persons in the media were independent predictors of binge eating in females of all ages. In males, negative comments about weight by fathers was predictive of starting to binge at least weekly.

Diagnosis:
Clinically, eating disorders are evaluated using instruments such as the Questionnaire of Eating and Weight Patterns (QEWP), which has specialized versions for adolescents and parents (QEWP-A, and QEWP-P). In addition to evaluating eating patterns, these tests also measure depression.

Medical problems that may arise as a result of eating disorders:

* Anorexia nervosa – Anorexia can slow the heart rate and lower blood pressure, increasing the chance of heart failure. Those who use drugs to stimulate vomiting, bowel movements, or urination are also at high risk for heart failure. Starvation can also lead to heart failure, as well as damage the brain. Anorexia may also cause hair and nails to grow brittle. Skin may dry out, become yellow, and develop a covering of soft hair called lanugo. Mild anemia, swollen joints, reduced muscle mass, and light-headedness also commonly occur as a consequence of this eating disorder. Severe cases of anorexia can lead to brittle bones that break easily as a result of calcium loss.
* Bulimia nervosa – The acid in vomit can wear down the outer layer of the teeth, inflame and damage the esophagus (a tube in the throat through which food passes to the stomach), and enlarge the glands near the cheeks (giving the appearance of swollen cheeks). Damage to the stomach can also occur from frequent vomiting. Irregular heartbeats, heart failure, and death can occur from chemical imbalances and the loss of important minerals such as potassium. Peptic ulcers, pancreatitis (inflammation of the pancreas, which is a large gland that aids digestion), and long-term constipation are also consequences of bulimia.
* Binge-eating disorder – Binge-eating disorder can cause high blood pressure and high cholesterol levels. Other effects of binge-eating disorder include fatigue, joint pain, Type II diabetes, gallbladder disease, and heart disease.

Treatment:
* Anorexia nervosa – The first goal for the treatment of anorexia is to ensure the person’s physical health, which involves restoring a healthy weight (NIMH, 2002). Reaching this goal may require hospitalization. Once a person’s physical condition is stable, treatment usually involves individual psychotherapy and family therapy during which parents help their child learn to eat again and maintain healthy eating habits on his or her own. Behavioral therapy also has been effective for helping a person return to healthy eating habits. Supportive group therapy may follow, and self-help groups within communities may provide ongoing support.
* Bulimia nervosa – Unless malnutrition is severe, any substance abuse problems that may be present at the time the eating disorder is diagnosed are usually treated first. The next goal of treatment is to reduce or eliminate the person’s binge eating and purging behavior (NIMH, 2002). Behavioral therapy has proven effective in achieving this goal. Psychotherapy has proven effective in helping to prevent the eating disorder from recurring and in addressing issues that led to the disorder. Studies have also found that Prozac, an antidepressant, may help people who do not respond to psychotherapy (APA, 2002). As with anorexia, family therapy is also recommended.

.* Binge-eating disorder – The goals and strategies for treating binge-eating disorder are similar to those for bulimia. Binge-eating disorder was recognized only recently as an eating disorder, and research is under way to study the effectiveness of different interventions (NIMH, 2002).

You may click for more information :->BBC NEWS:20 Dec.2000

->National Institute Of Mental Health

Resources:
http://en.wikipedia.org/wiki/Eating_disorder
http://mentalhealth.samhsa.gov/publications/allpubs/ken98-0047/default.asp

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