Clinical Interview

The clinical interview provides the clinician with an opportunity to obtain information related to the child's current feeding difficulties, feeding history, and other relevant psychosocial and developmental factors. This information is typically obtained from the child's caregiver(s) and provides an important perspective on the onset, development, and presentation of the child's feeding disorder (Linscheid et al. 2003). Given the diversity of pediatric feeding disorders, as well as the numerous potential contributors to the presenting problem, the clinical interview should focus not only on current behaviors but also on the historical course of the child's feeding problems. Developing a timeline of the child's feeding behaviors, including periods of normal feeding as well as the onset of problems, is essential. The clinician should attempt to identify any events that may have triggered the feeding problem (e.g., traumatic choking, onset of abdominal pain) or exacerbated existing problems (e.g., force-feeding). Information regarding the child's medical history can be obtained from the referring physician; however, the caregiver's perspective on this information can also be helpful.

In addition to information related to the child's feeding presentation and history, an assessment of the child's psychosocial and developmental history is important. The child's mental health history, including disruptive behaviors, mood problems, or anxiety, can be relevant to both the development and the treatment of a feeding problem. The child's developmental history, including timing of major milestones and any significant delays in development, should be assessed. Other relevant areas for assessment include the caregiver-child relationship, as well as caregiver stress and psychosocial functioning (Davies et al. 2006; Linscheid et al. 2003). Finally, pediatric feeding behaviors occur within the context of caregiver expectations regarding food and eating (Birch 1990). Such expectations, which can be influenced by personal and cultural factors, can impact the child's eating behavior and should be considered in the clinical interview. Table 11-1 lists some broad and specific areas that might be useful in conducting a clinical interview with caregivers of a child with feeding problems.

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