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MD Email the author MD Irene Chatoor. Infant and Toddler Mental Health Center, Department of Psychiatry, Children's National Medical Center, George. Irene Chatoor. James Egan. Irene Chatoor. James Egan. 71 DEVELOPMENTAL APPROACH TO FEEDING DISTURBANCES Irene Chatqor, M.D., Sharon. Sheela Stuart, BA, MS, PhDa, Irene Chatoor, MDe abstract Many young children Chatoor, and Stewart participated in discussion and refinement of the original.

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PDF | On 24, , Irene Chatoor and others published Feeding and Eating Disorders of Infancy and Early Childhood. Request PDF on ResearchGate | Feeding disorders in infants and toddlers: Diagnosis and treatment Irene Chatoor at Children's National Medical Center. Irene Chatoor Play Scale was developed as a scale that complements the Parent‐Child Feeding Scale, created by I. Chatoor et al. (), to.

The scale consists of 46 mother and infant behaviors, which are rated at the end of the feeding session. Observations of mother — infant interactions during two feedings separated by 2 weeks showed considerable stability. Five subscale scores are derived: 1 Dyadic Reciprocity, 2 Dyadic Dr. This research was supported by grants to Dr. The authors wish to acknowledge the thoughtful assistance of Drs.

IA is characterized by food refusal and significant growth deficiency, the young child does not communicate hunger, lacks interest in food, but shows strong interest in exploration and interaction with the caregiver. Further research revealed a fussy-difficult temperament and a heightened level of physiological arousal in children with IA Chatoor et al. Moreover, the feeding interactions between children with IA and their mothers have been characterized by low dyadic reciprocity, interactional conflict, and negative affect in both the children and their mothers Chatoor et al.

Interestingly, the level of dyadic conflict between the mother and her child with IA can be a significant factor to differentiate IA from other feeding disorder subtypes, such as Sensory Food Aversions or Feeding Disorder Associated with Insults to the Gastrointestinal Tract, also named Post-Traumatic Feeding Disorder Chatoor et al.

Finally, research in the field of IA also demonstrated associations between maternal psychopathology, difficult infant temperament, and mother—child interactional conflict during feeding, and revealed that both child and maternal characteristics are significant predictors of dyadic interactional conflict during infancy Chatoor et al.

The long-term outcome of IA is still poorly understood. Some prospective studies of large community-based samples from early childhood to young adulthood showed that child feeding problems [as defined by Marchi and Cohen , i.

A few longitudinal studies of IA that investigated a shorter period of time, i. In a clinical sample that was treated during infancy, two-thirds of children had developed healthy eating patterns and good growth at follow-up during mid-childhood, whereas one-third of the children continued to show various degrees of poor growth Chatoor, Both longitudinal studies Ammaniti et al.

American Journal of Psychiatry, , , — Google Scholar Harris, J. Non-organic failure to thrive syndromes. Accardo Ed.

Baltimore: University Park Press, , — Google Scholar Homer, C.

(PDF) Developmental approach to feeding disturbances | Irene Chatoor -

Categorization of etiology of failure to thrive. American Journal of Diseases of Children, , , — Oppositional syndrome and oppositional behavior. Hock, J. Zubin Eds. Psychopathology of Childhood. Google Scholar Mahler, M.

Failure to thrive and cognitive development in toddlers with infantile anorexia.

The Psychological Birth of the Human Infant. Google Scholar Malone, C. A prospective study of failure to thrive: Outcome data for the children up to the age of two. San Francisco, Google Scholar Murray, S. Nutritive sucking patterns in infants at risk for sudden infant death. Presented at the International Conference on Infant Studies. New York, NY, Google Scholar Pollitt, E. Psychosocial developmental behavior of mothers of failure-to-thrive children. American Journal of Orthopsychiatry, , 45, — Failure to thrive, the role of clinical and laboratory evaluation.

Hospitalism, an inquiry into the psychiatric conditions of early childhood. Frequently, FTT and feeding disorder have been used as synonyms although not all in- fants with feeding problems are failing to thrive and not all infants who do not thrive have feeding problems. Third, a variety of observational methods have been used to code in- fant and parent behaviors in order to understand FTT and feeding disorders. A review of the major studies illustrates the problems in comparability. A matched comparison group of mothers and their physically healthy infants were also evaluated.

Research assistants rated maternal-infant feeding interactions during home visits on three dimensions described by Ainsworth and Bell Haynes, Cutler, Gray, and Kempe studied mother — child interactions of 50 chil- dren who had been hospitalized for NOFTT and 25 thriving children.

Pdf irene chatoor

Five minutes of a videotape of both feeding and play sessions for each dyad was coded. The authors were able to differentiate three patterns of interaction in these FTT infants: 1 benign ne- glect; 2 incoordination, and 3 overt hostility.

Based on observations of play be- havior, the NOFTT infants were found to be more fussy, demanding, and unsociable than the control infants. Furthermore their mothers were noted to express more negative emo- tions during play interactions than the control mothers. Fosson and Wilson studied the behavioral style of 34 infants with FTT ranging in age from 4 weeks to 13 months during minute family evaluation sessions.

Within the context of a family diagnostic session, trained family therapists systematically identi- fied problematic interactions that they believed were associated with disturbed feeding. Examples included intense sibling rivalry and displaced maternal aggression. Powell and Low identified infants ranging in age from 3 months to 34 months, who were subsequently diagnosed with NOFTT.

They demon- strated six interpersonal behaviors characteristic of NOFTT: crying when approached, lack or decreased vocalization, lack of cuddliness, poor eye contact, lack of smiling re- sponse, and indifference to separation. Rosenn, Loeb, and Jura developed a 7-point approach-withdrawal scale to mon- itor a standardized sequence of brief social interactions between examiners and infants ranging in age from 6 to 16 months.

Chatoor pdf irene

Infants with NOFTT were found to prefer distant so- cial encounters and inanimate objects, whereas infants with organic FTT and medically ill control patients consistently responded most positively to close personal interactions, such as touching and holding.

Barnard de- veloped a binary scale with 50 items that reflect maternal sensitivity to infant cues, maternal response to infant distress, and maternal skill in fostering social, emotional, and cognitive infant abilities. The scale has been used widely in behavioral research studies to identify adaptive and maladaptive parent and infant behaviors during feeding.

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How- ever, only infants in the first year of life were assessed. Sanders, Patel, Le Grice, and Shepherd reported on feeding interactions of problem and nonproblem eaters. The MOS measures 17 categories of child feeding behaviors and 14 categories of parent behaviors. An observer records the occurrence of each category of behavior in second time intervals over the course of a minute videotaped observation period. The micro- analytic nature of this method limits its use in clinical practice.

In addition, this scale does not cover the first year of life when mother — infant interactions during feeding are established. The aim of this paper is to report on the development and ini- tial validation of such a scale. Initially a pool of items describing diagnostically rele- vant behaviors of mothers and infants was generated by experienced clinicians who had treated infants who presented with various feeding problems and failure to thrive.

Eighty items were initially selected to measure affect, nonverbal communications, verbal expres- sions, and specific feeding behaviors of mother and infant. For each item, an observer in- dicated on a 4-point Likert scale how often and how intensely each of the behaviors occurred. In a pilot study, 20 videotapes of mother — infant pairs with a wide range of feeding behaviors were each rated by five observers who were blind to the diagnosis of the individual children.

These 20 children ranged in age from 5 weeks to 32 months and included normally feeding infants, infants with feeding disorders associated with failure to thrive, and two 2-year-old autistic toddlers with feeding disorders without failure to thrive.

Item variability and observer agreement were assessed for each item. Sixty-five items were re- tained from this initial study. During the first month of life, the regulation of feeding is closely tied to the mother — infant relationship. Both infant and parent characteristics appear to contribute to these regulatory feeding difficulties. Infant 1. Onset of feeding problems between birth and 3 months of age. Irregular feeding pattern and poor food intake: a.

Chatoor pdf irene

Lack of weight gain leading to failure to thrive B. Differential Diagnosis The following associated organic problems of the infant may contribute but not fully explain the feeding problems: a. Participants ranged in age from 6 weeks to 36 months. Only the mothers of those infants who were failing to thrive and who also met clinical diagnostic criteria for a developmental feeding disorder see Tables 1 — 3 were in- vited to participate in the study.

Ninety-six percent of the mothers who were invited chose to participate. These infants were matched to the feeding-disordered infants by age, sex, race, and so- cioeconomic status.

The demographic data for these three groups of infants and toddlers with feeding disorders and the three control groups are summarized in Table 4. Each of the 74 failure-to-thrive infants was evaluated by a trained clinician. One third of the subjects were seen independently by a second diagnostician.

The mother frequently denies any feeding problems of the infant, and the infant may come to the attention of professionals because of marked growth failure or other health problems. Onset of growth failure between 2 and 8 months 2. The infant shows lack of age-appropriate social responsivity a.

Development of infant: a. Bottles may be propped for the infant to feed independently, or feedings may be forgotten altogether. Differential Diagnosis This feeding disorder needs to be differentiated from organic conditions which may lead to a lack of weight gain in the infant. However, mother and infant usually show better mutual engagement.

Table 3 Infantile Anorexia Feeding Disorder of Separation This feeding disorder is characterized by food refusal of the infant and intense conflict in the mother—infant relationship over issues of autonomy, dependency, and control. Food refusal of infant: a. Inadequate food intake has resulted in failure to thrive: a.

Weight is below the 5th percentile of age, or weight has deviated across two major percentiles over a 2- to 6-month period. Development appears normal except for: a. Delay in motor development in severe cases secondary to malnutrition. Delay in expressive speech in some infants who appear to refuse to talk as they refuse to eat.

Parent 1. Parental perception of infant: a. As having a poor appetite b. As being curious and demanding of attention c. As being difficult and stubborn during feedings, rejecting parental efforts to get infant to eat 2.

Coaxing infant to eat more b. Distracting infant with toys or games to induce infant to eat c. Feeding infant around the clock including at night d.

Trying different types of food if infant does not eat e. Force-feeding infant C. Differential Diagnosis Food refusal of infant is not due to a traumatic event such as choking, gagging, insertion of feeding or endotracheal tubes, vomiting or pain secondary to gastroesophageal reflux, or any other medical illness.

The clinical evaluation focused on age of onset of the growth failure, contributory organic conditions, feeding history, developmental history, temperament of the infant, and family psychosocial stressors. Using the subclassification of developmental feeding disor- ders see Tables 1 — 3 , eight infants were diagnosed as Feeding Disorder of Homeostasis, 24 infants as Feeding Disorder of Attachment, and 42 infants as Feeding Disorder of Sep- aration Infantile Anorexia.

After the clinical evaluation, a videotape of 20 minutes of feeding was rated by two ob- servers who were blind to the diagnostic status of the child. All raters were experienced in principles of child development. Prior to coding, observers were informed of the age of the infant. After having viewed the entire feeding on video- tape, each observer then independently completed the Feeding Scale. Construct validity was determined in part by factor analyses that were conducted using the 65 items that had been shown to be reliably rated in the initial study.

A general factor structure among the items was first determined followed by the def- inition of the strongest factor structure under orthogonal considerations. A five-factor solution was assessed to be the most appropriate after inspection of the factor loadings and assessment of the clinical relevance of each item see Table 5. Those items with factor loadings of.

Chatoor pdf irene