Feeding Behaviours in Early & School Years - Paediatric-Nutrition

Carine Henry RD
Nutritional Assessment
Dietary Treatment
Diet-related Conditions
- Feeding Difficulties in Infancy
  
  Feeding difficulties include a range of scenarios where infants are not willing to feed in order to meet their nutritional needs.
- Feeding Behaviours in Early & School Years
  
  Feeding behaviours respond well to a framework of structure, nurture & boundaries, including feeding difficulties, toddler refusal and ARFID.
- Cows Milk Difficulties
  
  Cow’s Milk Allergy affects 1 in 20 infants in their first year of life. It is a spectrum condition, with a wide range of presentations, sometimes difficult to distinguish from other common problems in infancy.
- Gastrointestinal Symptoms
  
  Constipation describes from the slow movement of poo through the bowel, which is affected by body movement, food, fibre and fluid intake, breath, stress & anxiety, repeated illness and the quality of the gut microbiota.
- Disordered Eating in Teens
  
  Most young people comfort eat at some point, we all do, because food feels nice and when we eat, neurochemicals like dopamine are released into the bloodstream, making us feel good. It’s absolutely normal to comfort eat from time to time.
- Eating Well for the Whole Family
  
  Dieting or not sharing foods with other family members, can feel difficult and upsetting at a deep and unconscious level.
Dietary Treatment Tools

Structure Nurture and Boundaries

Carine uses this framework in all the work she does with infants, children, teens and families. She acts as nutrition educator, guide and supporter, providing resources and strategic tools.

Benefits of Diet Diversity

A diverse diet is the single most valuable way of meeting a child’s nutritional needs. The first nutritional need for a child to thrive well is energy.
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Food Refusal in Toddlers

Food refusal is a normal developmental phase in toddlers, the so-called neo-phobic phase, when young children become selective about the food they eat. Beginning around 12-18 months, toddler’s developmental tasks are focussed on exploration, movement and play. They are also developing the power to say “no!”. Toddlers with limited experience throughout the sensitive weaning period e.g. because of repeated illness, allergies or feeding aversion, find it more challenging to accept new tastes and textures. Those toddlers often have limited variety and show preference for easier, soft textures and sweeter, bland tastes. They may also prefer to fill up on milk. Compromising diet diversity and key nutrients such as iron, Vitamin C and folic acid, young children will usually grow out of this phase with exposure, practice and encouragement. Managing these behaviours over the toddler years and supporting their relationship with food and feeding is a valuable task that responds to a consistent framework. What I call Structure, Nurture and Boundaries.

Structure, Nurture & Boundaries

Why young children refuse food

The most likely reason for extreme food refusal in toddlers is continued lack of experience. Toddlers who reach the neo-phobic phase whilst only being used to a few tastes and textures, will find it more difficult to accept unfamiliar foods. They have not yet acquired the necessary feeding skills to chew, sift, organise and swallow a wider range of foods. Unfamiliar foods or difficult textures like meat will present greater challenges and are therefore often refused, held in the mouth or provoke gagging. Key nutrients like iron will be limited, and if prolonged, may result in iron deficiency or other nutritional deficiencies. Gagging and vomiting can become a learned response, and so behavioural management is needed to limit distress, which will only make matters worse! Young children will gradually progress; broaden their experience and learn to accept new tastes and textures. Consistent exposure to “next steps” foods, with reassurance, encouragement, positive feedback and praise.

Understanding ARFID

A highly selective eating-disorder in children or young people, ARFID presents with responses to food including anxiety, disinterest, sensory processing differences, nutritional deficiencies and eating a narrow range of foods. Differences are often present in how a person experiences foods and occurs more commonly within individuals within a neuro-variant spectrum. Sensory differences in e.g. touch, look, mouthfeel, texture, taste and smell, as well as heightened anxiety or selectiveness about eating, especially unfamiliar foods, may be present. Eating of a narrow range of foods puts children and young people at risk of nutrition deficiencies and growth faltering is an additional concern for children with ARFID. Nutritional assessment is essential to consider next steps in dietary advice, supplementation and behavioural modifications to support children who experience ARFID. I work with a nutritional and behavioural lens, to extend what is more easeful and accessible, attending, in the first instance, to nutrient deficiencies highlighted in the initial nutritional assessment with nutrient supplementation and food fortification.

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Paediatric Nutrition

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Nutritional Assessment Dietary Treatment