The understanding of maternal factors associated with child feeding problems is limited due to a lack of research which has examined a comprehensive range of maternal factors and the existing literature focussing on a narrow range of ideas about the wider familial context in which feeding problems occur. The broad aim of this thesis is to investigate maternal parenting of children with and without clinical feeding problems to provide insights into the wider context in which feeding problems occur. In study 1, thematic analysis of interviews with 10 mothers of children with, and 10 mothers of children without, clinical feeding problems revealed that mothers of children with clinical feeding problems appeared to have less maternal self-efficacy for managing parenting challenges than mothers in the non-clinical group. A template analysis found that these perceptions seemed to be informed by four theoretical sources of self-efficacy: mastery experiences, verbal persuasion, vicarious experience and physiological state. In study 2, 278 mothers of children with and without clinical feeding problems completed existing self-report measures of maternal self-efficacy. It was found that lower levels of maternal self-efficacy for establishing structure and routine around instrumental child care tasks and for implementing discipline and setting limits for the child was predictive of problematic child feeding behaviour and maladaptive maternal responses to child feeding problems. In study 3, 215 mothers of children with and without feeding problems completed self-report measures of the theoretical components of self-efficacy (mastery experiences, verbal persuasion, vicarious experience, physiological state). Physiological state was found to be the strongest predictor of maternal self-efficacy for establishing structure and routines as well as for providing discipline and setting limits for the child. Maternal self-efficacy mediated the relationship between physiological state and problematic child feeding behaviour and the relationship between parenting stress and maladaptive maternal responses. The final study was a pilot study using autophotography. This study explored parenting dimensions and tasks which contributed towards perceptions of maternal self-efficacy in 13 mothers of children without clinical feeding problems. Findings suggested that child feeding was an especially difficult and complex task for mothers to manage, with many mothers reporting perceptions of low efficacy for managing mealtimes. This appeared to be due to the large number of health related concerns and the worry mothers felt when children did not eat a healthful diet. Overall, results of this thesis suggest that mothers who lack confidence in their ability to manage child behaviour report more problematic child feeding behaviours and use more maladaptive strategies for managing feeding problems. Findings of the studies in this thesis suggest that mothers of children with feeding problems, and who are experiencing high levels of stress, may be especially vulnerable to lower levels of maternal self-efficacy which may exacerbate difficulties. Increasing maternal self-efficacy for providing structure, routines and discipline in mothers experiencing feeding problems in their children may improve outcomes for those affected.

No description available.

The purpose of this study was to determine the efficacy of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) in identifying children at risk for feeding difficulties when given to parents by interview versus without assistance. Thirty subjects from Emory Developmental Progress Clinic (Emory DPC) participated in the study and were randomized to receive the BPFAS either by interview or without assistance. Mean BPFAS scores were compared by survey administration method and nutrition referral status for the total cohort as well as by age (1.5 year) and weight status (<25th percentile, 25-75th percentile, >75th percentile) using the t-test. The association between survey administration method as well as nutrition referral status and referral score category (84) was determined using the Chi-square test, as was the relationship between nutrition referral status and the response to each BPFAS question. No difference in mean BPFAS score or referral score category by survey administration method was found in the total cohort. However, a higher BPFAS score was observed for children >1.5 years of age who were referred for nutrition intervention vs. not referred (95.33 vs. 62.5, respectively; p=0.004). There was also a significant association between the number of patients referred for nutrition intervention vs. not referred and referral score (11 vs. 19, respectively; p=0.041). There was no association between responses to individual BPFAS questions and nutrition referral status. In conclusion, evaluation of other feeding assessment surveys or the in-house development of a screening tool may be better alternatives for the Emory DPC.

A prospective, longitudinal and observational study, using a non-clinical population of mother-child dyads was conducted to evaluate the contribution of family-environmental factors in predicting child food avoidance and feeding problems across early childhood. The contribution of maternal feeding practices, mealtime structure and interactional behaviour during mealtimes, were explored in predicting child food avoidance between 2 and 5 years, whilst also evaluating the role of maternal psychopathology and child temperament. This thesis also assessed the validity of maternal reports of child eating behaviour and feeding practices by obtaining independent observations of these constructs, and explored the longitudinal stability and continuity of both independent observations and maternal reports of child eating behaviour and maternal feeding practices. Concurrently and prospectively, observations of mothers eating with their child, displaying high sensitivity, low control, and more positive emotion and verbalisation during mealtimes predicted less avoidant child eating behaviour. Reports of mothers providing a healthy food-related home environment, encouraging balanced food intake, and involving their child in food planning, in addition to a less emotional child temperament, were also significant longitudinal predictors of less avoidant child eating behaviour. Maternal descriptions of their child s eating behaviour were validated by independent observations; however maternal descriptions of their own feeding practices were not. Child eating behaviour and maternal feeding practices were predominantly stable and continuous across early childhood, with the exception of child difficulty to feed and maternal pressure to eat which decreased between the ages of 3 and 4. This thesis demonstrates many interesting and novel findings but primarily through the utilisation of observational and longitudinal data it demonstrates the important causal contribution of family-environmental factors in the development of food avoidant eating behaviours during early childhood.

A feeding disorder occurs when a child does not consume enough food to meet his or her caloric needs to gain weight and grow. Approximately 25% to 40% of infants and toddlers with normal development and 33% to 80% of infants and toddlers with developmental disabilities are affected by feeding problems. Types of treatments used to address feeding problems commonly include behavioral treatments that involve escape extinction or medical procedures that involve a gastrostomy tube. Both types of treatments are associated with negative side effects. The purpose of the current study was to evaluate the individualistic and interactive effects of response effort and quality of reinforcement on bites accepted within an outpatient clinic program with five children diagnosed with feeding problems. The effects of effort and quality were studied as motivating operations, meaning that their presence altered the child's motivation to eat. Response effort was defined based on the oral-motor manipulations required to consume different types and textures of food. Quality of reinforcement was defined as the individual choosing to consume a food of a similar type and/or texture over another food. Interobserver agreement (IOA) was assessed across at least 30% of feeding sessions for all children with an average IOA of 98.2% for bites accepted/mouth closures and 96.9% for problem behavior for one child. For each child, three evaluations were conducted: (a) an analysis of the independent effects of quality or effort, (b) an analysis of the interaction of quality and effort, and (c) implementation of a reinforcement-based treatment matched to the results of the assessments. The assessment and treatment evaluations were conducted within single case designs. The results of the current study demonstrated that the influence of effort and quality alone or together (i.e., exclusive or interactive) functioned in a highly individualistic way as motivation operations. Effort influenced bites accepted for one child, quality influenced mouth closures for one child, quality and effort both influenced bites accepted for two children, and the interaction of effort and quality influenced bites accepted for one child. The treatment matched to these assessment results showed improvement in bites accepted with a reinforcement-based treatment that did not rely on escape extinction for three of the children. For all three children, total food consumption increased sufficiently that either the G-tube feedings were reduced or bottle feedings with a high caloric liquid (e.g., Pediasure) were decreased or eliminated. Treatment consisted of escape extinction for one child because he did not respond to the manipulations of quality and effort. Overall, the results of the current study demonstrated that specific dimensions of reinforcement function as motivating operations for food refusal and could be altered for four of the five children to improve eating without relying on escape extinction.

No description available.

Ätproblem hos barn är relativt vanliga och existerar både hos i övrigt friska barn och hos barn med andra sjukdomar och diagnoser. I vissa fall är ätproblemen så allvarliga att de leder till malnutrition. Ofta delas ätproblem in i kategorier beroende på om man tycker sig se en medicinsk orsak eller inte, man skiljer därmed på organiska och icke-organiska problem. Detta arbete fokuserar främst på det som i litteraturen brukar kallas matvägran. Syftet var att belysa området i stort genom att presentera och diskutera aktuell litteratur och forskning om matvägran samt att kritiskt granska olika förklarings-modeller och begrepp. Tre fall av barn med matvägran beskrivs också. Beskrivningarna är baserade på information som lämnats av barnens mödrar i intervjuer och syftar till att beskriva hur naturalförloppet vid matvägran kan se ut samt att undersöka föräldrarnas attityder och känslor kring problemet i sig och kring vårdkontakter. Gemensamma drag var bland andra att barnen haft problem med att äta redan från början och att de alla kräkts frekvent. Mödrarna i de tre fallen beskriver också att de är besvikna över vården av deras barn. Genomgången av etiologi och orsaksteorier pekar mot att matvägran sannolikt är en komplex samverkan mellan en rad olika fysiologiska, psykologiska och miljömässiga faktorer. Att kalla besvären antingen organiska eller icke-organiska kan vara missvisande. Huruvida barnet uppvisar en ovilja eller aversion mot att äta borde vara avgörande för val av behandling och behandlingen bör utformas så att barnets integritet respekteras. / Feeding problems in children are common and exist both in otherwise healthy children and in children with medical conditions. In some cases the feeding problems are severe enough to cause malnutrition. A distinction is often made between organic feeding problems, which are thought to be caused by a medical condition and non-organic problems, where no obvious medical reason can be found. This study was primarily focused on what is referred to as food refusal. The aim of the study was to illuminate the area by presenting and discussing current research as well as critically view common terminology and theories. Three case studies of children with food refusal are also posed. The descriptions are based on information extracted from interviews of their mothers and aim to describe how the natural course of food refusal can present itself as well as to explore parental attitudes and feelings around the problem itself and around contacts with the health care system. Some of the common denominators were that the children all exhibited feeding problems from the beginning and that they have suffered frequent vomiting. The mothers have been disappointed with the care that their children have received. The review of etiology and theories points towards food refusal being a complex interplay between physiological, psychological and environmental factors. To label the problem as being either organic or non-organic can be misleading. Weather the child exhibits an aversion or unwillingness to eat should be an important aspect in choosing treatment form and respecting the child´s integrity should be a priority in treatment.