Eating behaviour in childhood week/lecture 4/5 Flashcards
(54 cards)
1
Q
what is weaning?
A
Weaning/complementary feeding:
- Major developmental change
○ Milk to solids
○ Sucking to chewing and biting
○ Dependent to independent
2
Q
when are infants weaned?
A
- Milk energy supply cannot satisfy infant or provide nutrients
- Motor skills are developed sufficiently
- Major variability
○ Thailand: 15% some solids at 2 weeks
○ UK: 3% some solids at 6 weeks
3
Q
weaning guidelines
A
- WHO (2001) recommends weaning at 6 months (because by this point babies can sit and hold themselves and their heads up and reaching behaviours have begun)
- UK department of health adopted this in 2003
4
Q
reality of weaning in the UK
A
○ 30% introduced solids by 4 months
○ 75% introduced solids by 5 months
○ 94% introduced solids by 6 months
§ 2010 infant feeding survey, DoH, 2013
5
Q
many start weaning earlier due to
A
○ Belief that baby is hungry
○ To encourage better sleep patterns
○ Following routine used with older offspring
6
Q
oral motor skills and weaning
A
- Necessary for weaning
- Highly complex: swallowing = 31 muscle pairs (take time to develop/mature enough)
- Delayed transition to solids - miss this developmental period –> problems
- Anxieties about choking can delay transition
- Aspiration can result (if solid feeding is too late): Accidental ingestion of food or fluids into the lungs
7
Q
gag reflex
A
- Adaptive; prevents choking
- Common in the transition period
- Not serious; but caregivers can panic
○ Gagging; retch and make a lot of noise
○ Choking; will be silent - Can become hypersensitive:
○ Learned from negative experience; e.g. choking
○ Generalises to all foods, even sight of food
○ Professional help required to ‘unlearn’ response
8
Q
food choice: distinguish between non-edible substances by
A
○ Sensory qualities of food
○ Anticipated consequences of eating food
§ E.g. poisoning
○ Cultural beliefs
§ Disgust
§ Disease
- Pica (eating non-foods)
9
Q
pica
A
eating non-foods
10
Q
neophobia
A
fear of the new
- New and previously liked foods
- Decreases with age
○ 69% 2yo refuse to taste new foods
○ 29% 3yo
○ <1% 5yo
- 10-20 tastes needed before may ‘like’ food
- Exposure during weaning sets foundation
- BF and exposure (BF supports exposure and familiarity with flavour profiles)
11
Q
critical period in weaning
A
- Fewer exposures needed over weaning period
○ Birch et al., (1998): 1 exposure = 50% increase in intake in 4-7 month olds- More exposures needed after weaning
- But not critical period because…
○ Older child/adult will accept novel food eventually
○ Continued cognitive development influences further acceptance
○ Information in healthiness, for example, an influence intake
12
Q
food preferences in childhood
A
- Children prefer
○ Sweeter tastes
○ Familiar foods
○ Greater post-indigestive feedback- Children dislike
○ Bitter tastes
○ Tastes associated with illness or treatment (e.g. cancer)
○ Less post-indigestive feedback
- Children dislike
13
Q
how much to eat?
A
- Infants and young children very good at self-regulation
- Early models based on homeostatic principles
- Motivated to maintain absence of hunger
- Eat until homeostasis is restored
- Birch and Dysher (1986)
○ 2-5yo children
○ High or low energy preload snack; 40kcal vs 150kcal
○ Lunchtime energy intake measured - Compensation very accurate
- More accurate than adults
- Birch et al., (2003)
○ Eating in the absence if hunger (EAH) increases from 5-9 years - Rolls et al., (2000)
○ Macaroni cheese offered in different portion sizes
○ 2-3 year olds eat approximately same
○ 4-6 yo eat +60% if portion size doubled
14
Q
types of weaning
A
traditional and baby-led
15
Q
traditional weaning
A
○ Caregiver spoon feeding
○ Pureed –> small lumps –> larger lumps –> solids
○ Semi-prescribed order of introduction
○ May include baby jars
○ Caregivers select meals
16
Q
baby-led weaning
A
○ Self-feeding solid finger foods
○ No purees or infant specific foods
○ Same foods as family
○ More able to influence own food choice
17
Q
weaning method and child weight gain
A
- Townsend and Pitchford (2012)
○ Compared 52 spoon-fed (SF) and 54 baby-led-weaned (BLW) infants
○ Found:
§ Higher incidence of overweight/obesity in SF group
§ Higher incidence of underweight in BLW group
§ Significantly increased liking for carbs in BLW group
§ Carbs most preferred food of BLW group, sweet foods most preferred food of SF group
18
Q
why is there a correlation between weaning method and child weight gain?
A
- Type of food given:
○ SF given sweet foods more often e.g., pork and apple
○ SF learned preference for sweet foods likely influences
preferences and unhealthy food choices in future
○ BLW: Post-ingestive feedback – when choose own foods, learn that carbs are more satiating = preference- Caregiver feeding practices
○ SF infants more likely to be pressured to eat; dictated by external cues (e.g., food left in the jar)
○ General differences in familial attitudes towards food
○ NB: findings cross-sectional
- Caregiver feeding practices
19
Q
problems with BLW
A
- Only effective if caregivers haver varied diet
○ Evidence some parents/caregivers don’t have appropriate diets; high in salt, sugar, saturated fat, yet low in energy density and folate (Rowan & Harris, 2012)- Rarely ready to self-feed before 6 months
○ If guidelines change to recommend earlier weaning, then BLW not as appropriate - Some evidence BLW infants consume less food and more milk
○ Could lead to nutritional deficiencies
- Rarely ready to self-feed before 6 months
20
Q
problems with SF weaning
A
- Prolonged duration of smooth foods – delays development of oral skills (Mason et al., 2005)
- Less exposure to different textures = more food refusal later on (Northstone et al., 2001)
○ Best predictor of eating chopped carrots in 12- month-old is experiences with carrots in variety of forms / textures (Blossfeld et al., 2007) - Effect of exposure to textures does not transfer from processed baby food to homemade meals (Birch et al., 1998)
- Less exposure to different textures = more food refusal later on (Northstone et al., 2001)
21
Q
how common is inappropriate feeding?
A
relatively common
22
Q
what is inapprpriate feeding driven by?
A
- Driven by inappropriate beliefs
○ Benefits to sleep
○ Belief hunger is main cause of distress- Some generational influences
○ Parents/grandparents - Confusion over guidelines
- Some generational influences
23
Q
risk factors for inappropriate feeding
A
- Wasser et al., (2011)
○ More common in certain populations
§ Mothers with depression, obesity
§ Low SES family
§ Non-breast-fed infants
○ Links to child temperament
§ Positive association between inappropriate feeding and both ‘activity level’ and ‘distress to limitations’
§ But, may be mediated by parent self-efficacy (Anzman-Frasca et al., 2013)
24
Q
how does inappropriate feeding link to obesity?
A
- Thompson and bentley (2013) - US study
○ 217 low SES, first-time mums in US Infant Care and Risk of Obesity Study
○ 78% of infants received age-inappropriate solids and liquids at 3 months old
○ 10% given fruit juice from 2 months of age
○ 25% drinking soft drinks by 18 months; 10 x higher than breast milk consumption!
○ Associated with higher mean daily intake of over 100 kcal and higher weight-for-length ratio- Ong et al. (2006) - UK study
○ Each 100-kcal excess per day at 4 months =
§ 46% increased odds of overweight at 3 years
§ 25% increased odds of overweight at 5 years
○ Why?
§ Clear excess in energy and protein
§ Changes in hypothalamus
□ Rat studies (Bouret, 2012)
§ Learned preferences
- Ong et al. (2006) - UK study
25
what anxieties are there around weaning?
- Infant Feeding Survey (2010) found 11% UK mothers of 1-year-olds reported experiencing difficulties with weaning
○ Portion size and eating enough
○ Dealing with food rejection
○ Offering enough variety
○ Seeking helpful advice
- Clear gap in provision of weaning information and support to parents/caregivers
26
where can people get help around weaning?
Child feeding guide - website, app, online training:
- Commercialisation of research knowledge
- Free for parents/caregivers
- Training courses for childcare staff and health professionals
27
what are the 2 places where there are common feeding problems?
childrens behaviour
caregivers behaviour
28
common feeding problems in childrens behaviour
- Food refusal
- Rejection of bitter tastes
- Unhealthy food preferences
- Many common difficulties reflect natural developmental stages or learned behaviour
29
common feeding problems in caregivers behaviour
- Pressure to eat
- Food as a reward
- Food to soothe
- Restriction
- Caregivers often rely on unfavourable practices that can undermine healthy eating behaviours
30
what is food refusal characterised by?
1. Refusing new of previously liked foods
2. Rejection of bitter tastes - especially vegetables
3. Can generalise to same texture, colours, etc
31
why does food refusal occur?
○ Neophobia/developing cognition/developmentally predictable
32
common caregiver responses to food refusal
○ Pressure to eat
○ Food as a reward
33
what does pressure to eat predict?
- Predicts ‘picky’ eating in adults (Batsell et al., 2002)
○ “Bad memories of school dinners still affect the eating habits of many adults, a survey suggests” (BBC poll of 2,000 Good Food Magazine readers)
34
how does pressure to eat come about?
coercion and bribing
35
concerns of pressure to eat
- Often out of concern
○ Linked to lower child weight (Ruzicka et al., 2021)
○ Unrealistic portion sizes?
Ruzicka et al. (2021).
36
study as evidence for pressure to eat reduces intake
- Galloway et al. (2006)
○ N = 27 preschoolers (3-5 yrs)
○ 2 conditions
§ Pressured to eat soup (“finish your soup please”)
§ Control
○ Parental questionnaire about whether they used pressure to eat
○ Pressure condition
§ Did not eat more soup
§ More negative comments about soup
37
evidence that pressure to eat increases intake
- Orell-Valente et al., (2007)
○ 142 families of kindergartners (52% females)
○ Observed at dinnertime using a focused-narrative observational system
○ 85% parents tried to get children to eat more
○ 83% of children ate more than they might otherwise
○ 38% ate moderately to substantially more
38
why might pressure to eat lead to decreased intake?
○ Fear response
○ Less liking, negative associations
39
why might pressure to eat lead to increased intake?
○ Fear response
○ Over-ride internal fullness
40
study for food as a reward
- "you're not having ice cream until you've eaten your peas"
○ e.g., Birch et al. (1984). Eating as the ‘means’ activity in a contingency: effects on young children's food preferences. Child Development, 55, 432–439.
41
why might foods become less liked when a reward is offered?
negative associations
42
why might foods become more liked when a reward is offered?
prize
desired
43
studies as food to soothe
- Stifter et al., (2011)
○ 43 male infants/toddlers (3-34 months)
○ Questionnaires on use of food to soothe, parent feeding practices, parenting self-efficacy, child temperament
○ Weight and length taken
- Blissett, Haycraft and Farrow (2010)
○ 25 children aged 3-5-years
○ Ate lunch to satiety
○ Allocated to control or negative mood condition
○ Children whose mothers used food to regulate emotions ate more cookies in the absence of hunger regardless of condition
○ Children whose mothers used food to regulate emotions ate more chocolate in the negative mood condition than in the control condition
○ Shows they have already learnt to deal with emotions using food
44
use of food to soothe is associated with
○ Higher child BMI
○ More negative child temperament
○ Lower parenting self-efficacy
45
what does the use of non-reward foods lead to?
increased liking
46
can incentives work?
- Incentives can be effective at
○ Altering children's food choices (Orrell-Valente et al., 2007)
○ Increasing children's consumption of foods (Baer et al., 1987)
- Significant, sustained increases in liking in children praised for repeated tasting of a vegetable over 12 days (Cooke et al., 2011)
47
Holley, Haycraft and Farrow (2015)
- 115 parent/child pairs recruited from toddler groups
- 2.5- to 4-year-olds
- Each child assigned a target disliked vegetable based on parent rankings verified with a taste test
- Experimental group parents: offered child target vegetable outside of a mealtime for 14 consecutive days
- Control group: no offerings, just baseline and follow-up 5 minute free-eating test
- Holley, Haycraft & Farrow (2015). ‘Why don’t you try it again?’ A comparison of parent led, home based interventions aimed at increasing children’s consumption of a disliked vegetable. Appetite, 87, 215-222.
results:
- Children’s consumption of a disliked / refused vegetable can be increased via a 14-day programme of offering and tasting with incentives and praise, plus parental modelling
- Although parental modelling may impact acceptance when combined with incentives, it does not seem to be sufficient as a solo method to achieve tastings
- Just seeing a parent eating it and saying it was nice wasn't effective enough, they needed an incentive
48
what is restriction characterised by?
1. Restricting access to desired foods/drinks
2. Often high-calorie “treat” foods
49
why does restriction occur?
○ Response to child weight / health concerns
Driven by child innate preferences
50
common caregiver responses to restriction - types of restriction
○ Overt restriction (restriction that the child is aware of "can I have another one?" "No you can't"
○ Inconsistent restriction (one day they get sweets after pudding, another day they don't - gets confusing
51
studies for over restriction
- Fisher and Birch (1999) 3-5y/o
○ Two snacks in daycare
§ Snack 1 available for full duration of snack time
§ Snack 2 only available for a limited duration
○ Snack 2
§ “I want it!”
§ Clapping when available
§ Pounding fists on table when access no longer available
§ Consumed more when available
- Birch et al. (2003). Learning to overeat: maternal use of restrictive feeding practices promotes girls' eating in the absence of hunger. Am J Clinical Nutrition, 78(2), 215-20.
○ 197girls: tested at 5, 7 and 9 years
○ Girls eat lunch until full
○ Free access food/toy
○ Found restriction at 5 led to eating in the absence of hunger at 7 and 9
§ Especially if overweight
52
why does restriction lead to increased intake?
prize
desired
want something cant have
53
how does a caregiver restrict in a good way?
covertly
54
factors motivating caregiver control
- Concern about child weight
- Demographic factors
- Sex of child/parent
