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Feeding development and difficulties

Jack

  • Feeding difficulties associated with excessive milk consumption

    • Feeding problems are common in toddlers with the majority of children maintaining normal patterns of growth [1].
    • Common behaviours perceived by parents to be problematic include eating a limited variety and preferring drinks to food.  Excessive milk consumption is a common cause of poor appetite at mealtimes [1].
    • At all stages of feeding development, mealtime responsibilities are shared between parent and child in a feeding relationship that is reciprocal in nature.
      • Parents are responsible for the what when and where of feeding
      • Children are responsible for how much they will eat or if they will eat at all.
    • Concerns regarding growth even when unwarranted can disrupt the feeding relationship as parents attempt to take control over how much their child eats in an effort to promote weight gain. 
    • Strategies used to manage a perceived feeding problem may inadvertently reinforce the problem behaviour or lead to other unforeseen problems e.g. encouraging more milk may provide reassurance to parent that their child will not be hungry but this inadvertently reduces appetite for other foods.

    1.    Wright, C.M., et al., How Do Toddler Eating Problems Relate to Their Eating Behavior, Food Preferences, and Growth? Pediatrics, 2007. 120(4): p. e1069-e1075.

    Case scenario

    Jack aged 22 months is referred for assistance with feeding.  His parents are concerned that Jack has a medical problem as he has a poor appetite and will only eat well mashed foods.  Often at dinner time he refuses to eat anything.  He drinks 5-6 bottles of cow’s milk per day.  He is reported to be typically developing and growth is currently tracking along the 25th percentile on the WHO growth charts.

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    Question 1

    What are the key elements of your assessment of Jack’s feeding difficulty?

    Answer Question 1

    Key elements of your assessment include:

    • Parent’s perception of the problem.
    • Medical, developmental, growth and social history.
    • Dietary assessment.
    • Observation of feeding or interactions between Jack and his parents.

    Your assessment reveals the following details:

    Parent’s perception of the problem

    • Jack’s parents report that feeding problems began at around 9 months when Jack required admission to hospital for severe gastroenteritis.
    • During this admission he lost a significant amount of weight and it took a lot of effort for this to be regained. This was especially concerning as he has always been smaller than his peers.
    • After the gastro Jack seemed to prefer his bottle and pureed or mashed foods. Parents were happy with this as they could feed Jack and be sure he ate everything. It was also less messy. However mealtimes now take forever. Sometimes he still hasn’t finished after 40 minutes. He has lost all interest in self feeding. He is reported to eat better at childcare where he will attempt finger foods.
    • Parents are not concerned about other aspects of Jack’s development. He enjoys messy play at childcare.
    • Both parents are frustrated and stressed with feeding but are reassured by the fact that “at least he drinks his milk”.

    Medical, Developmental, Growth and Social History

    • Apart from the gastroenteritis there is no other history of illness.
    • Jack has achieved all developmental milestones as expected.
    • Plotting his weight and length measurements on appropriate growth charts shows that Jack did lose weight while unwell. However weight has been regained and growth is now tracking as previously along the 25th percentile as shown.
    • Jack is an only child who lives with both his parents. His father works full time and mother part time. He attends child care 3 days per week.
    Jack - Length Jack- Weight
    Jack - Length jpg Jack Weight

    Dietary assessment

    • Jack’s diet consists of 5-6 bottles of cow’s milk with small amounts of a variety of mashed foods.
    • Comparing Jack’s estimated requirements for energy (Kilojoules or Calories) to his intake shows that milk is meeting approximately 85% of his requirements reducing appetite for other foods.
    Estimated Energy Intake
    • Cow’s milk 5-6 bottles/day = approx. 1200 ml/day
    • Energy from milk= 3420 kJ/day
    		Estimated Energy Requirement
    • Age – 22 months
    • Weight approx. 11 kg
    • Estimated requirement = 4000 kJ /day

    Mealtime Observation

    • Mealtime observation was not possible however Jack attended the consultation. During this time he was given his bottle and was frequently prompted to have a drink even although he is happily playing with his toys and did not indicate that he was hungry or thirsty.

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