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Nutrition and Care

Social and Psychological Issues

 

FEEDING PROBLEMS IN YOUNG CHILDREN

Problematic  feeding behaviors occur more often in children with CF and other chronic diseases.  The use of problematic feeding behaviors is associated with lower nutrient intake and lower weight in children with CF. Children use ineffective feeding behaviors to seek caretaker attention no matter how negative the attention may seem.  Caretakers give increased amounts of attention to the child in response to these behaviors and so they are repeated.

Prevention of Behavioral Feeding Problems

Foster feeding skills appropriate at various stages of development

    Start purees at 4-6 months of age

    Transition to soft table food starting at 8-10 months

    Transition to cup by one year of age

Maintain a separation of responsibility when feeding your infant or child

    The caretaker should be responsible for when and what food and beverages are offered and for providing a non-pressured, enjoyable family meal environment.  The caretaker should also be aware that appetite may decrease because of any of the gastrointestinal issues common to CF as well as during illness.

    The child should be responsible for how much is eaten, which foods are eaten, and even if he or she is going to eat at all.

    Learn more about fostering healthy eating habits http://www.cff.org/UploadedFiles/LivingWithCF/StayingHealthy/Diet/HealthyEating/Healthy-Eating.pdf

    Support your child with alternative feeding methods.  It is not uncommon for caretakers to engage in ineffective feeding behaviors that result in less food intake rather than more and can cause a large amount of family stress.

Treatment for behavioral feeding problems

Recognize common ineffective feeding behaviors of young children and commonly employed but ineffective behavioral responses caretakers engage in.

    Child: Chatting instead of engaging in eating

    Parent: Prompting child to eat, take one more bite, eat his veggies etc

Child: Repeatedly leaving the table or disrupting the meal

Parent: Talking to the child and insisting they stay at the table and have to eat eat, eat one more bite, eat their veggies etc.

    Child: Drinking instead of eating

    Child: Not taking bites

    Parent: Urging, bribing, negotiating with the child to eat, eat one more bite etc.

Child: Not trying, refusing novel or “non-preferred food”

Parent: Urging, bribing, negotiating with child or forcing the child to eat the food, short order cooking, or providing only preferred food.

In each scenario the caretaker is giving his or her attention for a negative behavior.

Behavioral strategies that include ignoring negative behaviors and giving attention for positive eating behaviors have proven effectiveness in improving food intake and weight status in children with CF.

Positive reinforcement of specific behaviors by giving your attention when your child is eating and ignoring when not is a powerful tool in helping your child eat normally.  Let your child know specifically what he or she is being praised for. 

“Good job taking that bite”

“Good job eating your veggies”

“I like the way you finished your meat so quickly”

“I think it great the way you take your enzymes when I put it by your plate”

“Wow, I am so proud of you for trying those carrots”

Using these reinforcers with other good eaters at the table while ignoring the child who is not eating, refusing to try,  demonstrates to your child how to get your attention in a positive way and that negative ways are not effective in getting your attention.

Your child may “push back” during this change in your behavior with even more attention seeking behaviors including screaming or throwing food.  Continue to ignore these behaviors, hang in there, be consistent and the child will figure it out.

Some may need assistance from a skilled mental health professional