Normal Development and Feeding

Conceptualization of feeding problems requires an understanding of normal feeding development and of how problems can arise. The complex and dynamic process of feeding involves a sequence of hierarchical steps (e.g., accepting, chewing, propelling, swallowing). Feeding difficulties can occur at any point along this continuum, and the complexity involved during the earliest stages of feeding development may serve as the root of feeding issues (Drewett and Young 1998; Patel et al. 2002). For example, the transition from milk to solid foods represents a period of rapid developmental adaptation for infants and toddlers, and feeding-related difficulties may arise around this time (Drewett and Young 1998). Although the stages involved in feeding remain fairly consistent, parenting practices and a family's cultural beliefs may result in some variations.

In accordance with the recommendations of the American Academy of Pediatrics (1988), Satter (1999) and Kleinman (2000) outlined recommendations for feedings of infants and young children, and these recommendations have remained fairly consistent over the past 40 years. The transitions in types and textures of foods have been shown to relate closely with motor and oral feeding development (Carruth and Skinner 2002). Specifically, these guidelines recommend breast feeding or formula feedings for the first 4-6 months of life and up to at least the first year of life. Smooth foods and pureed textures are usually introduced at about age 6 months, and easily dissolvable foods between 6 and 9 months. By age 12 months, most children are introduced to table foods, and by age 24 months, most children are eating a diet consisting primarily of solid foods similar to those eaten by the entire family (Satter 1999). These guidelines caution against introducing small, hard foods during the first 2-3 years of life and recommend that single-ingredient foods be introduced separately in repeated presentations over several days. A detailed table identifying normal feeding development is provided in Figure 11-1.

Important considerations with regard to feeding development are critical and sensitive periods. According to Stevenson and Allaire (1991), a critical period is a well-defined period in which a stimulus must be applied for the individual to learn a behavior pattern, whereas a sensitive period refers to the optimal time to apply a stimulus. After the window of a sen sitive period has expired, the individual has more difficulty learning a specific behavior. After a critical period has passed, however, those particular behaviors can no longer be learned (Illingsworth and Lister 1964). For example, the period between 4 and 6 months represents a sensitive period for acceptance of new food tastes, and the critical period for chewing should occur around age 6 months, following the disappearance of the tongue protrusion reflex (see Figure 11-1). Delays during critical and sensitive periods of feeding may have serious negative consequences and may contribute to feeding issues. For example, Skuse (1993) found that infants who had not experienced chewing firm solid foods beyond 1 year often had immature and restricted tongue movements, which then often caused difficulty swallowing solid foods, leading to gagging behavior. This, in turn, led these infants to experience the swallowing of solid foods as an aversive stimulus (Skuse 1993).

New Mothers Guide to Breast Feeding

New Mothers Guide to Breast Feeding

For many years, scientists have been playing out the ingredients that make breast milk the perfect food for babies. They've discovered to day over 200 close compounds to fight infection, help the immune system mature, aid in digestion, and support brain growth - nature made properties that science simply cannot copy. The important long term benefits of breast feeding include reduced risk of asthma, allergies, obesity, and some forms of childhood cancer. The more that scientists continue to learn, the better breast milk looks.

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