Article

Feeding Behaviors and other motor development in healthy children (2-24 months)

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Abstract

Objectives: To monitor infant's gross, fine and oral motor development patterns related to feeding. Design: An incomplete block design was used with 57 to 60 (sample = 98) mothers interviewed when their children were 2, 3, 4, 6, 8, 10, 12, 16 and 24 months (within +/- 5 days of birth date). Each mother had 5 to 6 interviews. Setting: Selected developmental feeding behaviors were monitored using in-home interviews conducted by trained interviewers (n = 2). At each interview, mothers reported the child's age when behaviors first occurred, and anthropometric measurements were performed. Subjects: Subjects were healthy white children who lived mostly in homes with educated two-parent families of upper socioeconomic status. Results: Mean behavioral ages were within normal ranges reported in the literature, whereas individuals exhibited a wide diversity in reported ages. Examples of gross motor skills (age in months, +/- SD) included sitting without help (5.50 +/- 2.08) and crawling (8.00 +/- 1.55). Mean ages for self-feeding fine motor skills showed children reaching for a spoon when hungry (5.47 +/- 1.44), using fingers to rake food toward self (8.87 +/- 2.58) and using fingers to self-feed soft foods ( 13.52 +/- 2.83). Oral behaviors included children opening their mouth when food approached (4.46 +/- 1.37), eating food with tiny lumps (8.70 +/- 2.03) and chewing and swallowing firmer foods without choking (12.17 +/- 2.29). Conclusions: Mean ages for feeding behaviors occurred within expected age ranges associated with normal development. However, mothers reported that individual children exhibited a wide age range for achieving these behaviors. Our results should be considered in counseling mothers about infant feeding practices.

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... The preschool years are a period of rapid oral sensorimotor development and consolidation, and they lay an important foundation for later skill acquisition. 11 By 18 months, children can typically manage a full range of food and fluid textures and drink from a standard cup. 11 Apart from our preliminary results, 10 there is only one other longitudinal study of feeding skill acquisition in children with CP. ...
... 11 By 18 months, children can typically manage a full range of food and fluid textures and drink from a standard cup. 11 Apart from our preliminary results, 10 there is only one other longitudinal study of feeding skill acquisition in children with CP. Researchers followed a cohort of 23 children from 4 to 7 years, and found a reduction in coughing across time, but no other changes to prevalence of impaired ingestion functions. ...
... The literature reports that by 18 months, children can manage a full range of food and fluid textures, although skill development for more complex textures continues beyond 6 years. 11,35 On the basis of the literature describing typical progression of feeding abilities, the rapid decrease in prevalence between 18 to 24 and 30 to 36 months found in this study was expected. It is important to consider, however, that the modified cut points for children aged 18 to 36 months were used to classify OPD, 9 which should account for "developmental limitations to ingestion functions." ...
Article
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Objectives: To determine the progression of oropharyngeal dysphagia (OPD) in preschool-aged children with cerebral palsy (CP) according to gross motor function. It was hypothesized that fewer children would have OPD at 60 months compared with 18 to 24 months (predominately Gross Motor Function Classification System [GMFCS] I-II). Methods: Longitudinal population-based cohort of 179 children (confirmed CP diagnosis, born in Queensland in 2006-2009, aged 18-60 months at study entry [mean = 34.1 months ± 11.9; 111 boys; GMFCS I = 46.6%, II = 12.9%, III = 15.7%, IV = 10.1%, and V = 14.6%]). Children had a maximum of 3 assessments (median = 3, total n = 423 assessments). OPD was classified by using the Dysphagia Disorders Survey part 2 and rated from video by a certified pediatric speech pathologist. GMFCS was used to classify children's gross motor function. Results: OPD prevalence reduced from 79.7% at 18 to 24 months to 43.5% at 60 months. There were decreasing odds of OPD with increasing age (odds ratio [OR] = 0.92 [95% confidence interval (CI) 0.90 to 0.95]; P < .001) and increasing odds with poorer gross motor function (OR = 6.2 [95% CI 3.6 to 10.6]; P < .001). This reduction was significant for children with ambulatory CP (GMFCS I-II, OR = 0.93 [95% CI 0.90 to 0.96]; P < .001) but not significant for children from GMFCS III to V (OR [III] = 1.0 [95% CI 0.9 to 1.1]; P = .897; OR [IV-V] = 1.0 [95% CI 1.0 to 1.1]; P = .366). Conclusions: Half of the OPD present in children with CP between 18 and 24 months resolved by 60 months, with improvement most common in GMFCS I to II. To more accurately detect and target intervention at children with persisting OPD at 60 months, we suggest using a more conservative cut point of 6 out of 22 on the Dysphagia Disorders Survey for assessments between 18 and 48 months.
... A avaliação das habilidades orais foi realizada quando as crianças tinham 4 e 6 meses de idade corrigida, tendo sido utilizado um protocolo (quadro 1) desenvolvido através de adaptação de vários estudos [4][5][6][7][8][9] . Aos 4 meses de idade corrigida, a observação dos movimentos se deu através da sucção no seio materno ou no uso da mamadeira. ...
... Aos 6 meses de idade corrigida, ao serem avaliadas as habilidades orais, com exceção da sucção, observou-se que o movimento de retirada do alimento pastoso da colher, pelo lábio superior, não foi eficiente em todas as crianças. No entanto, este seria um movimento esperado em uma criança com 6 meses de idade cronológica 9 . Dificuldades nas primeiras tentativas, em usar a colher, para ingerir alimentos pastosos foram descritas por Marujo 3 , porém, ressalta-se que as crianças deste estudo, já tinham feito a transição alimentar, em média há 1,6 meses. ...
... Em relação aos movimentos de mandíbula e língua, com o uso da bolacha e na mascagem, na maioria das crianças, não foram observadas dificuldades aos 6 meses de idade corrigida, fato esperado uma vez que a criança, nessa idade, tem capacidade para mover sua língua lateralmente, buscando o alimento que é colocado do lado da boca 9 . No entanto, em estudo com crianças a termo, Telles e Macedo 6 , verificaram prejuízo nas habilidades referentes à mascagem aos 6 meses, sendo 31% nos movimentos de língua e 24% nos movimentos de mandíbula. ...
... More mature chewing patterns involving skills such as tongue lateralization develop and improve throughout childhood. 5,6 Additionally, children who have incisors but whose molars have not yet erupted are able to bite off pieces of food that cannot then be ground up appropriately for swallowing. 3,5 Several other anatomic considerations make infants and toddlers more likely to choke compared with older children. ...
... 9 For a normally developing full term baby, these developmental milestones are usually achieved between 6 and 9 months; however, there is significant variability in normal development from child to child. 6 Evidence suggests that after about 10 months, it becomes difficult for infants to learn new oral-motor 1 Cohen Children's Medical Center of New York, Lake Success, NY, USA movements, and those infants who have not been introduced to a varied diet by this point may be at risk for future oral-motor problems. 7 The AAP recommends starting with finger foods that are (1) soft, (2) easy to swallow, and (3) cut into small pieces. ...
... Evidence indicates that most infants will be developmentally ready to handle and benefit from the introduction of complementary foods at around age 6 mo (139,142,146,147). However, some infants may be ready earlier or later (146)(147)(148)(149)(150). The key signals that caregivers should pay attention to are the infant's ability to sit with little or no help; to munch/chew and swallow soft, solid foods; to have lost the extrusion reflex (the projection of food from the mouth); and to demonstrate interest in food (151). ...
... However, some infants may be ready earlier or later (146)(147)(148)(149)(150). The key signals that caregivers should pay attention to are the infant's ability to sit with little or no help; to munch/chew and swallow soft, solid foods; to have lost the extrusion reflex (the projection of food from the mouth); and to demonstrate interest in food (151). Achieving these developmental milestones strongly correlates with the maturation of the gastrointestinal tract, kidneys, and immune system required to benefit from introducing complementary foods (147,148). ...
Article
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The WHO recommends exclusive breastfeeding of infants for the first 6 mo of life (EBF-6). We reviewed the evidence behind concerns related to this recommendation. The risk of iron deficiency among EBF-6 infants can be significantly reduced if delayed cord clamping is performed in all newborns. At the moment there is no population-level evidence indicating that exclusive breastfeeding for 6 mo compared with <6 mo increases the risk of developing food allergies. Mild to moderate maternal undernutrition may reduce amounts of some nutrients in breast milk but does not directly diminish milk volume. Persistent reports of insufficient milk by women globally are likely to be the result of lack of access to timely lactation counseling and social support rather than primary biological reasons. All newborns should have their growth, hydration status, and development carefully monitored. In instances where formula supplementation is required, it should be done under the guidance of a qualified provider taking into account that early introduction of breast-milk supplements is a risk factor for early termination of exclusive breastfeeding and any breastfeeding. We found no evidence to support changes to the EBF-6 public health recommendation, although variability in inter-infant developmental readiness is recognized. We suggest that infant and young feeding guidelines make clear that complementary foods should be introduced at around 6 mo of age, taking infant developmental readiness into account.
... For the transition to solid foods, children have to acquire specific feeding skills, and these skills require more effort from a child than the oral manipulation of liquids such as milk. The acceptance of food with a given texture, here defined as the infant's ability to swallow the food, is strongly conditioned by the acquisition of feeding skills, which can develop differently in children of the same age (Carruth & Skinner, 2002;Carruth, Ziegler, Gordon, & Hendricks, 2004;. At the beginning of CF, children process semi-solids (i.e., purees) by sucking because they have only experienced drinking liquids (Torola, Lehtihalmes, Yliherva, & Olsen, 2012). ...
... Similar results were found in a recent French survey where mothers were asked to assess their child's acceptance level of foods with different textures. This finding was also observed in a US study: small pieces of foods were accepted from 8-9 mo (Carruth & Skinner, 2002). In our study, the probability of chewing soft cooked pieces at 8 mo was high, which suggests that infants were sufficiently developed orally to cope with soft cooked pieces from 8 mo onward. ...
Article
The timely complementary food introduction is important for the development of healthy eating. However, little evidence is available about when to introduce which texture during this period. This study aims to fill this gap by measuring the evolution of food texture acceptance and feeding behaviours between 6 and 18 months. Two groups of healthy children participated in the study: at 6, 8, and 10 months (n = 24) and at 12, 15 and 18 months (n = 25), respectively. They were offered foods with different textures (purees, double textures, cooked pieces, sticky and hard foods) at an age when few infants were already familiar with these textures. For each food texture, children's acceptance (ability to process and swallow a food) and feeding behaviours (sucking and chewing) were assessed by the investigator; liking was assessed by parents. At 6 months, pureed and double textures were highly accepted (Acceptance Probability AP > 0.8); when offered at 8 months, cooked pieces were highly accepted (AP > 0.8). Up to 10 months, the acceptance of more complex textures (e.g. cheese, bread crust) increased strongly with age as did chewing behaviour. At 12 months, most food textures were accepted (AP > 0.5), except raw vegetable pieces and pasta (AP < 0.35), and chewing behaviour was predominant over sucking. Up to 18 months, raw vegetable pieces and pasta acceptance increased with age and was >0.5 at 18 months. In conclusion, children accepted most textures at an earlier age than their parents’ feeding practices; their feeding behaviours depended on age and food texture and acceptance of hard textures was related to the development of chewing.
... More mature chewing patterns involving skills such as tongue lateralization develop and improve throughout childhood. 5,6 Additionally, children who have incisors but whose molars have not yet erupted are able to bite off pieces of food that cannot then be ground up appropriately for swallowing. 3,5 Several other anatomic considerations make infants and toddlers more likely to choke compared with older children. ...
... 9 For a normally developing full term baby, these developmental milestones are usually achieved between 6 and 9 months; however, there is significant variability in normal development from child to child. 6 Evidence suggests that after about 10 months, it becomes difficult for infants to learn new oral-motor 1 Cohen Children's Medical Center of New York, Lake Success, NY, USA movements, and those infants who have not been introduced to a varied diet by this point may be at risk for future oral-motor problems. 7 The AAP recommends starting with finger foods that are (1) soft, (2) easy to swallow, and (3) cut into small pieces. ...
Article
The American Academy of Pediatrics (AAP) recommends when to start first finger foods (FFFs) and what types of foods to start with, but it is unclear whether products marketed as FFF comply with these recommendations. We evaluated FFF products for compliance with AAP recommendations and product safety using 41 adult product testers, who were asked to dissolve each product in their mouth. Product characteristics, comments pertaining to product safety, and time to dissolve each product were recorded. Only 2 products met all AAP criteria, and safety concerns were raised for an additional 2 products. One product showed a large change in dissolvability after being left out of original packaging. Consumers should not assume that products marketed for infant/toddler consumption comply with AAP recommendations. Also, products left out of original packaging may change consistency, presenting a choking hazard. Additional research is warranted to guide the development of regulations surrounding labeling and marketing of these foods.
... The attainment of early oral motor skills needed to process more solid foods around the mouth shows a wide diversity across individuals. Carruth and Skinner [53] found that the mean age at which infants used the tongue to move food to the back of the tongue to swallow was 4.95 months, with a standard deviation of 1.27 and a range of 2.0-7.5 months. This variation may reflect normal differences in the development of the central nervous system and opportunities the infant has to practice skills [53,54]. ...
... Carruth and Skinner [53] found that the mean age at which infants used the tongue to move food to the back of the tongue to swallow was 4.95 months, with a standard deviation of 1.27 and a range of 2.0-7.5 months. This variation may reflect normal differences in the development of the central nervous system and opportunities the infant has to practice skills [53,54]. Weaning guidelines currently recommend that spoon feeding should not be commenced before 17 weeks of age but infants started taking solids from a spoon at this earlier age in previous decades [55], so the oral motor skills required to eat from a spoon precede the need for their use. ...
Article
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Purpose of Review A sensitive period in development is one in which it is easier for learning to take place; the behaviour can however still be learned at a later stage, but with more difficulty. This is in contrast to a critical period, a time at which a behaviour must be learned, and if this window of opportunity is missed, then the behaviour can never be acquired. Both might determine food acceptance in childhood. Recent Findings There is evidence to support the idea of a sensitive period for the introduction of tastes, a critical period for the introduction of textures and for the development of oral motor function, and a possible critical period for the introduction of new foods but only in children where there is an innate disposition to develop early and extreme disgust responses. Summary There are both sensitive and critical periods in the acquisition of food preferences.
... As children acquire complex fine motor skills, it is common for them to transition from bottle feeding to self-drinking with an open cup (Carruth & Skinner, 2002 ). Most children selfdrink with minimal guidance by 10 months (Pridham, 1990) and begin exclusively self-drinking from an open cup by 36 months (Carruth & Skinner, 2002). ...
... As children acquire complex fine motor skills, it is common for them to transition from bottle feeding to self-drinking with an open cup (Carruth & Skinner, 2002 ). Most children selfdrink with minimal guidance by 10 months (Pridham, 1990) and begin exclusively self-drinking from an open cup by 36 months (Carruth & Skinner, 2002). Although most children begin self-drinking independently or with some guidance from parents, children with feeding disorders often fail to progress to age-typical eating (e.g., self-drinking) in the absence of treatment (Peterson et al. 2015; Rivas et al. 2014; Vaz, Volkert, & Piazza, 2011). ...
Article
Self-drinking is an important skill for children to acquire as they transition from infancy to early childhood; however, the literature is limited (e.g., Collins, Gast, Wolery, Holcombe, & Leatherby, 1991; Peterson, Volkert, & Zeleny, 2015). We manipulated the consequences associated with self-drinking relative to those associated with being fed along the dimension of response effort. Results demonstrated that self-drinking increased when the child could either choose to self-feed one drink or be fed one drink and 5 practice trials with an empty cup.
... Thus similar to another study reported that, during infancy, the infant has a relationship with the type of food, during milk-feeding, the introduction www.iarjournals.com of complementary foods and the transition to family foods, can be critical health and development. (Carruth and Skinner, 2002). ...
Article
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An infant's growth pattern may be particularly relevant starting as early as the first months of life, since it may be associated with later health outcomes. Differences in weight and length progression between atopic infants and healthy children are significant from the second month of age onward and become marked in the second 6 months of life. The cross-section and hospital-based study were conducted to assess the growth rate of infants aged from birth up to one-year-old with respecting nutrition risk factors. In addition, to compare anthropometric measurements with gender and medical history of infants. The study was investigated randomly 226 respondents, those who attended Misurata Maternity and Pediatrics hospital from Feb. to Oct. 2020. The questionnaire was structured according to study purposes. Four parts of the questionnaire had compiled, these included basic information, medical history, anthropometric assessments, and biochemical tests. Pearson Correlation was used to evaluate the relationship between variables. The result revealed that more than one-third of infants were stunted, and 12% of them were underweight (less than 5% percentile). Whereas 22% of infants had acute malnourishment, this finding may be correlated with a high risk of morbidity among infants. The majority of participants were infected with respiratory infections, 87%, and chronic diarrhea 22% because. There was an insignificant (p≥0.05) correlation between gender, birth weight, body weight, common illness, continuation of breastfeeding, and types of formula. The nutrition risks of infants will be threatening child growth and development unless the maternal has committed with initiation and duration breastfeeding and regular follow up with a pediatric nutritionist.
... The acceptability of foods in general, including complementary foods, is greatly influenced by the perceived organoleptic properties of the food. The organoleptic properties such as aroma, flavour and texture are key parameters in the initial acceptance of foods by infants as a result of their limited motor oral functioning (Carruth and Skinner 2002;Nicklaus 2011). Consumers generally start the eating process with their eyes; as such colour plays an important role in the acceptance of a food product. ...
Chapter
Complementary foods are important in ensuring adequate nutrition in infants and young children. Commercially available complementary foods are usually nutrient dense and sufficient to meet recommended nutrient requirements. However, these foods are usually unaffordable by resource-poor populations resulting in need for low-cost traditionally formulated foods. Bambara groundnut is a grain legume that has been employed in formulating traditional complementary foods in sub-Saharan Africa. It has been used singly or in combination with different food such as maize, locust bean and banana to produce different nutrient dense complementary foods. Bambara groundnut has been used as an adjunct in many food formulations to boost the nutritional profile especially protein quality, consumer acceptability depending on the amount of Bambara groundnut inclusion in the formulation and the form in which it is used. This chapter presents the use of Bambara grains in complementary feeding and outlined the nutritional, physical and functional characteristics of these formulated foods. Comparisons were made where applicable with commercially available complementary foods. Prospects for commercialisation of Bambara groundnut complementary foods were also discussed.
... Information regarding attainment of developmental milestones, such as walking and talking, is one way to quantify very early aspects of the phenotype. Extensive data on such developmental milestones are available for the general population (Carruth & Skinner, 2002;Sheldrick et al., 2019;Størvold, Aarethun, & Bratberg, 2013;Taanila, Murray, Jokelainen, Isohanni, & Rantakallio, 2005;World Health Organization, 2006). Information about developmental milestone attainment is lacking in rare genetic conditions, but has been a focal point in ASD research. ...
Article
Background: Recent large-scale initiatives have led to systematically collected phenotypic data for several rare genetic conditions implicated in autism spectrum disorder (ASD). The onset of developmentally expected skills (e.g. walking, talking) serve as readily quantifiable aspects of the behavioral phenotype. This study's aims were: (a) describe the distribution of ages of attainment of gross motor and expressive language milestones in several rare genetic conditions, and (b) characterize the likelihood of delays in these conditions compared with idiopathic ASD. Methods: Participants aged 3 years and older were drawn from two Simons Foundation Autism Research Initiative registries that employed consistent phenotyping protocols. Inclusion criteria were a confirmed genetic diagnosis of one of 16 genetic conditions (Simons Searchlight) or absence of known pathogenic genetic findings in individuals with ASD (SPARK). Parent-reported age of acquisition of three gross motor and two expressive language milestones was described and categorized as on-time or delayed, relative to normative expectations. Results: Developmental milestone profiles of probands with genetic conditions were marked by extensive delays (including nonattainment), with highest severity in single gene conditions and more delays than idiopathic ASD in motor skills. Compared with idiopathic ASD, the median odds of delay among the genetic groups were higher by 8.3 times (IQR 5.8-16.3) for sitting, 12.4 times (IQR 5.3-19.5) for crawling, 26.8 times (IQR 7.7-41.1) for walking, 2.7 times (IQR 1.7-5.5) for single words, and 5.7 times (IQR 2.7-18.3) for combined words. Conclusions: Delays in developmental milestones, particularly in gross motor skills, are frequent and may be among the earliest indicators of differentially affected developmental processes in specific genetically defined conditions associated with ASD, as compared with those with clinical diagnoses of idiopathic ASD. The possibility of different developmental pathways leading to ASD-associated phenotypes should be considered when deciding how to employ specific genetic conditions as models for ASD.
... The onset of food allergies usually occurs in early childhood, a time of rapid growth, cognitive and oral motor development, and a period when feeding patterns are established. 5,6 The mainstay of food allergy management is the elimination of the offending food. 7 Many of the more common allergens contribute essential nutrients during this vulnerable time and inappropriate advice and alternatives may increase risk of growth faltering and nutrient deficiencies with potential long-term effects. ...
Article
Worldwide food allergy prevalence is increasing, especially in children. Food allergy management strategies include appropriate avoidance measures and identifying suitable alternatives for a nutritionally sound diet. Individualized dietary intervention begins teaching label reading, which differs among countries or regions. Dietary intervention must result in a nutritionally sound plan including alternatives to support optimal growth and development. Inappropriate or incomplete dietary advice may increase the risk of adverse reactions, growth faltering, and nutrient deficiencies. Evidence indicates input from a registered dietitian improves nutritional outcomes. Nutritional input plays a critical role managing nutritional disorders related to food allergy.
... Luego el niño logra la coordinación ojo-mano, lo que le permite llevarse alimentos a la boca por sí solo y después la coordinación del movimiento tronco-brazo, con lo que finalmente puede acercarse los alimentos y consumirlos según su interés. Este proceso requiere mucha madurez del sistema nervioso y de la estructura anatómica, por lo que puede tardar entre los 15 y 20 meses (Carruth & Skinner, 2002). La progresión en el desarrollo de las habilidades para alimentarse se presenta en la tabla 4. ...
... The concern is that squeeze packs may lead to poor feeding skills acquisition and oro-motor development, delaying self-feeding skills (6) . Feeding directly from a squeeze pouch discourages active exploration and handling of food that facilitates independent feeding skills such as picking up food, finger and spoon feeding and drinking from a cup (14,15,32) . ...
Article
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Infant Feeding Guidelines worldwide recommend first foods be iron rich with no added sugars and that nutrient poor discretionary foods be avoided. Feeding guidelines also recommend exposing infants to a variety of foods and flavours with increasingly complex textures. Here, we compare nutritional and textural properties of commercial infant and toddler foods available in Australia with established infant feeding guidelines. Nutrition information and ingredient lists were obtained from food labels, manufacturer and/or retailer websites. In total, 414 foods were identified, comprising mostly mixed main dishes, fruit and vegetable first foods, and snacks. Most products were poor sources of iron, and 80% of first foods were fruit-based. Half of all products were purees in squeeze pouches and one third of all products were discretionary foods. The nutritional content of many products was inconsistent with guidelines, being low in iron, sweet, smooth in consistency, or classified as discretionary. Reformulation of products is warranted to improve iron content, particularly in mixed main dishes, expand the range of vegetable only foods, and textural variety. Greater regulatory oversight may be needed to better inform parents and caregivers. Frequent consumption of commercial baby foods low in iron may increase risk of iron deficiency. Excessive consumption of purees via squeeze pouches may also have implications for overweight and obesity risk.
... Most children have developed the motor skills necessary to self-feed by around 14 months of age. 175 During this time, caregivers typically try to socialize children and their eating behaviors to their personal, familial, and cultural values. Such socialization is enabled by children's rapid cognitive development during early childhood, when children learn language comprehension (≈11-12 months of age 176 ), and that others have beliefs, requests, and intentions (≈14 months of age 177 ). ...
Article
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A substantial body of research suggests that efforts to prevent pediatric obesity may benefit from targeting not just what a child eats, but how they eat. Specifically, child obesity prevention should include a component that addresses reasons why children have differing abilities to start and stop eating in response to internal cues of hunger and satiety, a construct known as eating self-regulation. This review summarizes current knowledge regarding how caregivers can be an important influence on children's eating self-regulation during early childhood. First, we discuss the evidence supporting an association between caregiver feeding and child eating self-regulation. Second, we discuss what implications the current evidence has for actions caregivers may be able to take to support children's eating self-regulation. Finally, we consider the broader social, economic, and cultural context around the feeding environment relationship and how this intersects with the implementation of any actions. As far as we are aware, this is the first American Heart Association (AHA) scientific statement to focus on a psychobehavioral approach to reducing obesity risk in young children. It is anticipated that the timely information provided in this review can be used not only by caregivers within the immediate and extended family but also by a broad range of community-based care providers.
... Chewing function is a complex and rhythmic process that begins with accepting food in the mouth, continues with placing the food between the molar teeth, crushing the food into smaller pieces and concludes with swallowing [1]. Children start to develop the necessary coordinated chewing movements by 9 months [2] and can manage solid foods at 12 months [3]. A 4-year-old child is expected to manage a normal diet that includes all food textures [4]. ...
Article
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The Mastication Observation and Evaluation (MOE) instrument is an objective assessment of the chewing process in children. This study aimed to translate the MOE into Turkish and to test its reliability and validity in children with cerebral palsy (CP). A total of 53 children with CP and 27 typical children were included in the study. The MOE was translated from Dutch into Turkish by using the forward, backward, forward translation method. The internal consistency, intra- and inter-observer reliability, criterion, and discriminant validity of the Turkish version of the MOE (T-MOE) were investigated. Internal consistency was excellent with a Cronbach’s alpha value of 0.98. The Intraclass correlation coefficient ranged from 0.89 to 0.97 for intra-rater reliability and from 0.86 to 0.94 for inter-rater reliability. The median score from Karaduman Chewing Performance Scale (KCPS) was 7 (min = 1, max = 8). All of the items in the T-MOE and the total T-MOE score had a negative and strong correlation with the KCPS score. Typical children without chewing disorders had greater T-MOE scores than the children with CP suffering from chewing disorders (p < 0.01). The T-MOE is a reliable and valid instrument for evaluating the observed oral motor behaviors of chewing function in children. It can be used in clinical practice and research. Clinical trial number: NCT03811353.
... As children got older, fewer chewing cycles were needed to eat a standardized piece of solid (cereal; Gisel, 1991). With continued exposure to solids that gradually need increased chewing strength and stamina, infants develop rotary chewing skills providing a more efficient means for food breakdown (Carruth & Skinner, 2002). Gisel (1991) notes that the ability to eat various food textures matures at different rates with optimal efficiency not achieved at 2 years but apparent from about 3 years of age. ...
Article
The dysphagia field is still in relative infancy with a sophisticated knowledge base amassed since the early 1980's. The desire to identify aspiration and prevent life threatening pneumonia has resulted in a focus on the complexities of swallowing liquids. However, humans also ingest saliva, food and oral medications, with the potential for these substances to incompletely clear the pharynx, be aspirated or block the airway. Safe swallowing of solid food in particular requires adequate chewing function, good oral control, and sufficient higher cortical function. Although screening and assessment for liquid swallowing safety is well established, the same cannot be said for the evaluation of safety to chew and swallow different food textures. While research into liquid swallowing physiology and its clinical application has largely come from the medical and allied health fields, our knowledge of chewing function for food textures comes from food texture research and food sensory science arenas. There is an exciting opportunity to bring the medical and food texture science fields together to expand our knowledge base on human chewing function, with clinical application to people with dysphagia. The development of the IDDSI Framework as an international standardized way of describing and labelling food texture and drink thickness allows the field to move towards management of texture modified food and thick liquids in a coordinated fashion, speaking the same language. This commentary will describe what we know of chewing function and how it is assessed clinically, proposing methods of assessment that utilize the IDDSI Framework. This article is protected by copyright. All rights reserved.
... We made some assumptions to estimate the exposure of infants to the cyclic polyester oligomers from the polyester coatings in the closures of complementary food (CF) filled in jars. Typically, the feeding of infants with semisolid, pureed or mushed CF starts around the fifth or sixth month of life and becomes one of the main sources of energy until the end of the first year of life (Gisel 1991;Carruth and Skinner 2002;Foterek et al. 2014Foterek et al. , 2016Fewtrell et al. 2017). Within this period, the body weight of an infant will be about 6-10 kg (EFSA NDA Panel 2014). ...
Article
Coatings for cans or closures are essential to protect the metal from corrosion and the food from migration of hazardous metal ions. Since coatings are no inert materials, they can release substances of potential health concern into food. In the present study, a comprehensive analysis is presented for a complex two-layered polyester–phenol-coating commercially used for metal closures of complementary infant food in sterilised glass jars. Focussed on the identity and migration of cyclic polyester oligomers as a kind of predictable non-intentionally added substances, polyester resin raw materials (n = 3) as well as individual coating layers (n = 3) were characterised by several analytical strategies (size exclusion chromatography, high-performance liquid chromatography mass spectrometry, diode array detection, charged aerosol detection, monomer determination after alkaline hydrolysis, overall migrate). The main polyester monomers were terephthalic acid, isophthalic acid, trimellitic acid, ethylene glycol, diethylene glycol, neopentylglycol, 2-methyl-1,3-propanediol, 1,4-butanediol and tricyclodecanedimethanol. The coatings were extracted with solvents acetonitrile and ethanol (24 h, 60°C), food simulants 50% ethanol, 20% ethanol and water (1 h, 121°C) as well as homemade and commercial baby food (1 h, 121°C). The released total polyester content determined by alkaline hydrolysis ranged from 288 µg/dm² (water, 1 h, 121°C) to 6154 µg/dm² (acetonitrile, 24 h, 60°C). However, individual cyclic oligomers, mainly dimers, were released from the coating to up to about 140 µg/dm². Migration into infant food was best represented by the food simulants water (up to 1% fat) and 20% ethanol (up to 5% fat). Cyclic polyester oligomers are classified as Cramer III substances by the threshold of toxicological concern concept associated to an exposure threshold of 1.5 µg/kg body weight per day. Exposure to cyclic polyester oligomers might be a potential concern for highly exposed infants.
... It has been suggested that BLCF could be considered a continuation of breast-feeding on demand, which promotes self-regulation of milk volume by the infant (7) . Proponents of this method assert that because the infant, rather than the adult, is responsible for his/her own feeding, it enables the infant to self-regulate his/her appetite, potentially lowering the risk of obesity later in life (6,8) , while encouraging the development of chewing and fine motor skills (9) . It has also been suggested that this method introduces infants to a wider variety of foods and textures and may lead to less fussy eating as the child matures (6,10) . ...
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Objective To compare food and nutrient intakes of infants aged 6–12 months following a baby-led complementary feeding (BLCF) approach and a standard weaning (SW) approach. Design Participants completed an online questionnaire consisting of sociodemographic questions, a 28 d FFQ and a 24 h dietary recall. Setting UK. Participants Infants ( n 134) aged 6–12 months ( n 88, BLCF; n 46, SW). Results There was no difference between weaning methods for the food groups ‘fruits’, ‘vegetables’, ‘all fish’, ‘meat and fish’, ‘sugary’ or ‘starchy’ foods. The SW group was offered ‘fortified infant cereals’ ( P < 0·001), ‘salty snacks’ at 6–8 months ( P = 0·03), ‘dairy and dairy-based desserts’ at 9–12 months ( P = 0·04) and ‘pre-prepared baby foods’ at all ages ( P < 0·001) more often than the BLCF group. The SW group was offered ‘oily fish’ at all ages ( P < 0·001) and 6–8 months ( P = 0·01) and ‘processed meats’ at all ages ( P < 0·001), 6–8 months ( P = 0·003) and 9–12 months ( P < 0·001) less often than the BLCF group. The BLCF group had significantly greater intakes of Na ( P = 0·028) and fat from food ( P = 0·035), and significantly lower intakes of Fe from milk ( P = 0·012) and free sugar in the 6–8 months subgroup ( P = 0·03) v . the SW group. Fe intake was below the Reference Nutrient Intake (RNI) for both groups and Na was above the RNI in the BLCF group. Conclusion Compared with the SW group, the BLCF group was offered foods higher in Na and lower in Fe; however, the foods offered contained less free sugar.
... Feeding skills, including oral-motor, sensory, behavioral or emotional, and communication skills, develop early, and disruption of this process caused by symptoms related to the noneIgE-mediated GI disease, or by the dietary interventions, can create feeding difficulties. 25 Levy et al 26 established common triggers for feeding difficulties in children, including size (faltering growth), transitioning (puree to lumpier textures), organic disease (including GI disorders), mechanistic feeding (ignoring absent hunger cues), and posttraumatic event (traumatic event around feeding, including choking and violent vomiting). In noneIgE-mediated food allergic GI disorders, most of these triggers are present in the welldocumented symptoms (Table 1). ...
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Objective: To review the signs and symptoms of feeding difficulties in children with non-IgE-mediated food allergic gastrointestinal disorders and provide practical advice, with the goal of guiding the practitioner to timely referral for further evaluation and therapy. Various management approaches are also discussed. Data sources: Articles and chapters related to normal feeding patterns and the diagnosis and management of feeding difficulties in children were reviewed. Study selections: Selections were based on relevance to the topic and inclusion of diagnostic and management recommendations. Results: Because most non-IgE-mediated food allergic gastrointestinal disorders occur in early childhood, feeding skills can be disrupted. Feeding difficulties can result in nutritional deficiencies, faltering growth, and a significant impact on quality of life. Specific symptoms related to each non-IgE-mediated food allergic gastrointestinal disorder can lead to distinctive presentations, which should be differentiated from simple picky eating. Successful management of feeding difficulties requires that the health care team views the problem as a relational disorder between the child and the caregiver and views its association with the symptoms experienced as a result of the non-IgE-mediated food allergic gastrointestinal disorder. Addressing the child's concern with eating needs to be done in the context of the family unit, with coaching provided to the caregiver as necessary while ensuring nutritional adequacy. Treatment approaches, including division of responsibility, food chaining, and sequential oral sensory, are commonly described in the context of feeding difficulties. Conclusion: A multidisciplinary approach to management of feeding difficulties in non-IgE-mediated food allergic gastrointestinal disorders is of paramount importance to ensure success.
... Another study on the effect of shape on the intake of raw vegetables by children (9-12 years) reported that shape was influential, but no differences were found between slices and sticks (Olsen, Ritz, Kramer, & Møller, 2012). The lack of a difference between slices and sticks may be different in toddlers, as children at this age are just developing the pincer grip (Carruth & Skinner, 2002). Therefore, a shape that allows eating with fingers vs. the whole hand may result in a measurable difference in finger food consumption in toddlers. ...
Article
Starting with finger foods is recommended from 7 months in typically developing children. However, information on which finger foods are appropriate and accepted for which age is largely lacking. The purpose of this exploratory study was to determine whether chewing skills, hand motor skills, and other personal and food characteristics influence the intake of finger foods in early life. Thirty children aged 12 to 18 months participated in this study. All children were offered four finger foods in a fixed order on four consecutive days at their home. Two finger foods varied mainly in texture (fresh banana vs. freeze-dried banana) and two other finger foods mainly in shape (stick vs. heart shaped cracker). The intake was measured after ten minutes of exposure to the product. Chewing skills were measured with the Mastication Observation and Evaluation instrument and fine motor skills with selected items of the Bayley-III-NL scales. The results suggest that texture but not shape was found to affect intake, as fresh banana was eaten more than freeze-dried banana and the consumed quantity of the two crackers was not significantly different. Hand motor skills affected the intake of fresh banana only and chewing skills did not affect intake of any of the finger foods. Age and experience with chewable foods were associated with an increased intake of some of the finger foods. In conclusion, the intake of the four finger foods in this study was found to be mainly affected by texture, hand motor skills, age and experience.
... A recent survey of families in the UK found that despite the 12-month UK recommendation to be transitioned to an open-cup, the majority of infants continue to use a combination of bottles and cups at 1 year [6]. Similarly, an earlier study in the US determined that open-cup drinking exposure varies widely and is highly influenced by parental practices [7]. ...
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This study evaluated the flow properties of viscosity and flow rate for water and two common pediatric liquids. The flow properties of the test liquids are of interest to create a cup simulation model and "smart" prototype training cup. Two objective methods of determining flow properties were utilized: a rheometer to assess viscosity and a modified version of the International Dysphagia Diet Standardization Initiative (IDDSI) to assess flow rate. Rheometer results concluded that the pediatric supplements were less than 50 cP at all shear rates evaluated and exhibited shear-thinning properties, placing both liquids into the "thin" category. The IDDSI, which was performed according to standardized protocol and also with experimental modifications of varying syringe volumes, determined that all three test liquids had greater than 1 mL/s flow rate across all syringe types/sizes. The experimental modification of the IDDSI with 60 mL syringe volume was found to be the most consistent and applicable with discrete values obtained across all liquids tested. A flow rate factor equation can be determined with the use of a 60 mL syringe, with our laboratory setup, to create the cup simulation model. This computer-generated cup simulation model also aims to integrate engineering with clinical practice to develop a "smart" prototype training cup equipped with software to control flow rate.
... 8,9 Nutritional management of infants with food allergies is not as simple as providing just elimination advice. Multiple factors impact on nutritional adequacy, including oral motor skills, 10 parental preferences and beliefs which impact on food choices and atopic comorbidities may also have an adverse effect. This review publication aims to assess the research on growth, micronutrient and feeding difficulties as common presenting nutritional disorders in childhood food allergy and intends to also provide some summary points from available research and implications for clinical practice. ...
Article
The elimination of food allergens that contribute essential nutrients in paediatrics, may lead to the development of nutritional disorders. The most common nutritional disorders include poor growth, micronutrient deficiencies and feeding difficulties. Of the aforementioned, growth faltering has been well studied and is seen as a common presenting factor in paediatric food allergy. However, the use of different criteria and cut‐off values makes it difficult to establish and overall effect. The impact of number and type of foods eliminated and co‐morbidities have yielded varying results, although there seems to be a trend towards worsening growth with atopic dermatitis and the avoidance of cow's milk. Low micronutrient intake is common in paediatric food allergy; however, a low intake does not necessarily translate into a deficiency as measured by biomarkers. Vitamin D and calcium have been well studied and a long‐lasting impact on bone mineral density has been found. However, other micronutrient deficiencies have also been found and should also be considered. Feeding difficulties is a common complaint in clinical practice but limited data has been published I food allergy. Poor growth and reflux/vomiting has been shown to be associated with feeding difficulties in particular in non‐IgE mediated food allergies. There seems to be a long‐ lasting effect on feeding in particular in cow's milk allergy, which needs to be taken into account with dietary input. The interplay between growth, feeding difficulties and micronutrient deficiencies has been implied in some studies, but cause and effect is not well established and requires further research. This article is protected by copyright. All rights reserved.
... There is considerable variation in the ages at which infants and young children achieve new feeding skills depending on differences in their psychomotor development, interaction with the environment and how often these skills are promoted by their parents. For instance, the mean age at which infants use the tongue to move food to the back of the tongue to swallow was observed as 4.95 months, with a standard deviation of 1.27 months and a range of 2.0-7.5 months (Carruth and Skinner, 2002). Similar interindividual variations are observable in eating capabilities in older infants and young children, for instance a median (10, 90th percentile) age of around 9 (11, 17) months for holding the bottle and of around 17 (13, 18) months for self-feeding with a spoon (Largo, 2008). ...
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Following a request from the European Commission, the EFSA Panel on Plant Protection Products and their Residues (PPR Panel) prepared a scientific opinion to provide a comprehensive evaluation of pesticide residues in foods for infants and young children. In its approach to develop this scientific opinion, the EFSA PPR Panel took into account, among the others, (i) the relevant opinions of the Scientific Committee for Food setting a default maximum residue level (MRL) of 0.01 mg/kg for pesticide residues in foods for infants and young children; (ii) the recommendations provided by EFSA Scientific Committee in a guidance on risk assessment of substances present in food intended for infants below 16 weeks of age; (iii) the knowledge on organ/system development in infants and young children. For infants below 16 weeks of age, the EFSA PPR Panel concluded that pesticide residues at the default MRL of 0.01 mg/kg for food for infants and young children are not likely to result in an unacceptable exposure for active substances for which a health-based guidance value (HBGV) of 0.0026 mg/kg body weight (bw) per day or higher applies. Lower MRLs are recommended for active substances with HBGVs below this value. For infants above 16 weeks of age and young children, the established approach for setting HBGVs is considered appropriate. For infants below 16 weeks of age the approach may not be appropriate and the application of the EFSA guidance on risk assessment of substances present in food intended for infants below 16 weeks of age is recommended. The contribution of conventional food to the total exposure to pesticide residues is much higher than that from foods intended for infants and young children. Because of the increased intake of conventional food by young children, these have the highest exposure to pesticide residues, whereas infants 3–6 months of age generally have lower exposure. The impact of cumulative exposure to pesticide residues on infants and young children is not different from the general population and the EFSA cumulative risk assessment methodology is also applicable to these age groups. Residue definitions established under Regulation (EC) No 396/2005 are in general considered appropriate also for foods for infants and young children. However, based on a tier 1 analysis of the hydrolysis potential of pesticides simulating processing, the particular appropriateness of existing residue definitions for monitoring to cover processed food, both intended for infants and young children as well as conventional food, is questionable. © 2018 European Food Safety Authority. EFSA Journal published by John Wiley and Sons Ltd on behalf of European Food Safety Authority.
... Self-drinking is one of the self-help skills typically mastered by young children. In general, children can drink by themselves from an open cup starting at the age of three (Carruth & Skinner, 2002). This skill is important for children's autonomy and nutrition. ...
... -Mit etwa sieben Monaten kann ein Kind Esswaren in die Hand nehmen (Carruth/Skinner 2002). Mit acht bis neun Monaten isst es einen Keks allein , kann jedoch bis unter zweieinhalb Jahren noch nicht unbedingt sauber essen (überwiegend selbstständig). ...
... The Child Oral and Motor Proficiency Scale (ChOMPS) is a valid and reliable parent-report assessment of eating, drinking and related skills in children six months to seven years old that can be used to identify children with eating skill delays (unpublished data). Like all developmental processes, children develop eating-related skills at different ages (6,7). For ChOMPS scores to be meaningful in clinical practice and research, the score needs to be interpreted with reference to values from a large sample of healthy, typically developing and typically eating children of the same age. ...
Article
Aim: To determine reference values for the Child Oral and Motor Proficiency Scale (ChOMPS) based on healthy, typically-developing and typically-eating children between 6 months and 7 years old. Methods: Parents of children 6 months to 7 years old (n=1057) completed the 63-item ChOMPS. Median, range, 5thand 10thpercentiles were calculated for scores on the four subscales of the ChOMPS as well as the total score in each of 11 age groups. Results: Age-based norm-reference values are reported. By 24 months, 95% of children could perform all skills in the Basic Movement Patterns subscale. By 4 years, more than 95% of children could perform all of the skills in the Fundamental Oral Motor Skills subscale. The Oral-Motor Coordination and Complex Movement Patterns skills developed later. By 5 years, 90% of children could perform all Oral-Motor Coordination skills. In 6 - 7 year olds, 95% received a score of 44/46 on the Complex Movement Patterns subscale, indicating that some typical children had not established all of these complex skills by 7 years. Conclusion: The ChOMPS is the first valid and reliable parent-report measure of eating, drinking, and related skills that has age-based norm-reference values for use in clinical practice and research. This article is protected by copyright. All rights reserved.
... At the same time, sensory experiences to the hands and mouth increase as the fine motor skills of bringing toys to the mouth, reaching for a spoon, using palmar grasp, and transferring objects hand to hand emerge. 28 This ability to explore textures with the hands and in the mouth is likely important to a child learning to accept varying and increasing food textures. ...
Article
Feeding problems in infants and young children are common. In healthy children who are developing and growing normally, feeding problems are usually not serious and can be managed conservatively by reassuring the family and providing them with anticipatory guidance and follow-up. A majority of serious childhood feeding problems occur in children who have other medical, developmental, or behavioral problems. These are best evaluated and treated by an interprofessional team who can identify and address issues in the medical and/or developmental history, problems with oral motor control and function, problems with swallowing, and behavioral and/or sensory issues that may interfere with normal feeding.
... The food-transportation stage represents transporting food from the front to the side of the mouth by the tongue, and food-processing stage represents breaking down of food between (pre) molar teeth into small pieces. 6,7 The chewing disorders and problems in solid food intake were reported as one of the feeding difficulties in children with EA. 1,3,[8][9][10] The inability of the transition of food to bolus, slowness in feeding, coughing or choking, and vomiting during feedings were reported upon the introduction of solid food in the diet. 1,8 The consideration and management of chewing disorder as a feeding difficulty are of importance because the diet of children with normal feeding skills includes a combination of liquid, semisolid, and/or solid food. ...
Article
Introduction Feeding problems are common in children with esophageal atresia and tracheoesophageal fistula (EA–TEF); however, chewing disorders, which may cause inability to intake solid food, have not been evaluated. Therefore, we aimed to evaluate the chewing function in children with repaired EA–TEF. Materials and Methods Age, sex, the type of atresia, the type of repair, and the time to start oral feeding were recorded. The level of the chewing performance was scored according to the Karaduman Chewing Performance Scale (KCPS). The International Dysphagia Diet Standardization Initiative (IDDSI) was used to determine the tolerated food texture in children. Results A group of 30 patients were included, of which 53.3% was male. The percentages of the isolated-EA and that of the EA–distal TEF were 40% and 60%, respectively. The median value for the time to start oral feeding was 4.5 weeks (min = 1, max = 72). Eleven (36.7%) children had chewing disorder. The KCPS scores showed level I in six cases, level III in four cases, and level IV in one case. Five children with chewing disorder had IDDSI level 3 and six had level 7, along with the sensation of stuck food. We found no significant difference between the KCPS scores according to the repair type (p = 0.07). The median values of the KCPS scores of children with primary repair, delayed repair, and colon interposition were 0 (min = 0, max = 4), 0.5 (min = 0, max = 3), 2 (min = 0, max = 3), respectively. A significant positive correlation was found between the time to start oral feeding and the KCPS scores (r = 0.63, p = 0.001). Conclusion Chewing disorders can be observed in children with EA–TEF, and the type of repair and the delay in oral feeding may be related to chewing disorder. Therapeutic maneuvers are needed to improve the chewing function in children with EA–TEF.
... For each item the corresponding age is given. (Carruth, Skinner, 2002) [7]. ...
Objectives: Congenital Aural Atresia (CAA) is a deformity of the external ear and it is commonly associated with malformations of middle and inner ear and, in some cases, with other facial deformities. Very few assessment measures exist for evaluating the functional impairment in children with CAA. Purpose of this study is to introduce and describe an assessment Checklist, (nominated FOS Checklist) that covers feeding abilities (F), oralmotor skills (O), communication/language development (S) in children with CAA. FOS wants to offer a range of assessment providing a profile of the child in comparison to hearing peers and it aims to make clinicians able to identify additional problems and areas of difficulties as well as specific abilities and skills. Secondary, we want to investigate the presence of correlations between disorders and side of CAA. Methods: a new Checklist (FOS Checklist) was administered to 68 children with CAA. Results: Feeding abilities are age-adequate in 94,3% of all patients. 54,4% of all patients are in need for further assessment of their oral-motor skills; delays in language development were found in 44,1% of cases. Orofacial development delays have been observed in 57.2% of subjects among the bilateral CAA group, in 53.9% among the right CAA group and in 53.4% among the left CAA group. Patients referred for further language evaluation were 42,9% in the bilateral CAA group, 33.3% in the right CAA group and 33.3% in the left CAA group. According to the χ2 analysis, referral for further assessment is independent from side of aural atresia. Conclusions: Subjects with bilateral CAA are more likely to be referred for further assessment, both for oral motor aspects and for speech perception and language development. However, there is not a significant statistical difference between the performances of children with bilateral or unilateral CAA. FOS Checklist is simple, reliable and time effective and can be used in everyday clinical practice. FOS enable clinicians to identify additional problems and areas of difficulties as well as specific abilities and skills; moreover, FOS allows to determine appropriate referrals and intervention strategies.
... Building from this explanation, one may suggest that young children are in a phase of discovery; therefore, they were exploring "how best to use perceptual information to calibrate the motor system in the service of action" (Fitzpatrick, Wagman, & Schmidt, 2012, p. 28). Although a glass (i.e., cup) is an object that children typically use early in life (Carruth & Skinner, 2002), it is possible that children are more familiar to being handed an upright glass, than having to re-orient it for use. It can also be argued that ESC planning is limited by physical capabilities. ...
Article
Young adults plan actions in advance to minimize the cost of movement. This is exemplified by the end-state comfort effect (ESC). A pattern of improvement in ESC in children is linked to the development of cognitive control processes, and decline in older adults' is attributed to cognitive decline. This study used a cross-sectional design to examine how movement context (pantomime, demonstrate with image/glass as a guide, actual grasping) influences between-hand differences in ESC planning. Children (5- to 12-year-olds), young adults and two groups of older adults (ages 60 to 70, and ages 71+) were assessed. Findings provide evidence for adult-like patterns of ESC in 8-year-olds. Results are attributed to improvements in proprioceptive acuity and proficiency in generating and implementing internal representations of action. For older adults, early in the aging process sensitivity to ESC did not differ from young adults. However, with increasing age, differences reflect challenges in motor planning with increases in cognitive demand, similar to previous work. Findings have implications for understanding lifespan motor behaviour.
... Oral motor skills evolve quickly over the first years of life, more or less independently from the development of the teeth (Carruth & Skinner, 2002;Gisel, 1991;Szczesniak, 1972). Although the efficiency of chewing continues to increase until at least 24 months, the most noticeable changes in oral motor skills occur between 6 and 10 months (Gisel, 1991). ...
Article
The present study examined the effect of meals varying in amount, size, and hardness of food pieces on the development of the chewing capabilities of 8-month-old infants. The study also examined changes in shivering, gagging, coughing, choking, and their ability to eat from a spoon. In an in-home setting two groups were given commercially available infant meals and fruits, purees with either less, smaller and softer or more, larger and harder pieces. Both groups were given these foods for 4 weeks and were monitored several times during this period. After the four week exposure period infants in both groups were given the same five test foods. Structured questionnaires with questions on eating behavior and the child's development were conducted 6 times in the 4-12 month period and video analyses of feedings were conducted 4 times between 8 and 9 months. After the four week exposure period, the group that had been exposed to the foods with more, larger and harder pieces showed a significantly higher rating for chewing a piece of carrot and potato for the first time, but not for a piece of banana nor for mashed foods. Shivering, gagging, coughing, choking, and ability to eat from a spoon were not different between the two groups. These results contribute to the insight that exposure to texture is important for young children to learn how to handle texture. This article is protected by copyright. All rights reserved.
... This development is closely related to gross, fine and oral motor functioning, and it continues to improve with age. [4][5][6][7] Acquiring feeding skills is a complex and fragile process during which certain adverse stimuli may easily cause feeding problems. In the neonatal intensive care unit (NICU), infants are continuously exposed to adverse stimuli and are known to have extended medical histories. ...
Article
Objective: To determine the prevalence of oral feeding problems in neonatal intensive care unit (NICU) graduates at 1 to 2 years, and to identify clinical risk factors during NICU admission. Study design: Observational cohort study of 378 children, who received level III/IV NICU care for 4 days or more in 2011 to 2012, chromosomal abnormalities excluded. We detected feeding problems in four gestational age (GA) groups (<28, 28 to 31, 32 to 36 weeks, and term-borns) using the Dutch standardized Screeningslijst Eetgedrag Peuters, and collected clinical factors for logistic regression analyses. Results: The prevalence of feeding problems was higher in NICU (20.4%) than in reference (15.0%) population (P=0.024), but similar for all GA groups (P=0.468). Prolonged tube feeding, that is, >30 days (odds ratio (OR) 2.50, confidence interval (CI) 1.13 to 5.56) and being born small for GA (OR 4.79, CI 1.64 to 14.03) were the most prevalent risk factors in children with GA ⩾32 and GA <32 weeks, respectively. Conclusion: Feeding problems are more prevalent in NICU graduates, with prolonged tube feeding as most important risk factor.Journal of Perinatology advance online publication, 19 January 2017; doi:10.1038/jp.2016.256.
... Carious lesions usually appear between 13-16 months after initial colonisation (Kawashita et al., 2011), suggesting the children in this study were affected at around 1 year of age. However, the administration of cariogenic foods and feeding habits may have occurred earlier, for instance between 6-12 months when infants start to sit up, develop better chewing and tasting mechanisms, and are eventually able to self-feed (Sheridan, 1991; Sellen, 2001; Carruth and Skinner, 2002; Delaney and Arvedson, 2008 ). Neither human breastmilk nor cow's milk are very cariogenic, but their cariespromoting properties are significantly increased when the infant is fed supplementary foods rich in carbohydrates such as fruits and honey (Moynihan, 2000; Azevedo et al., 2005; Kawashita et al., 2011). ...
Article
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Dental disease in childhood has the potential to inform about food availability, social status, and feeding practices, in addition to contributing to a child’s overall health status. This paper presents the first comprehensive overview of carious lesion frequencies in 433 nonadults (1-17 years), and 6283 erupted permanent and deciduous teeth from 15 urban and rural Romano-British settlements. Pooled deciduous and permanent caries rates were significantly higher in major urban sites (1.8%) compared to rural settlements (0.4%), with children from urban sites having significantly higher lesion rates in the deciduous dentition (3.0%), and in younger age groups with mixed dentitions. The differences in dental caries between urban and rural populations suggest disparities in maternal oral health, early childhood feeding practices, food preparation and access to refined carbohydrates. A richer, perhaps more ‘Roman’, cuisine was eaten in the urban settlements, as opposed to a more modest diet in the countryside. The effect of early childhood stress on caries frequency was explored using evidence for enamel hypoplasia. Co-occurrence of caries and enamel hypoplasia was highest in the major urban cohort (5.8%) and lowest in the rural sample (1.3%), suggesting that environmental stress was a contributing factor to carious lesion development in Romano-British urban children.
... They were also made before spoons. It is well recognised (e.g., Carruth and Skinner, 2002) that most children have the oral skills to manage 'table' foods at an age when they are not yet proficient with a spoon, yet this apparent skill discrepancy is rarely questioned. Connolly and Dalgleish (1989, p.897) dismiss using the fingers to get food to the mouth as "not very efficient". ...
Article
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The current recommended age to start complementary feeding is 6 months. At this age, most infants are capable of picking up pieces of food and taking them to their mouth; and yet there is an expectation that spoon-feeding will feature—in the early weeks, at least—in the transition to solid foods. This article looks at the rationale for this practice and presents evidence that, far from being necessary, spoon-feeding may contribute to feeding and health problems.
... In the absence of teeth, anecdotal evidence suggests that gums are effective for chewing all but the toughest foods. In a study by Carruth and Skinner (2002), the mean age for being able to chew 'firmer' foods was ten and a half months, while that for the eruption of the first molar was 15 months. By 20 months, all the children were reportedly able to chew and swallow firmer foods, even though some still had no cheek teeth. ...
Article
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Current guidance recommends that infants be introduced to solid foods from 6 months, an age at which chewing skills are rapidly developing. However, there is a general assumption that the first solid foods should be offered as purees. This article considers the rationale for this practice and presents evidence that, far from being either necessary or beneficial, insistence on pureed foods may contribute to feeding and health problems.
... Если для приема полужидкой пищи важно угасание «рефлекса выталкивания ложки», то для приема более плотной пищи младенец должен быть способен пребывать в сидячем положении и устойчиво удерживать голову; необходима координация глаз, движений рук и рта, для того чтобы ребенок мог смотреть на еду, брать ее и класть в рот; помимо этого, ребенок должен быть в состоянии проглотить твердую пищу. Возраст достижения этих навыков индивидуален и колеблется в достаточно широком диапазоне, и лишь у очень небольшого числа младенцев они развиваются в полной мере к 6-му мес жизни [44]. Именно поэтому предлагать плотную пищу, а также пищу, содержащую плотные кусочки, следует тогда, когда ребенок к этому готов. ...
Article
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Despite the availability of a national consensus document describing in detail modern approaches to feeding infants, pediatricians keep on giving most diverse recommendations on the time of supplemental feeding introduction. The article presents a brief historical review, as well the modern view on the issue of introduction of supplemental feeding to children. In the previous century, it was common both in Russia and most European countries to introduce supplemental feeding to children at the age of 2 or even 1.5 months. In 2002, the World Health Organization put forward an initiative in support of breastfeeding and recommended not to introduce supplemental feeding before the age of 6 months. A certain “golden mean” has apparently been achieved on the basis of results of studies and a longterm discussion among the specialists in feeding from different countries — all scientific communities and national recommendations of most countries define the optimal age for supplemental feeding introduction as “from 4 (completed) months to 6 (completed) months” with certain individual approach.
Article
BackgroundA balanced, age-appropriate, sustainable diet, and plenty of physical activity contribute to a healthy development and well-being of young children. An early adaptation of appropriate behavior can positively influence later behavior and thus improve health in the short, medium and long term. The recommendations for action on nutrition and physical activity in young children have been updated and are intended to provide professionals with a reliable basis for counselling of families with young children.Methods Current systematic reviews, meta-analyses, guidelines, and other relevant articles on the topics of nutrition and physical activity in young children (aged 1–3 years), were reviewed by representatives of the professional societies and institutions of the network. They evaluated the scientific evidence and updated the existing recommendations or formulated recommendations for action on some issues for the first time. Sustainability aspects were also taken into account. The process was coordinated by the Healthy Start—Young Family Network.RecommendationsSmall children should have regular mealtimes. They should participate in family meals and eat with other family members as often as possible. Attention to the child’s hunger and satiety signals (responsive feeding) contributes to the development of healthy eating habits. Food should not be used as a reward or punishment. The recommended infant diet includes plenty of plant foods and moderate amounts of animal foods. A vegetarian diet must be carefully matched to the child’s nutritional needs. Young children should be physically active as much as possible, especially outside and in a variety of ways. Parents should support physical activity. Screen devices are not recommended for young children. Parents should provide the child with opportunities for regular rest and sleep. Professionals and families should explore together ways to implement these recommendations in everyday family life.
Article
The Centers for Disease Control and Prevention's (CDC) Learn the Signs. Act Early. program, funded the American Academy of Pediatrics (AAP) to convene an expert working group to revise its developmental surveillance checklists. The goals of the group were to identify evidence-informed milestones to include in CDC checklists, clarify when most children can be expected to reach a milestone (to discourage a wait-and-see approach), and support clinical judgment regarding screening between recommended ages. Subject matter experts identified by the AAP established 11 criteria for CDC milestone checklists, including using milestones most children (≥75%) would be expected to achieve by specific health supervision visit ages and those that are easily observed in natural settings. A database of normative data for individual milestones, common screening and evaluation tools, and published clinical opinion was created to inform revisions. Application of the criteria established by the AAP working group and adding milestones for the 15- and 30-month health supervision visits resulted in a 26.4% reduction and 40.9% replacement of previous CDC milestones. One third of the retained milestones were transferred to different ages; 67.7% of those transferred were moved to older ages. Approximately 80% of the final milestones had normative data from ≥1 sources. Social-emotional and cognitive milestones had the least normative data. These criteria and revised checklists can be used to support developmental surveillance, clinical judgment regarding additional developmental screening, and research in developmental surveillance processes. Gaps in developmental data were identified particularly for social-emotional and cognitive milestones.
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Objetivo Adaptar e validar conteúdo e aparência do Protocolo de Avaliação Miofuncional Orofacial com Escores Expandido (AMIOFE-E) para lactentes de 6 a 24 meses de idade. Método Estudo de validação. Os parâmetros foram baseados em literatura sobre desenvolvimento motor orofacial, experiência dos autores e painel de 10 especialistas. Os dados foram analisados por estatística descritiva, Índice de Validade de Conteúdo e concordância entre especialistas. Resultados O protocolo foi organizado em blocos funcionais após manutenção, exclusão, modificação e acréscimo de itens, adaptando-se à faixa etária. Obteve-se alto nível de concordância em 90% dos itens. Na versão final foram acrescidos: histórico de alimentação e hábitos parafuncionais orofaciais, mobilidade facial, dentição, modo oral de respiração, deglutição de pastoso e detalhamentos específicos para a faixa etária. Acrescentou-se um manual operacional e uma tabela para registro de escores. Conclusão O Protocolo AMIOFE-E Lactentes e respectivo manual operacional foram validados quanto ao conteúdo e aparência, e poderá contribuir no diagnóstico miofuncional orofacial na faixa etária de 6 a 24 meses de idade.
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p>O objetivo do presente estudo foi definir formas seguras de apresentação dos alimentos na abordagem de introdução alimentar Baby Led Weaning . Foram escolhidos alimentos dos seguintes grupos alimentares: frutas, legumes e verduras, cereais, leguminosas e carnes, e que passaram por etapas de pré-preparo e preparo para serem submetidos a cortes em pedaços de forma que sejam ofertados para o bebê conforme seu desenvolvimento. As análises das amostras dos cortes dos alimentos ocorreram por meio de registros fotográficos, sendo classificados de acordo com o tipo de preensão: palmar, pinça e preensão superior do indicador (habilidade para manusear talher). Dessa forma, conclui-se que existem formas de apresentações adequadas e seguras para introduzir alimentos sólidos na nova abordagem de introdução alimentar Baby Led Weaning de acordo com as habilidades do bebê, proporcionando assim benefícios para o seu desenvolvimento motor, cognitivo e nutricional.</p
Thesis
La néophobie alimentaire est une réticence à goûter et/ou le rejet des aliments inconnus. Elle a une incidence négative sur la variété du répertoire alimentaire de l’enfant et sur le climat familial lors des repas. L’objectif de notre étude, qui se situe dans une perspective développementale, est de répondre à trois questions concernant cette conduite qui demeurent insuffisamment traitées dans la littérature scientifique : 1/ la néophobie alimentaire émerge-t-elle brusquement à 2 ans ; 2/ si oui, quels sont les processus développementaux à l’origine de cette évolution ? ; 3/ quels liens la néophobie alimentaire entretient-elle avec la sélectivité alimentaire (réticence à goûter des aliments familiers) et l’alimentation difficile (rejet d’aliments inconnus et familiers, assorti de fortes préférences alimentaires) ?Via l’utilisation de questionnaires, nous avons évalué : 1/ la néophobie alimentaire en termes de prévalence et d’intensité ; 2/ les compétences développementales susceptibles d’expliquer son évolution dans les sphères motrice, praxique, linguistique et psycho-affective ; ces compétences ont été sélectionnées sur la base d’arguments temporel (évolution synchrone) et fonctionnel (liens théorique et psychologique) ; 3/ les conduites avec lesquelles elle est fréquemment confondue, à savoir la sélectivité alimentaire et l’alimentation difficile. Notre échantillon principal s’est trouvé composé de 432 sujets âgés de 3 à 60 mois. Nos résultats ont indiqué que la néophobie alimentaire constituait une période normale du développement de l’enfant. La prévalence de la néophobie alimentaire était de 57 % et associée à une intensitée modérée entre 3 et 6 mois ; elle augmentait de manière importante en termes de prévalence et d’intensité entre 19 et 36 mois, concernant 90 % des enfants à cet âge, puis elle se stabilisait jusqu’à 60 mois. Suivant cette évolution, nous avons proposé un modèle développemental de la néophobie alimentaire comprenant deux phases : 1/ une néophobie primaire commune aux nourrissons et aux animaux, liée à la perception de la nouveauté d’une texture ou d’une flaveur et sous-tendue par des processus de pensée intuitifs ; 2/ une néophobie secondaire, liée aux acquisitions réalisées par les enfants aux alentours de 2 ans, reposant largement sur l’aspect visuel des aliments et impliquant des traitements cognitifs plus élaborés. Nous n’avons pas identifié les processus développementaux à l’origine de son évolution entre 19 et 36 mois. Plusieurs explications méthodologiques et théoriques ont été envisagées pour expliquer cette absence de résultat telles que l’existence d’une phase intermédiaire dans l’acquisition des compétences ou l’implication d’autres mécanismes psychologiques ou neurobiologiques non mesurés dans cette recherche. De plus, nous avons constaté une intrication des processus développementaux mesurés aux alentours de 2 ans. Tous les progrès réalisés par l’enfant sur une courte période semblent converger dans une même direction, celle de l’autonomie : une autonomie à la fois motrice, avec l’acquisition de la marche et de la capacité à se nourrir seul, et une autonomie psychique, avec l’acquisition de la conscience de soi et l’entrée en phase d’opposition. Dans ce cadre, le développement du langage permettrait à l’enfant d’exprimer son individualité à travers l’affirmation de ses goûts et de ses besoins. La capacité à exprimer des demandes verbales et l’acquisition de la conscience de soi ont d’ailleurs été les compétences approchant le plus des critères de validation d’hypothèse. De ce fait, nous pouvons nous demander si l’augmentation de la néophobie alimentaire aux alentours de 2 ans vise à protéger l’enfant d’un éventuel empoisonnement à un moment où il devient de plus en plus autonome et/ou si elle reflète simplement des tentatives d’individuation.
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Early childhood obesity from birth to 2-years (B-24) is a growing public health concern. The current lack of consistent and comprehensive child feeding materials may contribute to barriers in childhood obesity prevention. The purpose of this study was to identify barriers preventing parents of B-24 from implementing optimal feeding and obesity prevention practices and develop evidence-based messages to overcome these barriers. For Phase 1 and 2, one-on-one interviews were audio-taped, transcribed, and thematic analysis was conducted. Phase 1 interviews with healthcare, community-based, and education providers working with families of B-24 identified barriers faced when promoting obesity prevention. Providers reported parental practices of overfeeding, early and inappropriate initiation of solids, lack of child autonomy and self-regulation, and unbalanced diets from cultural, familial, and media influences, and lack of knowledge. Phase 2 interviews with parents of B-24 identified information needed regarding child feeding practices. Overarching themes included meal preparation, optimal intake, affordable healthy foods, child self-feeding, and food and ingredient knowledge. Low-income parents needed information on preparation skills and proper amounts whereas non-low-income parents sought information on safety concerns and transitioning to solids. Phase 3 interviews with parents of B-24 tested messages related to findings in Phase 1 and 2 to determine potential effectiveness. Interviews were recorded by note-taking, thematic analysis was conducted for qualitative data, and descriptive statistics for quantitative data. Parents reported the material as easy to understand, relevant, and feasible to implement. Future research should evaluate the impact of message implementation and outreach with parents on childhood obesity risk.
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Many people cannot swallow whole tablets and capsules. The cause ranges from difficulties overriding the natural instinct to chew solids/foodstuff before swallowing, to a complex disorder of swallowing function affecting the ability to manage all food and fluid intake. Older people can experience swallowing difficulties because of co-morbidities, age-related physiological changes, and polypharmacy. To make medicines easier to swallow, many people will modify the medication dosage form e.g. split or crush tablets, and open capsules. Some of the challenges associated with administering medicines to older people, and issues with dosage form modification will be reviewed. Novel dosage forms in development are promising and may help overcome some of the issues. However, until these are more readily available, effective interdisciplinary teams, and improving patient health literacy will help reduce the risk of medication misadventures in older people.
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Food allergy is becoming increasingly common in infants and young children. This paper set out to explain the different factors that should be taken into account during an individualized allergy consultation: Foods to avoid and degree of avoidance, suitable alternatives, self-management skills, co-and cross-reactive allergens and novel allergens alongside the role of the industry in allergen avoidance, importance of nutritional aspects of the diet and the future directions that nutritional guidance make take.
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INTRODUCTION: head circumference is an indicator of health and global cranial growth in early childhood, so it must be monitored. Usually, the WHO reference patterns use the Box Cox Power exponential model and the LMS method to model the behavior of head circumference growth. These methods are limited because they compare each individual against the median of a population, which prevents characterizing individual growth, while mixed-effect longitudinal models allow assessing individual growth patterns and controlling variability among subjects. The objective of this study was to use mixed-effect longitudinal models to characterize growth patterns based on head circumference in children 0 to 3 years of age. METHODS: being a prospective longitudinal study, the criteria for children eligibility considered inclusion and exclusion factors (WHO); 265 Colombian children (116 girls, 149 boys) living in Bogotá were distributed in 3 groups: G1: (0-12], G2: (12-24], G3: (24-36] months. They were measured every 3 months for 1 year. Two examiners were trained and continuously standardized, and they were monitored on adherence to data quality and data collection procedures. Random and systematic errors were calculated. Growth curves were constructed using mixed longitudinal models. The model was estimated through the method of estimation of restricted maximum likelihood (REML), free R statistical software, version 2.15. To adjust the models, we used the lme4 package. RESULTS: 6 models were adjusted, with maximum gradient of growth from 0 to 12 months. The model showed a growth pattern by age group and sex, in groups G1 and G2, confidence bands allowed identifying atypical data, better adjustment, and distribution of residuals, contrary to the behavior in group G3, which showed more atypical data outside the bands. CONCLUSIONS: : this methodology allowed understanding the behavior of head circumference by age group and sex, and analyzing data with unbalanced structures. .
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The onset of directed reaching demarks the emergence of a qualitatively new skill. In this study we asked how intentional reaching arises from infants' ongoing, intrinsic movement dynamics, and how first reaches become successively adapted to the task. We observed 4 infants weekly in a standard reaching task and identified the week of first arm-extended reach, and the 2 weeks before and after onset. The infants first reached at ages ranging from 12 to 22 weeks, and they used different strategies to get the toy. 2 infants, whose spontaneous movements were large and vigorous, damped down their fast, forceful movements. The 2 quieter infants generated faster and more energetic movements to lift their arms. The infants modulated reaches in task-appropriate ways in the weeks following onset. Reaching emerges when infants can intentionally adjust the force and compliance of the arm, often using muscle coactivation. These results suggest that the infant central nervous system does not contain programs that detail hand trajectory, joint coordination, and muscle activation patterns. Rather, these patterns are the consequences of the natural dynamics of the system and the active exploration of the match between those dynamics and the task.
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The purposes of this study were to document mealtime communication behaviors used by 98 Caucasian infants who were studied longitudinally from 2 to 24 months of age and to describe how these behaviors changed in the group over time. Using both closed- and open-ended questions in personal interviews, these middle and upper socioeconomic status mothers reported how their infants communicated hunger, satiety, and food likes and dislikes. Mothers also reported their own response behaviors when they believed that their infants had not eaten enough. Only a few mealtime communication behaviors were common to all infants, suggesting that infants use various behaviors to communicate similar messages. Food likes were most often communicated by mouth/eating behaviors, such as opening the mouth as food approached, eating readily, or eating a large amount of food. Food dislikes were communicated by mouth/eating behaviors, by facial expressions, and by body movements, such as turning the head or body away from food or throwing disliked food. When the mother perceived that the child had not eaten enough, most mothers offered alternative choices, either at mealtime or shortly thereafter.The results indicate that most infants are communicating via behaviors in feeding situations throughout the 2- to 24-month period.
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Three studies are reported, investigating changes in body engagement by 5- to 6-month-old infants as they reach for objects in the environment. Infants are distinguished and compared based on their relative ability to maintain a sitting posture without any external body support. The first study demonstrates that manual reaching by sitter infants is coordinated with forward leaning of the trunk, whereas reaching by nonsitters is not. The second study demonstrates that nonsitter infants provided with hip support also show signs of a coordination between reaching of the hand and forward leaning of the trunk. The third study compares nonsitter, nearsitter, and sitter infants as they reach for multiple objects spread across their prehensile space. Results demonstrate expansion in the mapping of infants' prehensile space and hand use as a function of self-sitting ability. The reported results are discussed as expressions of the interaction between the development of postural, perceptual, and action systems in infancy.
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Article
To determine the nutrient and food intakes of healthy, white infants from families of middle and upper socioeconomic status and to compare intakes to current recommendations. Using an incomplete random block design, we interviewed 98 mother-infant pairs longitudinally when infants were 2, 3, 4, 6, 8, 10, 12, 16, 20, and 24 months old. Data obtained included 24-hour dietary recalls, usual food intake, and food likes and dislikes. Interviews were conducted in the mother's home by registered dietitians. Subjects resided in two urban areas of Tennessee. Of the original 98 subjects, 94 completed the 2-year study. Mean energy and nutrient intakes generally met or exceeded the Recommended Dietary Allowance (RDA). Exceptions were zinc and vitamin D, which were each below 100% of the RDA at 9 of the 10 data points, and vitamin E, which was below the RDA in the infants' second year. Fat intake decreased from more than 40% of energy in the first 6 months to 30% to 32% from 10 to 24 months. One third of the infants drank reduced-fat milks at 12 months and more than half drank them at 24 months. Although infants ate a variety of foods, vegetables often were the least favorite foods. A variety of dairy products provided calcium for the infant but lacked vitamin D. Several nutritional issues about infant feeding before 2 years of age arose. Low intakes of zinc, vitamin D, and vitamin E were observed. In the second year, low fat intake, use of reduced-fat milks, and dislike of vegetables were areas of concern.
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Infant feeding practices are integral parts of individuals' ethnic and cultural beliefs, with culturally-based feeding beliefs influencing how individual mothers in various ethnic groups make decisions. Strongly held feeding beliefs have led to resistance against nationally and internationally established recommendations upon infant feeding practices. The context for mothers' beliefs changes for women who immigrate to another culture and geographic region where practices differ. The authors investigated whether Asian-Indian (AI) mothers who immigrate to the US change their infant feeding beliefs from those held in India, and how the infant feeding beliefs of Anglo-American (AA) mothers differ from those held by Asian-Indian-American (AIA) mothers. Survey responses from 141 AA mothers and 133 AIA mothers living in the southeastern US, and 101 AI mothers living in Coimbatore, India, are presented. The mean ages of the ethnic groups were similar, all 3 groups were relatively well educated, and the AIA mothers had lived in the US for a median of 5.9 years. The infant feeding beliefs of the AIA and AI mothers indicate that they are especially in need of services provided by dietitians and other health care providers. Otherwise, differences in beliefs were found between the 3 groups, except that all 3 groups believe that a baby should not take a bottle to bed.