Feeding disorders are psychological conditions that occur during infancy and early childhood, and result in insufficient intake of foods. Existing feeding disorder research identifies a raft of factors associated with predisposition, development and maintenance of feeding disorders, as well as a multitude of potential outcomes for the child and the system around them. However, neither feeding disorders nor their aetiological bases are well defined or uniformly applied in general, academic or clinical domains. Furthermore, the relationships and differences between observable characteristics, diagnostic criteria, and problem perceptions, and the bearing of these on disorder identification and treatment, are under-researched. The numerous definitions and profiles for feeding disorders make comprehension and knowledge gathering very difficult for caregivers and researchers, and thus hinder research and clinical progression in the field. The overarching aim of this thesis was to examine and characterise paediatric feeding disorders. The objective was to characterise and triangulate what feeding disorders are in terms of observable appearance, external perception, and psychometric properties, and better understand what constitutes a feeding disorder from multiple relevant perspectives. A mixed methods approach was taken to the collection and analysis of data, to obtain both depth and breadth of information. The results of the current thesis suggest that feeding disorders are characterised by a variety of behaviours and features within a biopsychosocial model. While physical models of feeding disorders are outdated, the potential for underlying physical contributing factors and resultant physical outcomes was highlighted throughout the current research and should not be ignored. However, overreliance on physicality, under-recognition of psychological processes, and consequent deficits to disorder identification within clinical settings, was also illustrated within the research. Furthermore, significant issues were raised regarding the lack of a consistent and inclusive model of feeding problems and disorders within healthcare systems. Though most clinicians saw feeding on a scale from normal to abnormal and frequently emphasised the value of early identification and treatment, the referral and treatment pathways that were discussed whereby only the most severe or physically affected children were treated, were not consistent with these models. Interviews with mothers highlighted the role of intrinsic child factors within the development of disordered feeding, including challenging behavioural characteristics, sensory sensitivities, difficult temperament, and lack of feeding motivation or avoidance of new foods. The importance of these child factors was supported by psychometric assessment, which identified distinct patterns of child characteristics associated with different types of problematic or disordered feeding, and a strong association between disordered feeding and the parent perception of having a difficult child. Furthermore, video observations of child mealtimes highlighted not only disparity in the amount of food eaten between disordered and non-disordered children, but a considerable deficit in the level of interest, motivation, and engagement with feeding shown by disordered children. Deficits to child feeding motivation pose a problem for parents that is less obvious than extreme emotional reactions, but which can be equally distressing for the parent who views nourishing their child as one of their major responsibilities. This point was reinforced across parent interviews and mealtime observations, and should be a key factor in the identification of families in need of support and intervention. Parent interviews, healthcare professional interviews, and psychometric assessment, all highlighted the considerable presence and role of parent anxiety within feeding disorder development. Parent anxiety was discussed as a potential cause and an outcome of challenging feeding behaviour, exacerbated by the perceived extent of the child s feeding condition and the dearth of support and information about dealing with significant feeding issues. Anxiety was seen by parents and healthcare professionals to influence the feeding strategies used by parents, and without intervention to contribute to a downward spiral of negative feeding interactions. Disordered feeding was also seen to interfere with social interactions, which would otherwise play an important role in the child s feeding and dietary development, and provide social support and guidance for parents. These patterns of problem and disorder perpetuation are liable to persist while general and clinical understanding of feeding disorders is minimal and inconsistent. The findings of the current thesis pose a great variety of potential influences and risk factors for feeding disorder development, supporting an individualistic approach to disorder identification and intervention, and the need for a significant change in the current systems for dealing with feeding disorders. It is essential to take each of the different components into consideration to understand the specific mechanisms underpinning the maintenance of the feeding disorder and aid selection of the most suitable and efficient approach to intervention. The pattern of factors implicated in each individual feeding disorder case will be differentiated according to the child, the parent and the child s general environment. Identification of the full range of children in need of support and intervention is reliant on recognition of the diversity in disorder type, severity and presentation.

Bakgrund Sömn och matproblem är vanliga hos små barn. Bekymren kan vara stora och föräldrarna i behov av professionell hjälp. Barnavårdscentralerna har stor stöd- och hjälpfunktion men inte alltid resurser för detta. I Uppsala län finns en specialbarnavårdscentral som erbjuder råd och stöd vid dessa problem. Syfte med studien var att studera föräldrarnas bedömning av barnets sömn- eller matproblem före och efter kontakt med Special-BVC, samt om det fanns ett samband mellan antal kontakter och föräldrarnas bedömning av barnets situation efter avslutat kontakt. Metod Designen var en deskriptiv, komparativ studie där 67 av 102 (66 %) föräldrar besvarade frågor om förhållanden före och efter kontakt med Special-BVC. Resultat Inom flera områden minskade barnens sömn- eller matproblem efter kontakten med enheten. Emellertid bedömde föräldrar till barn med matproblem att dessa fortfarande var ett problem för barnet men inte för familjen medan barns problem gällande sömn minskat både för barnet och familjen. Diskussion Kvalitetssäkring av vårdverksamheters resultat är viktigt. Studien visade att Special-BVCs arbete ledde till en förbättrad situation för familjerna. Barnen hade haft sina problem länge, i genomsnitt tio månader. Många familjer borde kunna få hjälp på sin ordinarie BVC genom primärprevention eller genom tidiga sekundärpreventiva åtgärder. Special-BVCs arbetsmetodik borde därför spridas till den ordinarie BVC-verksamheten. / Background Sleeping and feeding problems are common in young children. The problem can be large and the parents need professional help. The Child Health Clinics aim to give help but hasn’t always enough resources. In Uppsala, a Specialist Child Health Team (Special-BVC) provides help to families with special needs. Aim was to study parents’ assessment of their child’s sleep or feeding problems before and after contact with "Special-BVC" and the relation between number of contacts and the child’s situation after the contact. Method The design was a descriptive, comparative study where 67 of 102 (66%) parents answered two questionnaires measuring the situation before and after contact with Special-BVC. Results In many areas the children's sleep or feeding problems decreased after the contact. Parents to children with food problems thought the child’s situation still was a problem for the child but not for the family, whereas parents to children with sleeping problems thought the problematic situation hade improved both for the child and the family. Discussion Quality assurance of care is important. The study showed the work done by Special-BVC improved the situation for the families. The children had had their problems a long time, an average of ten months. Many families should be help from their regular child health clinics through primary prevention or earlier secondary prevention. The working methods used at the Special-BVC should be disseminated to the regular child health clinics.