Eating and Feeding Disorders in Early Childhood

CHAPTER 23

Miri Keren

Eating and sleep problems are among the most Brief Historical Considerations common for referral of infants and toddlers to pediatricians and to infant mental health units, Spitz, as early as 1946, observed a link between including our own (Keren, Feldman, & Tyano, severe food refusal and “anaclitic depression.” 2001). This is not surprising, as eating and Kreisler (1981) introduced the concept of devi- sleeping are the main daily activities during ant eating behaviors in the first year of life as the first year of life, and both are dependent on a psychosomatic disorder, like sleep problems, the interplay between an infant’s characteristics breath-holding spells, and infant colic, thus em- and a caregiver’s behaviors. phasizing the now well-accepted mind–body In this chapter, after reviewing some histori- interplay. Later, describing “psychogenic fatal cal considerations about the concept of eating vomiting,” Kreisler (1999) reminded us of how and feeding problems in infancy, I emphasize severe an eating disorder in the first year of life the distinction between eating and feeding pro- can be. Green (1985), drawing on the work of cesses and problems, then follow with a review Powell, Brasel, and Blizzard (1967), noted a of the parental risk factors and the role of the special category of reactive attachment disorder quality of the parent–infant relationship in the of infancy, “psychosocial dwarfism,” character- development of eating disorders. Regarding ized by growth retardation and mood distur- the classification of eating disorders in infan- bance associated with a reversible hypopituita- cy, I describe the similarities and differences, rism and low growth hormone levels. Through as well as the contributions and shortcomings, the 1980s, feeding disturbances were often of DC:0–3R (Zero to Three, 2005), DC:0–5 conflated with reactive attachment disorder, in- (Zero to Three, 2016), and DSM-5 (American cluding in DSM-III (American Psychiatric As- Psychiatric Association, 2013). I then provide sociation, 1980), but it is now clear that although a clinical description and treatment of each of eating disorders and attachment disorders may the three main categories—overeating disorder, co-occur, they are distinct disorders. undereating disorder, and atypical eating dis- Chatoor and Egan (1983), for example, re- order—with short, illustrative case vignettes. I ported their own observation that a disturbed end with a section on the different aspects of parent–infant primary caregiving relationship the evaluation of infants referred for an eating may be the underlying cause of a significant behavior problem. eating disorder, even in the absence of the ex- Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

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treme condition of reactive attachment disorder. procedures or conditions. On the other hand, Both Chatoor, Hirsch, Ganiban, Persinger, and disturbed eating may be observed only in the Hamburger (1998) in the United States and Kre- context of a specific feeding relationship, as it isler (1999) in France defined infantile anorex- reflects the disturbed dyadic or family relation- ia nervosa as clinical feeding disturbances in ship of which the eating problem is only one of which a very serious battle around control and its manifestations. separation–individuation takes place between an infant and mother, and often leads to forced feeding. In pediatric textbooks, the traditional Parental Risk Factors distinction between “organic failure to thrive” and “nonorganic failure to thrive” led to a di- Maternal eating disturbances, including buli- chotomous approach that did not fit the clinical mia and anorexia nervosa, are risk factors for reality. Currently, the most accepted approach all types of eating disorders in infancy. In the is the multifactorial one that integrates the Avon Longitudinal Study of Parents and Chil- physical and psychological aspects of normal dren (ALSPAC), women with lifetime eating and abnormal eating behaviors (Benoit, 2009; disorders have been compared with women Bryant-Waugh, Markaham, Kreipe, & Walsh, without any lifetime psychiatric disorder (Mi- 2010). cali, Simonoff, Stahl, & Treasure, 2009, 2011). The authors’ main finding was that lifetime eating disorder and active eating disorder during Eating and Feeding Disorders pregnancy increased the risk for infant feeding difficulties, while maternal distress (depression Beyond their nutritional aspect, meals are so and/or anxiety) was the main mediating factor. central in the very young child’s daily life that A controlling parenting style during mealtimes the quality of the feeding and eating experience and play was observed among mothers with affects the child’s sense of security and basic eating disorders of all kinds, while their infants trust, inner sense of self, mastery, autonomy, suffered from eating problems (Cooper, Whel- and initiative. Metaphorically, we may define an, Woolgar, Morrell, & Murray, 2004; Micali the optimal value of a meal as the sum of its et al., 2009, 2011; Stein et al., 2001). calories and its related emotional experience. A longitudinal study of mothers and fathers The term “feeding” reflects the interaction with binge-eating disorder and their children at that takes place between the caregiver and the 18 and 36 months of age (Cimino et al., 2016) infant, whereas “eating” reflects the infant’s showed that the presence of this diagnosis in autonomous handling of food (e.g., reaching for one or both parents influences the severity of food, opening the mouth, swallowing). Obvi- maladaptive parent–infant feeding interactions ously, the younger the child, the more depen- and the children’s emotional–behavioral prob- dent he or she is on the caregiver’s attitudes lems over time. Sherkow, Kamens, Megyes, and on the quality of their relationship in the and Loewenthal (2009) observed mother–infant development of his or her eating patterns. Birch dyads at a therapeutic play nursery for mothers and Doub (2014) have described the process of with eating disorders and their children, and infants learning to eat in the first 2 years of life, suggested a developmental pathway, as well as and have shown how parenting and feeding ap- several mechanisms that help in understanding proaches may facilitate or impede the child’s the pathogenesis of the intergenerational trans- development of self-regulation of hunger and mission of eating disorders from mothers to food preferences. For instance, feeding prac- daughters. tices that encourage eating for soothing may Maternal depression and anxiety have been promote a dysfunctional habit of eating in the consistently associated with feeding difficul- absence of hunger. ties in young children (Benoit, 2009; Blissett, Not all eating problems are relational. In- Meyer, & Haycraft, 2007; Chatoor, Hirsch, et deed, on the one hand, the very young child’s al., 1998; Coulthard, Blissett, & Harris, 2004). eating disturbance may be a reflection of his Stein and colleagues (2001) have further char- or her own characteristics, such as constitu- acterized the feeding styles of these mothers as tional difficulties of state regulation, difficul- nonresponsive (i.e., too controlling, too indul- ties in making changes and transitions, sensory gent or underinvolved). Noncontingent feeding,

Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. aversions, and reactions to traumatic medical in turn, has been related to under- or overweight

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conditions among young children (Micali et al., toms on the Edinburgh Postnatal Depression 2009). A relatively recent study (Braden et al., Scale. In another study of 219 fathers of infants 2014) has shown that mothers with binge eating ages 1–24 weeks, Cockshaw, Muscat, Obst, and and depression tend to offer food to soothe their Thorpe (2014) found a link between paternal child’s negative emotions, which leads the child depressive symptoms and infant feeding dif- to develop “emotional eating.” ficulties. Similar findings about the impact of Parents who have conflicts about control of parent depression and parenting stress on the their own food intake often adopt controlling young child’s eating behavior (both undereating child-feeding practices in an attempt to prevent and overeating) have been reported (Hughes, the child from becoming overweight (Birch Power, Liu, Sharp, & Niklas, 2015). General & Davison, 2001), instead of promoting their risk factors, such as low parental education, child’s ability to self-regulate intake. Sonnev- low income, and young maternal age, have been ille and colleagues (2013) have found a strong found to be relevant both for undereating and link between parental control and overeating, overeating (Dubois, Farber, Girard, Peterson, & and food sneaking, hiding, and hoarding. Paren- Tatone-Tokuda, 2007). tal pressure, control, and restriction over what how much the child eats increases risk for child overeating, as well as undereating (Scaglioni, Parent–Infant Relationship Disturbances Salvioni, & Galimberti, 2008). Maternal sense of competence has been found to negatively In 1998, Chatoor and colleagues demonstrated correlate with mother–child conflict and con- an association between feeding disorders and trol around mealtimes (Aviram, Atzaba-Poria, mother–infant disturbed relationships, with Pike, Meiri, & Yerushalmi, 2015). control struggles predominant. Mothers of in- The important role of the father in the young fants with feeding disorder have been shown to child’s eating behavior has been shown in a rel- exhibit greater negative affect, intrusiveness, atively recent study (Blissett et al., 2007). More and struggle for control, and they are less in- recently, Thullen, Majee, and Davis (2016) have clined to physically touch their child than moth- looked at the father’s involvement and the qual- ers whose infants do not exhibit feeding dif- ity of coparenting (satisfaction with task distri- ficulties. Infants with feeding disorders have bution, mutual support, cooperation, agreement been observed to be more withdrawn (Feldman, on upbringing practices) as they relate to infant Keren, Rosval, & Tyano, 2004). Mothers of in- eating behaviors. They showed how fathers’ fants with feeding difficulties did not facilitate participation in feeding is different from that of their child’s attempt to eat autonomously and mothers, with increased involvement in feeding to explore food, and were more intrusive and over the first few years requiring an ongoing in a constant struggle for control. In turn, the negotiation around coparenting related to feed- children had difficulty self-regulating during ing. meals, and tended to be oppositional (Ammani- Maternal postpartum depression is well ti, Ambruzzi, Lucarelli, Cimino, & D’Olimpio, known to affect all domains of parenting nega- 2004). These studies do not make clear a di- tively (see Murray, Halligan, & Cooper, Chap- rection of effects, that is, whether mothers are ter 10, this volume). It is less known that a responding to aberrant infant cues or whether significant percentage of fathers also develop their behaviors are contributing to infant feed- postpartum depression. Paulson, Dauber, and ing difficulties (or both). Leiferman (2006) studied more than 5,000 More recently, fathers have been included American families and detected postpartum in studies about feeding disorders, and have depression among 14% of mothers and 10% of been shown to be less sensitive and more in- fathers. Mothers who were depressed were ap- trusive, and their children were less responsive proximately 1.5 times more likely to engage in to them during play and feeding (Atzaba-Poria less healthy feeding and sleep practices, and et al., 2010). Interestingly, child temperament both mothers and fathers engaged less positive- was linked to father–child conflict and con- ly with their child. Similarly, in a general popu- trol around mealtimes, but not to mother–child lation screening study conducted in Finland conflictual feeding interaction (Aviram et al., (Luoma et al., 2013) among 194 families, 21% 2015). Family conflicts around food and control of fathers and 24% of mothers scored above the are quite common; often one of the parents is

Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. cutoff point for depressive and anxiety symp- him- or herself a picky eater, and the tense at-

mosphere impacts on the young child’s eating ing behaviors and social problems. There were behavior (Davies et al., 2006). significant correlations between the children’s eating problems and their emotional difficulties, and their mothers’ increased emotional Approaches to Classification in Early Childhood distress and disturbed eating attitudes. Very recently, this team (Lucarelli, Ammaniti, Porreca, Recent attempts to classify feeding and eat- & Simonelli, 2017) also showed that families of ing disorders in young children have varied infants with infantile anorexia have difficul- widely, from those proposing many different ties in expressing and sharing pleasure, and in types of disorders to those that lump disparate structuring a predictable and flexible context. types together by emphasizing common fea- Their infants showed little autonomy and had tures. Though other classifications have been difficulty in being actively engaged and tuned proposed, I am limiting this brief discussion to with parents. three that have been or potentially will be espe- The DC:0–3R (Zero to Three, 2005) classi- cially important within infant mental health— fication has been criticized for several reasons. DC:0–3R (Zero to Three, 2005), DSM-5 (APA, Davies and colleagues (2006) criticized the lim- 2013), and DC:0–5 (Zero to Three, 2016). I con- ited inclusion of infant–parent relational distur- sider these different conceptualizations briefly, bances in the conceptualization. Bryant-Waugh indicating their similarities, differences, contri- and colleagues (2010) noted limited research butions, and shortcomings wherever possible. and validation of the specific disorders. A large- scale survey (800+ respondents from five con- DC:0–3R tinents) conducted by Zero to Three and World Association for Infant Mental Health (WAIMH) This system, derived from a conceptualization in 2013 revealed that numerous clinicians were developed by Chatoor (2002), is an etiology- concerned about the overlap of several catego- based classification of six subtypes of eating ries in the conceptualization, a criticism also disorders in the first 3 years of life, designated noted by Bryant-Waugh and colleagues. For ex- “feeding behavior disorders”: (1) feeding disor- ample, they reported that posttraumatic feeding, der of state regulation; (2) feeding disorder of feeding disorder associated with a medical ill- caregiver–infant reciprocity; (3) infantile an- ness, and parent–child relationship disturbance orexia; (4) sensory food aversion; (5) feeding often co-occur and may manifest as a general disorder associated with concurrent medical refusal to eat and poor interest in food, as ob- condition; and (6) posttraumatic feeding disor- served in the infantile anorexia study. Also, the der. In all six subtypes, failure to gain appro- general term “feeding behavior disorders” may priate weight is one of the required diagnostic imply that all the types of eating problems in criteria. the first years of life are essentially relational, This approach was adopted with modifica- which is obviously not true for all cases (e.g., tion in the Research Diagnostic Criteria—Pre- infants with sensory aversions or regulatory school Age (American Academy of Child and difficulties). Adolescent Psychiatry, 2002) and later adopted The use of the term “behavior” may rein- with further modification in the Diagnostic force the dichotomous and outdated distinction Classification of Mental Health and Develop- between organic and nonorganic eating disor- mental Disorders of Infancy and Early Child- ders (Reilly, Skuse, Wolke, & Stevenson, 1999). hood—Revised (DC:0–3R; Zero to Three, The obligatory criteria “failure to gain weight,” 2005). Nevertheless, since the introduction of “growth deficiency,” “nutritional deficiencies,” the DC:0–3R classification in 2005, there have or “delay of oral development” did not include been few validating investigations from other young children with problematic eating patterns clinical groups or settings (see Bryant-Waugh who do not exhibit these specific features. For et al., 2010). example, picky eaters who receive multivitamin One exception is a longitudinal study by Am- supplements, 2-years-olds fed with several bot- maniti and his colleagues (2012), who focused tles a day or even breast-fed, and young children on infantile anorexia and showed that infants with parenteral feeding are exhibiting clinical with this diagnosis in early childhood later de- significant eating problems (Bryant-Waugh et veloped ongoing eating problems, anxiety/de- al., 2010; Steinberg, 2007). Hence, this criti-

Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. pression and withdrawal, as well as rule-break- cism is that impairment criteria should not be

based on weight or nutritional deficiencies, but observable eating behaviors: overeating disor- more on the impact of the eating problem on the der, undereating disorder, and atypical eating child’s physical and social–emotional develop- disorders. ment, and/or on the family overall functioning. “Feeding disorder of caregiver–infant reciprocity” is confusing because, on the one hand, Overeating Disorder it implies the presence of a parent–infant relationship disorder; on the other hand, if a rela- Parents’ awareness of the potentially pathologi- tionship disorder is present, the disorder is ex- cal significance of overeating in infancy is less cluded. Also, the term “infantile anorexia” is than that for undereating disorders, and most misleading because it may imply that this is an eating-related referrals of infants to pediatri- early form of the classic anorexia nervosa ob- cians are for undereating. In fact, there are few served in adolescence, although no longitudinal data about overeating behaviors among infants data support continuity between these two dis- and toddlers (despite rising concern about obe- orders. The typical conflict over control and au- sity among school-age children). To date, the tonomy seen in these cases labeled as “infantile prevalence of overeating in infants is unknown. anorexia” seem to suggest symptoms of a par- Still, clinical observations suggest that some ent–infant relationship disorder. toddlers express verbally a preoccupation with food at the expense of other developmentally ap- DSM-5 propriate activities. These toddlers may actively search for food and become very distressed at In part because of some of the critiques of efforts to redirect them. Hence, this is a clinical DC:0–3R’s classification, DSM-5 authors de- condition that warrants diagnosis, treatment, cided to “lump” disparate disorders together in and collection of data for better understanding. a single avoidant/restrictive food intake disor- In clinical settings, overt preoccupation with der (ARFID) that covers infants through adults. food and active searching for it is rarely seen As such, it emphasizes commonalities across before age 2 years because autonomy, verbal developmental periods, with core features of skills, and motor skills are required to search for eating/feeding disturbance not accounted for the food. In contrast, overfeeding is quite com- by food unavailability, cultural norms, or other mon under age 2 years, and especially during eating disorders that involves weight loss, nutri- the first year of life, often as a result of the care- tional deficiency, dependence on a feeding tube, giver’s use of food as soother and/or attribution or dietary supplements (American Psychiatric of hunger in response to the infant’s crying. If Association, 2013). overfeeding occurs only with one primary care- Because it is a relatively new diagnostic en- giver, a diagnosis of relationship-specific disor- tity, few studies are available that permit an as- der of early childhood, with manifestations of sessment of the validity of the criteria of ARFID. overeating, is appropriate. Nevertheless, the disorder has the advantage of not requiring inferences about etiology, as the Risk Factors DC:0–3R does, and it focuses on behaviors that are relatively easy to observe. Virtually all of There is evidence of a strong genetic compo- the six disorders in DC:0–3R would be best cap- nent in the regulation of appetite and food tured by ARFID in DSM-5. The obvious down- preferences (sweet and salty vs. bitter and sour side to such an all-encompassing definition is tastes) during the early years (Scaglioni, Ar- that variable phenotypes may exist within the rizza, Vecchi, & Tedeschi, 2011). Still, parents broad criteria. and caregivers play a crucial role in modeling children’s eating behaviors (Birch et al., 2001; DC:0–5 Birch & Doub, 2014). Chronic misreading of infant feeding cues, such as feeding when the The overarching changes that were made in infant is not hungry, has been shown to con- DC:0–5 classification, as well as the specific tribute to the development of overweight by im- changes in the category of eating disorders, pairing the infant’s response to internal states have been described in detail elsewhere (see of hunger and satiation. Caregivers who exert Keren, 2016). DC:0–5 defines three main cat- excessive control over what and how much

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weight gain and obesity. Control comes in three velopment in Quebec (Dubois et al., 2007) per- forms: restriction of food to prevent overweight formed on 1,498 children revealed that overeat- (especially common among parents who have ers at the age of 2.5 years were six times more problems controlling their own food intake), likely to be overweight at 4.5 years. Hence, it is pressure to eat more food, and pressure to eat important to diagnose and to treat the disorder “healthy food” (Scaglioni et al., 2011). as early as possible. Caregiver instrumental feeding, restriction, emotional feeding (i.e., using food to help the Treatment child regulate emotions), encouraging the child to eat and using food as a reward, weight-based To date, there are no specific guidelines for restriction, and fat restriction have been asso- the treatment of overeating disorder in infancy ciated prospectively with the development of and early childhood. However, treatment must emotional eating, snacking behavior, and over- be based on the diagnosis and on the identified eating (Rodgers et al., 2013). In an interesting contributing factors in either the infant, the par- study, Bergmeier, Skouteris, Horwood, Hooley, ent, or their relationship. Providing psychoedu- and Richardson (2014) looked at the contribu- cation to parents on the importance of setting tion of the child’s characteristics, such as tem- limits with the child, having fixed meal sched- perament, to maternal feeding practices and ules, modeling their own eating habits, and found a significant correlation between difficult providing adequate playful activities between temperament and maternal feeding practices. meals is always the first therapeutic step. In cases in which the overeating is a manifestation Diagnosis of a relationship-specific disorder, the main focus of the treatment will be the relationship The disorder is present when infants/young rather than the child’s overeating behavior (Es- children exhibit a pattern of overeating or at- cobar et al., 2014). In complex cases with paren- tempting to overeat. They seem preoccupied by tal psychopathology and problematic feeding food and engage in food seeking or talk exces- styles, the treatment may be lengthy because of sively about food even though there is no food the need to work through parental projections scarcity. Finally, the food preoccupation is as- and negative attributions. In contrast, whenever sociated with distress or impaired functioning. there is no specific risk factor, psychoeducation and dietary guidance usually lead to improve- Course and Prognosis ment. Helping parents find nonfood alternatives to occupy their infants’/toddlers’ time and en- No controlled longitudinal study of infants with ergy, such as toys, books, and music, has been clinically significant overeating behaviors has found helpful (Kong et al., 2016). Universal pre- yet been reported. Any link between overeat- ventive interventions at well-baby clinics may ing in infancy and binge eating or bulimia ner- be beneficial, as has been shown by Paul and vosa later has not been supported by research. A colleagues (2014). very recent publication of a 30-year prospective study (Nicolls, Statham, Costa, Micali, & Viner, 2016) reported lack of correlation between CLINICAL VIGNETTE childhood eating behaviors and obesity with the A 2½-year-old boy persistently asked for food, development of bulimia and compulsive eating at home and at kindergarten, and ate significant- in adulthood. Furthermore, a prospective birth ly more than his peers. He was slightly over- cohort study (Munkholm et al., 2016) has shown weight, with normal development; his affect that overeating at ages 5–7 years was associated was sober, and he preferred staying close to his with restrained eating in preadolescence. These father rather than playing during his assessment findings do not support continuity of diagnosed in the clinic. He had been a fussy baby, and he eating disorders in early childhood into adoles- was given the bottle as a soother. Daily separa- cence/young adulthood. tions were hard on him, as was falling asleep at Still, there are significant long-term conse- night. His mother typically put him to bed, and quences of overeating in early childhood, in- he protested vigorously if she tried to leave his cluding obesity, lack of participation in age-ap- side when he was awake. He was described as propriate social activities, and ultimately, peer oppositional with his mother only. His mother had a history of depression and anxiety that was

exacerbated after he was born. The level of par- failure to taste new textures, are common as- enting distress for both parents was high. sociated features. This child met criteria for several DC:0–5 Picky eating is often not associated with poor disorders, including (1) overeating disorder weight gain, but tension and distress are very (persistently asking for food, at home and at common among the parents of these children. kindergarten, and eating significantly more than Attempts at either praising or criticizing do his peers), and (2) relationship-specific disorder not have any effect on the child. Some of these of early childhood (mother) with oppositional children exhibit aversion to specific smells, tex- and sleep symptoms. The recommended treat- tures, and tastes, and may seem to have some ment for this child included triadic and dyadic kind of sensory aversion, combined with a be- sessions, in addition to the mother’s referral for havioral component. Selective picky eating may individual treatment. start in the second half of the first year. Some infants start being selective at around age 9 months, at the transition to solids; others have a Undereating Disorder history of refusal to wean from breast feeding. However, selective eating may start at any age. The common reasons for referral of infants If there is an accompanying physical illness, it with undereating include delay or lack of eating is important to make sure that the undereating skills; difficulty with fluids or with foodstuffs; pattern is not fully explained by it or by a medi- reluctance or refusal to eat based on taste, tex- cation side effect. ture, temperature, or any other sensory factors; lack of interest in food/poor appetite; slow eating; and fear of shocking and selective eating Comorbid Diagnoses (Bryant-Waugh et al., 2010). Estimates are that Comorbid medical diagnoses are often relevant 25% to 40% of infants and toddlers are referred in the most complex cases in which both physi- by their caregivers because of feeding problems cal and emotional/behavioral factors interact. (McDermott et al., 2008). Severe refusal to eat These should be recorded on Axis III of the is diagnosed in 3–10% of children but only DC:0–5 classification. The most common medi- 1–2% of them have a severe, long-lasting eating cal diagnoses include milk allergy; esophagitis, disorder (Manikam & Perman, 2000). Among due to structural abnormalities that affect the subgroups of the general population, such as gastrointestinal system; neurodevelopmental children with developmental disabilities, in- disabilities; oral hypersensitivity and oral– cluding autism, these figures may be different; motor dysfunction; systemic chronic illnesses, in our clinical experience, severe undereating such as cardiac, kidney diseases, cystic fibrosis; problems are quite frequent and more complex, and chronic pain due to various conditions. in that they involve a complex transactional Based on the general principles of the DC: model with dysfunction in sensory, cognitive, 0–5, a diagnosis of relationship-specific disor- and emotional responses (de Moor, Didden, & der with one caregiver may co-occur with the Korzilius, 2007; Keen, 2008). diagnosis of undereating disorder, if the infant exhibits symptomatic behaviors (other than ab- Diagnosis normal eating) and the other symptoms are limited to one relational context. A diagnosis of undereating disorder is made when young children consistently eat less than expected for their age and exhibit maladap- Differential Diagnosis tive eating behaviors. Loss of weight or failure Undereating may be a symptom of adjustment to gain weight is not a criterion because some reaction, depression, posttraumatic stress disor- infants have pathological patterns of eating der, or reactive attachment disorder, rather than but maintain their weight. For instance, infants a diagnosis in itself; therefore, these diagnoses may refuse the transition to solids but drink must be ruled out, based on the child’s history milk without weight loss. Prolonged mealtimes, and symptoms. A diagnosis of relationship- stressful mealtimes, lack of appropriate autono- specific disorder of early childhood should be mous feeding, nocturnal eating (after 1 year of made instead of undereating disorder whenever age), prolonged breast or bottle feeding, and the eating problem is observed only in the con- Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

text of the relationship with one specific care- eating disorder (Chatoor, 2009; Kerzner et al., giver. 2015; Luiselli, 2000; Silverman, 2015). The basic principle is to have the parents determine Course and Prognosis “what, when, and where” the infant eats, and to have the infant decide “how much” to eat. This Despite lack of continuity in categorical disor- seems straightforward, but it is often is difficult ders, there is some degree of continuity between to implement. Challenges increase when par- eating problems in infancy and in older ages. ents have their own issues about trust, autono- McDermott and colleagues (2010) have found my, and control, or when infants do not provide that around 40% of the irregular eaters at age clear cues about their needs. When undereating 5 years were still irregular eaters at 14 years. behavior reflects a significant relationship dis- Independent contributions included the chil- order, the main focus of treatment needs to be dren’s own capacity to regulate their sleep and the relationship and not necessarily the feeding. mood, as well as maternal anxiety and negative Medications for undereating disorder in infancy feelings toward the child during the early years. are very rarely administered, except in cases Hemmi, Wolke, & Schneider (2011) showed of trauma to the oropharynx or esophagus, in that infants with crying, sleeping, and/or feed- which the infant’s anticipatory anxiety before ing problems have more behavioral problems as each meal leads to full food refusal and does children than controls, especially in multiprob- not improve with desensitization techniques. lem families. Administration of fluoxetine (0.3 mg/kg per Picky eating often improves spontaneously day) to 2-year-old twins with food refusal that over time, especially when parents stop react- had developed after several invasive gastroin- ing to the child’s eating behavior, but some chil- testinal procedures was reported (Celik, Diler, dren remain picky eaters into adulthood. Still, Tahiroglu, & Avci, 2007) as a successful inter- in a recent longitudinal study of 1,327 children vention that led to significant decrease in the from the Copenhagen Child Cohort 2000 (Mi- twins’ fear and anxiety, and improvement in cali, Rask, Olsen, & Skovgaard, 2016), those their eating behavior. children who were very picky or slow and poor The duration of these treatments is extremely eaters in infancy, who came from non-Danish variable, depending especially on the parents’ parents, and whose mothers suffered from a capacity for self-reflection and change. Un- psychiatric diagnosis, persisted in being picky surprisingly, parental psychopathology makes and poor eaters at 5–7 years of age. these treatments much more complex and lengthy. Treatment The treatment plan should be based on the CLINICAL VIGNETTE identified biological and/or psychological con- A 3½-year-old girl was referred for evaluation tributors in the infant, the parent, and/or the of the timing of an eventual weaning of naso- relationship. A multidisciplinary team can tai- gastric tube (NG) feeding; the tube had been in lor psychoeducational, behavioral, and/or psy- place since she was 4 months old, following an chotherapeutic interventions for the infant and unexplained lack of thriving. She was born pre- family. maturely at 33 weeks’ gestation and had a very Treatment outcome studies are sparse (Mc- significant developmental delay. Her mother Grath Davis, Schurle Bruce, Mangiaracina, stayed at home for 2 years and gave up her own Shulz, & Hyman, 2009), although a variety professional career to care for her daughter. The of approaches have been reported. Behavioral child entered child care at age 2 years, and up to management (e.g., regular mealtimes, no be- the referral time, she had exhibited strong sepa- tween-meals snacks or drinks, no use of praise ration anxiety when away from her mother. A nor criticism), parental psychoeducation about miniseparation between the girl and each of her the infant’s needs for autonomy, control and parents revealed a resistant attachment behavior mastery, and parent–infant interactive guid- with her mother but secure attachment. Accord- ance aimed at improving the caregiver feeding ing to DC:0–5, the young child met criteria for styles (e.g., controlling or indulgent) are the two comorbid disorders: undereating disorder most commonly reviewed approach for under- (with chronic NG tube feeding) and relation- Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

ship-specific disorder of early childhood with nosed following intestinal obstruction and/or separation anxiety symptoms with her mother. perforation, infections such as toxoplasmosis On Axis III, the child’s failure to thrive and lan- and toxocariasis following ingestion of feces or guage delay would be noted. dirt, and lead poisoning from ingestion of dirt or wood chips with lead paint. Pica predisposes to iron deficient anemia, which in turn is asso- Atypical Eating Disorders ciated with pica. Treatment of pica depends on the specific Studies of atypical eating behaviors in in- associated features that have been determined fancy, such as pica, rumination, hoarding, and in the evaluation process of each case. Specific pouching, are scarce, and additional research is treatments vary from strictly behavioral to rela- needed. Their respective prevalence is unclear. tionship-focused approaches. Bryant-Waugh and colleagues (2010) raised the question of possible obsessive and compulsive features of pica and rumination, and accord- Rumination ingly, whether they should be classified as a Rumination is defined as the repeated regurgi- form of obsessive–compulsive disorder (OCD). tation of food following feeding or eating. The Both pica and rumination disorder may occur in Rome III diagnostic criteria (Rasquin et al., association with mental retardation and autism 2006) differ from DSM-5 criteria, as the latter spectrum disorder, and they are designated as requires a minimum duration of 3 months rather independent diagnoses only if severe enough than 1 month, an onset of 3–8 months, a lack of (Bryant-Waugh & Piepenstock, 2008; O’Brien, distress in the infant, together with poor inter- Bruce, & Camilleri, 1995). action with others, and its absence during sleep. It is a rare but serious condition, with a typi- Pica cal presentation: The ruminating infant often arches its back with its head held back, while Pica is defined as persistent eating of nonfood making sucking movements with the tongue, substances, such as earth, chalk, paper, soap, and seems to be engaged in a self-soothing or cloth, string, wool, soil, paint, gum, hair, ice, self-stimulating activity. Between meals, the clay, starch, metal or plastic objects, or feces. infant may be hungry and irritable. Weight loss Pica usually does not involve general aversion and failure to gain weight are common, up to to food; neither is it necessarily accompanied the point of malnutrition, especially when the by failure to thrive. Iron and zinc deficiencies regurgitation follows every meal (O’Brien et have been reported in some cases. Before the al., 1995). Rumination can be observed across age of 2 years, mouthing of objects with occa- all the age range, from the first year of life to sional ingestion is part of normal development; adulthood (Malcolm, Thumshirn, Camilleri, & therefore, caution is warranted about making Williams, 1997). a diagnosis of pica in children less than 24 Identified contributing factors to the appear- months of age (indeed, ICD-10 diagnostic crite- ance of rumination in infancy include neglect, ria for pica specify a minimum age of 2 years). lack of stimulation, and severely disordered Pica can occur in otherwise normally devel- parent–infant relationship, though in some oped young children, although the phenomenon cases the etiology cannot be determined. is more common in children with diagnoses of Differential diagnosis includes gastroesoph- intellectual disability, autism, childhood-onset ageal reflux, vomiting, pyloric stenosis, hiatal schizophrenia, and Kleine–Levin syndrome. hernia, and Sandifer syndrome. These need to Some cases of pica are linked with neglect or be ruled out before the diagnosis of rumination lack of parental supervision. In these cases, pica is made. may be considered as a symptom of a parent– The course of rumination disorder varies infant relationship disorder. Pica may be asso- from being self-limited to becoming protracted ciated with trichotillomania (hair pulling and and potentially fatal (due to malnutrition). As swallowing) and skin-picking disorder (Bryant- for pica, if rumination is one of the symptoms Waugh & Piepenstock, 2008). of parent–infant relationship disorder, diagno- The course of pica is variable. It may be self- sis of rumination on Axis I in DC:0–5 is noted limited or become protracted and lead to medi- only if severe and warrants a special nutritive

Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. cal emergencies. Some cases of pica are diag- treatment.

Hoarding feeding, pain management, oral–motor difficulties, and behavioral patterns of both child and Hoarding is described as storing food in un- parent (Edwards et al., 2016). Clinical, multi- usual places (e.g., under a pillow, in a closet, in disciplinary monitoring of hunger provocation a desk). Finding food in unusual places is in- by decreasing the amount of the tube feeds has dicative of the diagnosis. The disorder has not been shown to be an effective approach (Benoit, been described in children less than 2 years old. Wang, & Zlotkin, 2000); Hartdorff et al., 2015). The child may be overweight or underweight, Though weaning treatment can be done in an depending on what he or she does with the hid- outpatient setting, an inpatient setting may be den food. Food hoarding requires ruling out recommended, as it enables a relatively short hunger, neglect, and maltreatment (Sonneville (e.g., 3 weeks) intensive multidisciplinary inter- et al., 2013). vention. Therapeutic gains of such a model have been reported to persist 1 year postdischarge Pouching (Brown et al., 2014). Pouching relates to the child holding food in his or her mouth for long periods of time without Clinical Assessment of Eating/Feeding Disorders swallowing it. There are no published cases of in Young Children pouching food in children less than 2 years old, yet, occasionally I see this behavior in failure The goals of assessing young children with eat- to thrive clinics, especially among infants who ing problems are to determine appropriate di- have been tube fed and are being weaned, as agnoses and to identify the specific factors that well as among toddlers who have experienced have led to the development of the disorder. This forced feeding and/or traumatic medical proce- formulation aids in planning and implementing dures. Dental caries are often an associated sign appropriate treatment. in cases in which pouching happens on a daily Regardless of the types and causes of eating basis and for several hours (Bhargav, Hedge, disorders, history taking must address several Chandra, Gaviappa, & Shetty, 2014). There are key elements (Birch & Davison, 2001): How no available data on risk and prognostic fea- does the problem manifest? Is the child suffer- tures of pouching during infancy. Obviously, ing from any medical disease? Have the child’s ruling out any medical condition that prevents weight, nutritional status, and development been the child from swallowing is warranted before a affected? What is the atmosphere during meals? diagnosis of pouching is made. Is the family under stress? Are daily routines disrupted because of the struggles over eating? Does the child have a concurrent sleep problem, Tube-Fed Infants since sleep and eating problems often co-occur and exacerbate one another? Answers to these Tube feeding is commonly used in nutrition questions help the clinician assess the degree of for infants while they are treated for systemic impairment in the child and/or the family. disease, congenital malformations, or men- Self-report measures completed by parents tal retardation (Hartdorff et al., 2015). Those are available to assess maternal feeding behav- young children who have had prolonged peri- iors, including the Child Feeding Questionnaire ods of tube feeds (NG tube feeding or percu- (Birch et al., 2001) for monitoring and restric- taneous endoscopic gastrostomy [PEG]), often tion of food intake and controlling behavior, the develop refusal to try any oral feeding, even Preschooler Feeding Questionnaire (Baughcum though they no longer require tube feeding. et al., 2001) for putting pressure or prompting Contributing factors to this complication in- the child to eat, the Parent Feeding Style Ques- clude age at which oral feeding starts, medical tionnaire (Wardle, Sanderson, Guthrie, Rapo- complications, exposure to taste and textures port, & Plomin, 2002) for assessing instrumen- during sensitive periods, aversive experiences, tal (i.e., using food for reward) and emotional and ways of giving tube feeds (Mason, Harris, feeding (i.e., using food to regulate children’s & Blissett, 2005). Weaning from the tube then negative emotions). The Control Over Eating becomes a challenging task that requires a mul- Questionnaire (Ogden, Reynolds, & Smith, tidisciplinary team to work through issues of 2006) examines covert and overt forms of pa- feeding schedules, sensory implications of tube Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. rental control, and the Comprehensive Feeding

Practices Questionnaire (Musher-Eizenman & is used to convey to the parents playfulness and Holub, 2007) assesses parents’ restriction of enjoyment, in contrast with the threatening per- high-sugar and high-fat foods, as well as the use ception of the hospital. Parents are instructed in of food for reward. advance to bring their infant after an overnight Because parent-report questionnaires are fast (in order to have the hunger drive activat- subject to bias, direct observation of both the ed). child’s eating behavior and the parent–child One parent sits close to the infant at the pic- interaction is necessary for the assessment of nic table, together with two other parent–infant any type of eating/feeding problem (Bergmeier, dyads and the multidisciplinary team (occu- Skouteris, & Hetherington, 2015). Contingen- pational therapist, dietitian, child psychologist cy, reciprocity, mutual enjoyment, absence of and/or psychiatrist, nurse, pediatrician), and control, struggle, and bargaining are the main the other parent sits in the rear (parents decide manifestations of optimal feeding interac- which of them sits close to the child). The food tions (Chatoor, Loeffler, McGee, & Menvielle, is placed at the middle of the table, within the 1998). A classification of feeding styles has infants’ reach but not on their plates. The parent been proposed recently (Kerzner et al., 2015) is instructed to let the infant do whatever he or and includes responsive (the parent divides re- she wishes, is given a plate of his or her own, sponsibilities; the parent’s responsibilities are and is encouraged to eat, too. So does the team. to determine what, when, where to eat, and This paradigm allows us to observe both lets the child determine how much), control- eating and feeding interaction. We assess the ling (the parent ignores the child’s hunger cues infant’s cognitive, emotional, and motor–oral and may use inappropriate coercive and reward skills, the extent of his or her autonomous ex- practices), indulgent (the parent feeds the child ploratory, imitation, and eating behavior, as whenever and whatever the child asks for), or well as the parent’s perception of the infant’s neglectful (the parent ignores the child’s physi- eating capacities and tolerance for letting the cal and emotional needs). Kerzner and col- child lead. When the infant is only breast- or leagues (2015) suggest that pediatricians can bottle-fed, the infant’s motor–oral skills and readily differentiate feeding styles by asking self-regulation are observed during the feeding three questions: How anxious are you about interaction, as well as the parent’s feeding be- your child’s eating? How would you describe havior. In this setting, we often encounter par- what happens during mealtime? What do you ents who want to feed their child according to do when your child won’t eat? Responses from their own perceptions of what and how much neglectful parents are vague; controlling par- their child should eat, though the infant wants ents describe pressuring/forcing their child to to eat by him- or herself. This direct and mul- eat; indulgent parents describe pleading, beg- tidisciplinary observation becomes the basis ging, and preparing special foods. Responsive for planning the intervention; quite often, the feeders follow the concept of a division of re- “picnic” is therapeutic in itself: the child, being sponsibility: The parent determines where, hungry and not pressed by the parent to eat, eats when, and what the child is fed; the child de- autonomously, to the parents’ great surprise. termines how much to eat. Responsive feeders This context of direct observation is also useful guide the child’s eating instead of controlling it. to elicit spontaneous parental statements/beliefs They set limits, model appropriate eating, talk about feeding practices, and attributions to their positively about food, and respond to the child’s child’s behaviors. feeding signals. Identification of the child’s and parents’ The young child’s eating behavior should be physical and emotional risk factors for the de- assessed in terms of motor and developmental velopment of eating disorders is essential for skills, as well as self-feeding skills and willing- treatment planning. More specifically, parental ness to try a variety of foods. Hence, an inter- psychopathology and especially eating disor- disciplinary team for both assessment and treat- ders must be assessed, as well as the child’s sen- ment is recommended (Silverman, 2010). sory processing, oral–motor skills, and temper- At the Schneider Hospital for Sick Children ament. Needless to say, a full medical workup (Tel Aviv), we have developed a multidisci- needs to be done in every case, as psychological plinary “breakfast picnic” assessment for chil- causes for eating disorder do not exclude physi- dren ages 9 months–4 years. The term “picnic” cal causes, and vice versa. Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Conclusions havioral treatment in early childhood: A randomized controlled trial. Journal of Pediatrics, 137, 498–503. Eating disorders of all types continue to be Bergmeier, H., Skouteris, H., & Hetherington, M. viewed as common but often complex and mul- (2015). Systematic research review of observational tifactorial disorders in infancy. Research on approaches used to evaluate mother–child mealtime interactions during preschool years. American Jour- eating disorders, especially intervention out- nal of Clinical Nutrition, 101(1), 7–15. come studies and long-term follow-up studies, Bergmeier, H., Skouteris, H., Horwood, S., Hooley, are still very much needed. It is my hope that M., & Richardson, B. (2014). Associations between the new DC:0–5 diagnostic criteria will help child temperament, maternal feeding practices and clinicians to plan well-designed studies. Both child body mass index during the preschool years: A assessment and treatment require an integrated systematic review of the literature. Obesity Review, multidisciplinary team rather than having men- 15(1), 9–18. tal health professionals separated from other Bhargav, N., Hedge, A., Chandra, P., Gaviappa, D., professionals. & Shetty, A. (2014). Problematic eating and its association with early childhood caries among 46–71 month-old children using Children’s Eating Behav- REFERENCES ior Questionnaire (CEBQ): A cross sectional study. Indian Journal of Dental Research, 25, 602–606. Birch, L. L., & Davison, K. K. (2001). Family environ- American Psychiatric Association. (1980). Diagnostic mental factors influencing the developing behavioral and statistical manual of mental disorders (3rd ed.). controls of food intake and childhood overweight. Washington, DC: Author. Pediatric Clinics of North America, 48, 893–907. American Psychiatric Association. (2013). Diagnostic Birch, L. L., & Doub, A. E. (2014). Learning to eat: and statistical manual of mental disorders (5th ed.). Birth to age 2 years. American Journal of Clinical Arlington, VA: Author. Nutrition, 99(3), 723–728. Ammaniti, M., Ambruzzi, A. M., Lucarelli, L., Cimi- Birch, L. L., Fisher, J. O., Grimm-Thomas, K., Markey, no, S., & D’Olimpio, F. (2004). Malnutrition and C. N., Sawyer, R., & Johnson, S. L. (2001). Confir- dysfunctional mother–child feeding interaction. matory factor analysis of the Child Feeding Ques- Journal of the American College of Nutrition, 23, tionnaire: A measure of parental attitudes, beliefs 259–271. and practices about child feeding and obesity prone- Ammaniti, M., Lucarelli, L., Cimino, S., D’Olimpio, ness. Appetite, 36, 201–210. F., Chatoor, I., & Anandakrisna, L. (2012). Feeding Blissett, J., Meyer, C., & Haycraft, E. (2007). Maternal disorders of infancy: A longitudinal study to middle mental health and child feeding problems in a non- childhood. International Journal of Eating Disor- clinical group. Eating Behaviors, 8, 311–318. ders, 45, 272–280. Braden, A., Rhee, K., Peterson, C. B., Rydell, S. A., Atzaba-Poria, N., Meiri, G., Millikovsky, M., Barkai, Zucker, N., & Boutelle, K. (2014). Associations be- A., Dunaevsky-Idan, M., & Yerushalmi, B. (2010). tween child emotional eating and general parenting Father–child and mother–child interactions in fami- style, feeding practices, and parent psychopathology. lies with a child feeding disorder: The role of pater- Appetite, 80, 35–40. nal involvement. Infant Mental Health Journal, 31, Brown, J., Kim, C., Lim, A., Brown, S., Desai, H., Volk- 682–698. er, L., & Katz, M. (2014). Successful gastrostomy Aviram, I., Atzaba-Poria, N., Pike, A., Meiri, G., & tube weaning program using an intensive multidisci- Yerushalmi, B. (2015). Mealtimes dynamics in child plinary approach. Journal of Pediatric Gastroenter- feeding disorder: The role of child temperament, ology and Nutrition, 58(6), 743–749. parental sense of competence, and paternal involve- Bryant-Waugh, R. J., Markaham, L., Kreipe, R. E., & ment. Journal of Pediatric Psychology, 40, 45–54. Walsh, B. T. (2010). Feeding and eating disorders in Baughcum, A. E., Powers, S. W., Johnson, S. B., Cham- childhood. International Journal of Eating Disor- berlin, L. A., Deeks, C. M., Jain, A., et al. (2001). ders, 43, 98–111. Maternal feeding practices and beliefs and their re- Bryant-Waugh, R. J., & Piepenstock, E. H. C. (2008). lationships to overweight in early childhood. Jour- Childhood disorders: Feeding and related disorders nal of Development and Behavioral Pediatrics, 22, of infancy or early childhood. In A. Tasman, J. Kay, 391–408. J. A. Lieberman, M. B. First, & M. Maj (Eds.), Psy- Benoit, D. (2009). Feeding disorders, failure to thrive, chiatry (3rd ed., pp. 830–846). New York: Wiley. and obesity. In C. H. Zeanah, Jr. (Ed.), Handbook Celik, G., Diler, R. S., Tahiroglu, A. Y., & Avci, A. of infant mental health (3rd ed., pp. 377–391). New (2007). Fluoxetine in posttraumatic eating disorder York: Guilford Press. in two-year old twins. Journal of Child and Adoles- Benoit, D., Wang, E. E. L., & Zlotkin, S. H. (2000). cent Psychopharmacology, 17(2), 233–236. Discontinuation of enterostomy tube feeding by be- Chatoor, I. (2002). Feeding disorders in infants and tod- Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

dlers: Diagnosis and treatment. Child and Adolescent Escobar, R. S., O’Donnell, K. A., Colallilo, S., Pawlby, Psychiatric Clinics of North America, 11, 163–183. S., Steiner, M., Meaney, M. J., et al. (2014). Better Chatoor, I. (2009). Diagnosis and treatment of feeding quality of mother–child interaction at 4 years of age disorders in infants, toddlers, and young children. decreases emotional overeating in IUGR girls. Ap- Washington, DC: Zero to Three Press. petite, 81, 337–342. Chatoor, I., & Egan, J. (1983). Nonorganic failure to Feldman, R., Keren, M., Rosval, O., & Tyano, S. (2004). thrive and dwarfism due to food refusal: A separa- Specifying the role of touch in infant feeding disor- tion disorder. Journal of the American Academy of ders: Maternal, child, and environmental correlates. Child and Adolescent Psychiatry, 22, 294–301. Journal of American Academy of Child and Adoles- Chatoor, I., Hirsch, R., Ganiban, J., Persinger, M., & cent Psychiatry, 43(9), 1089–1097. Hamburger, E. (1998). Diagnosing infantile anorex- Green, W. H. (1985). Attachment disorders in infancy ia: The observation of mother–infant interactions. and early childhood. In H. I. Kaplan, A. M. Freed- Journal of the American Academy of Child and Ado- man, & B. J. Sadock (Eds.), Comprehensive textbook lescent Psychiatry, 37, 959–967. of psychiatry (Vol. 4, pp. 1722–1731). New York: Chatoor, I., Loeffler, C., McGee, M., & Menvielle, E. Williams & Wilkins. (1998). Observational Scale for Mother–Infant In- Hartdorff, C. M., Kneepkens, C. M., Stok-Akerboom, teraction during Feeding: Manual (2nd ed.). Wash- A. M., van Dijk-Lokkart, E. M., Engels, M. A., & ington, DC: Children’s National Medical Center. Kindermann, A. (2015). Clinical tube weaning sup- Cimino, S., Cemiglia, L., Porreca, A., Simonelli, A., ported by hunger provocation in fully-tube-fed chil- Ronconi, L., & Ballarotto, G. (2016). Mothers and dren. Journal of Pediatric Gastroenterology and fathers with binge eating disorder and their 18–36 Nutrition, 60(4), 538–543. months old children: A longitudinal study on par- Hemmi, M. H., Wolke, D., & Schneider, S. (2011). As- ent–infant interactions and offspring’s emotional– sociations between problems with crying, sleeping, behavioral profiles. Frontiers in Psychology, 7, and/or feeding in infancy and long-term behavioural 580. outcomes in childhood: A meta-analysis. Archives of Cockshaw, C. W. D., Muscat, T., Obst, P. L., Thorpe, Diseases in Childhood, 96, 622–629. K. (2014). Paternal postnatal depressive symptoms, Hughes, S. O., Power, T. G., Liu, Y., Sharp, C., & Nick- infant sleeping and feeding behaviors, and rigid las, T. A. (2015). Parent emotional distress and feed- parental regulation: A correlational study. Journal ing styles in low-income families: The role of par- of Psychosomatic Obstetrics and Gynecology, 35, ent depression and parenting stress. Appetite, 92, 124–131. 337–342. Cooper, P. J., Whelan, E., Woolgar, M., Morrell, J., & Kong, K. L., & Epstein, L. H. (2016). Food reinforce- Murray, L. (2004). Association between childhood ment during infancy. Preventive Medicine, 92, 100– feeding problems and maternal eating disorder: Role 105. of the family environment. British Journal of Psy- Keen, D. V. (2008). Childhood autism, feeding problems chiatry, 184, 210–215. and failure to thrive: Seven case studies. European Coulthard, H., Blissett, J., & Harris, G. (2004). The Child and Adolescent Psychiatry, 17(4), 209–216. relationship between parental eating problems and Keren, M. (2016). Eating and feeding disorders in the children’s feeding behavior: A selective review of first five years of life: Revising the DC:0–3R and ra- the literature. Eating Behaviors, 5, 103–115. tionale for the new DC:0–5 proposed criteria. Infant Davies, W. H., Satter, E., Berlin, K. S., Sato, A. F., Sil- Mental Health Journal, 37, 498–508. verman, A. H., Fischer, E. A., et al. (2006). Recon- Keren, M., Feldman, R., & Tyano, S. (2001). Diagnoses ceptualizing feeding and feeding disorders in inter- and interactive patterns of infants referred to a com- personal context: The case for a relational disorder. munity-based infant mental health clinic. Journal of Journal of Family Psychology, 20, 409–417. the American Academy of Child and Adolescent Psy- de Moor, J., Didden, R., & Korzilius, H. (2007). Behav- chiatry, 40, 27–35. ioral treatment of severe food refusal in five toddlers Kerzner, B., Milano, K., MacLean, W. C., Berall, G., with developmental disabilities. Child Care Health Stuart, S., & Chatoor, I. (2015). A practical approach Development, 33(6), 670–676. to classifying and managing feeding difficulties. Pe- Dubois, L., Farmer, A., Girard, M., Peterson, K., & diatrics, 135, 344–353. Tatone-Tokuda, F. (2007). Problem eating behaviors Kong, K. L., Eiden, R. D., Feda, D. M., Stier, C. L., related to social factors and body weight in preschool Fletcher, K. D., Woodworth, E. M., et al. (2016). Re- children: A longitudinal study. International Jour- ducing relative food reinforcement in infants by an nal of Behavioral Nutrition and Physical Activity, 4, enriched music experience. Obesity (Silver Spring), 4–9. 24(4), 917–923. Edwards, S., Davis, A. M., Bruce, A., Mosa, H., Lyman, Kong, K. L., Feda, D. M., Eiden, R. D., & Epstein, L. B., Cocjin, J., et al. (2016). Caring for tube-fed chil- H. (2015). Origins of food reinforcement in infants. dren: A review of management, tube weaning, and American Journal of Clinical Nutrition, 101(3), 515– emotional considerations. Journal of Parenteral and 522. Enteral Nutrition, 40, 616–622. Kreisler, L. (1981). L’enfant du désordre psychosoma- Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

tique [The psychosomatic child]. Toulouse, France: life in babies of women with eating disorders. Jour- Toulouse Privat. nal of Pediatrics, 154, 55–60. Kreisler, L. (1999). Conduites alimentaires déviantes du Micali, N., Simonoff, E., Stahl, D., & Treasure, J. bébé: L’anorexie mentale [Deviant eating behaviors (2011). Maternal eating disorders and infant feeding in infants: Infantile anorexia nervosa]. In S. Lebo- difficulties: Maternal and child mediators in a lon- vici, R. Diatkine, & M. Soulé (Eds.), Nouveau Traité gitudinal general population study. Journal of Child de Psychiatrie de l’Enfant et de l’Adolescent [New Psychology and Psychiatry, 52, 800–807. handbook of child and adolescent psychiatry] (pp. Munkholm, A., Olsen, E. M., Rask, C. U., Clemmensen, 2061–2072). Paris: Quadrige Presses Universitaires L., Rimvall, M. K., Jeppesen, P., et al. (2016). Early de France. predictors of eating disorders in pre-adolescence— Lucarelli, L., Ammaniti, M. , Porreca, A., & Simonelli, a prospective cohort study. Journal of Adolescent A. (2017). Infantile anorexia and co-parenting: A Health, 58(5), 533–542. pilot study on mother–father–child triadic interac- Musher-Eizenman, D., & Holub, S. (2007). Comprehen- tions during feeding and play. Frontiers in Psychol- sive Feeding Practices Questionnaire: Validation of ogy, 8, 376. a new measure of parental feeding practices. Journal Lucarelli, L., Cimino, S., D’Olimpio, F., & Ammaniti, of Pediatric Psychology, 32, 960–972. M. (2013). Feeding disorders of early childhood: An Nicolls, D., Statham, R., Costa, S., Micali, N., & Viner, empirical study of diagnostic subtypes. Internation- R. M. (2016). Childhood risk factors for lifetime bu- al Journal of Eating Disorders, 46, 147–155. limic or compulsive eating by age 30 years in a Brit- Luoma, I., Puura, K., Mantymaa, M., Latva, R., Salme- ish national birth cohort. Appetite, 105, 266–273. lin, R., & Tamminen, T. (2013). Fathers’ postnatal O’Brien, M. D., Bruce, B. K., & Camilleri, M. (1995). depressive and anxiety symptoms: An exploration The rumination syndrome: Clinical features rather of links with paternal, maternal, infant and family than manometric diagnosis. Gastroenterology, 108, factors. Nordic Journal of Psychiatry, 67, 407–413. 1024–1029. Luiselli, J. K. (2000). Cueing, demand fading, and posi- Ogden, J., Reynolds, R., & Smith, A. (2006). Expanding tive reinforcement to establish self-feeding and oral the concept of parental control: A role for overt and consumption in a child with chronic food refusal. covert control in children’s snacking behavior? Ap- Behavior Modification, 24, 348–358. petite, 47, 100–106. Malcolm, A., Thumshirn, M. B., Camilleri, M., & Wil- Paul, I. M., Williams, J. S., Anzman-Frasca, S., Beiler, liams, D. E. (1997). Rumination syndrome. Mayo J. S., Makova, K. D., Marini, M. E., et al. (2014). The Clinic Process, 72, 646–652. Intervention Nurses Start Infants Growing on Health Manikam, R., & Perman, I. A. (2000). Pediatric feeding Trajectories (INSIGHT) study. BMC Pediatrics, 14, disorders. Journal of Clinical Gastroenterology, 30, 184. 34–46. Paulson, J. F., Dauber, S., & Leiferman, J. A. (2006). In- Mason, S. J., Harris, G., & Blissett, J. (2005). Tube feed- dividual and combined effects of postpartum depres- ing in infancy: Implications for the development of sion in mothers and fathers on parenting behavior. normal eating and drinking skills. Dysphagia, 20(1), Pediatrics, 118, 659–668. 46–61. Powell, G. F., Brasel, J. A., & Blizzard, R. M. (1967). McDermott, B. M., Mamun, A. A., Najman, J. M., Wil- Emotional deprivation and growth retardation simu- liams, G. M., O’Callaghan, M. J., & Bor, W. (2008). lating idiopathic hypopituitarism: I. Clinical evalua- Preschool children perceived by mothers as irregular tion of the syndrome. New England Journal of Medi- eaters: Physical and psychosocial predictors from a cine, 276, 1271–1278. birth cohort study. Journal of Developmental and Rasquin, A., Di Lorenzo, C., Forbes, D., Guiraldes, Behavioral Pediatrics, 29, 197–205. E., Hyans, J. S., Staino, A., et al. (2006). Childhood McDermott, B. M., Mamun, A. A., Najman, J. M., Wil- functional gastrointestinal disorders: Child/adoles- liams, G. M., O’Callaghan, M. J., & Bor, W. (2010). cent. Gastroenterology, 130, 1527–1537. Longitudinal correlates of the persistence of irregu- Reilly, S. M., Skuse, D. H., Wolke, D., & Stevenson, J. lar eating from age 5 to 14 years. Acta Paediatrica, (1999). Oral–motor dysfunction in children who fail 99, 68–71. to thrive: Organic versus non-organic? Developmen- McGrath Davis, A., Shurle Bruce, A., Mangiaracina, tal Medical Child Neurology, 41, 115–122. C., Schulz, T., & Hyman, P. (2009). Moving from Rodgers, R. F., Paxton, S. J., Massey, R., Campbell, K. tube to oral feeding in medically fragile nonverbal J., Wertheim, E. H., Skouteris, H., et al. (2013). Ma- toddlers. Journal of Pediatric Gastroenterology and ternal feeding practices predict weight gain and obe- Nutrition, 49, 233–236. sogenic eating behaviors in young children: A pro- Micali, N., Rask, C. U., Olsen, E. M., & Skovgaard, A. spective study. International Journal of Behavioral M. (2016). Early predictors of childhood restrictive Nutrition and Physical Activity, 10, 24–35. eating: A population-based study. Journal of Devel- Scaglioni, S., Arrizza, C., Vecchi, F., & Tedeschi, S. opmental and Behavioral Pediatrics, 37(4), 314–321. (2011). Determinants of children’s eating behav- Micali, N., Simonoff, E., Stahl, D., & Treasure, J. ior. American Journal of Clinical Nutrition, 94(6), (2009). Infant feeding and weight in the first year of 2006S–2011S. Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

Scaglioni, S., Salvioni, M., & Galimberti, C. (2008). S., Noble, F., et al. (2001). Influence of psychiatric Influence of parental attitudes in the development disorder on the controlling behavior of mothers with of children eating behavior. British Journal of Nutri- 1 year-old infants: A study of women with maternal tion, 99(Suppl. 1), 22–25. eating disorder, postnatal depression and a healthy Sherkow, S. P., Kamens, S. R., Megyes, M., & Loewen- comparison group. British Journal of Psychiatry, thal, L. (2009). A clinical study of the intergenera- 179, 157–162. tional transmission of eating disorders from mothers Steinberg, C. (2007). Feeding disorders of infants, tod- to daughters. Psychoanalytic Study of the Child, 64, dlers, and preschoolers. British College of Medicine 153–189. Journal, 49, 129–136. Silverman, A. H. (2010). Interdisciplinary care for feed- Thullen, M., Majee, W., & Davis, A. N. (2016). Co-par- ing problems in children. Nutrition and Clinical enting and feeding in early childhood: Reflections of Practice, 25(2), 160–165. parent dyads on how they manage the developmental Silverman, A. H. (2015). Behavioral management of stages of feeding over the first three years. Appetite, feeding disorders of childhood. Annals of Nutrition 105, 334–343. and Metabolism, 66(Suppl. 5), 33–42. Wardle, J., Sanderson, S., Guthrie, C. A., Rapoport, L., Sonneville, K. R., Rifas-Shiman, S. L., Haines, J., & Plomin, R. (2002). Parental feeding style and the Gortmaker, S., Mitchell, K. F., Gillman, M. W., et inter-generational transmission of obesity risk. Obe- al. (2013). Associations of parental control of feed- sity, 10, 453–462. ing with eating in the absence of hunger and food Zero to Three. (2005). Diagnostic classification of sneaking, hiding, and hoarding. Child Obesity, 9, mental health and developmental disorders of infan- 346–349. cy and early childhood: DC:0–3R (rev. ed.). Wash- Spitz, R. (1946). Anaclitic depression. An inquiry ington, DC: Author. into the genesis of psychiatric condition in early Zero to Three. (2016). Diagnostic classification of men- childhood. Psychoanalytic Study of the Child, 2, tal health and developmental disorders of infancy 313–342. and early childhood: DC:0–5. Washington, DC: Au- Stein, A., Woolley, H., Murray, L., Cooper, P., Cooper, thor. Copyright @ 2019. The Guilford Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.

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