INFANTILE ANOREXIA

Adrienne Trennepohl

NSCI 5373

Dr. Kennedy

October 31, 2002HAPPY HALLOWEEN!

What is Infantile Anorexia

• Infantile Anorexia Nervosa is considered to be a severe feeding disorder, which usually arises during the toddler years.

• Can also be found in the infant years of life as well as toddler age.

Overview…

• There are many factors that are associated with Infantile Anorexia Nervosa, but much research has been conducted concerning the mother-to-infant interaction, and that much conflict arises between the two.

• Therefore, this presentation focuses on the mother-to-infant interaction and the conflict they share.

Definition…

• Infantile Anorexia can be defined as a serious feeding disorder that develops during the infant’s transaction to spoon- and self-feeding stage, which can lead to acute & chronic malnutrition.

• This can endanger the infant’s overall development, Mal-adaptive interactional patterns between the mother &/or caregiver.

Specific Diagnostic Criteria…

• The specific diagnostic criteria for this disorder are categorized in 4 areas:

1. Food Refusal for at least 1month- may involve primarily solid foods, which worsened or started during the transition to spoon to self-feeding

Diagnostic Criteria…

2. Acute &/or chronic malnutrition

3. Parental concern about the toddler’s eating expressed by coaxing the infant or toddler to eat more

• Allowing distractions or play during feeding

• Frequently feeding the infant or toddler at night

• Expressing worry and frustration to the infant or toddler

• Force feeding

Diagnostic Criteria…

4. Intense parent-to-toddler conflict, which is expressed by the toddler’s/infant’s food refusal and the parents or caregivers negative affect or comments about the toddler’s/infant’s refusal to eat.

Conflict: Mom vs. Infant

• Infantile anorexia can by conceptualized as a relational disorder that arises when highly conflicutal feeding interactions disrupt the transition to self-feeding.

• Ex: intense conflict during feeding can be stressful to mobilize the toddler’s sympathetic nervous system & suppress hunger sensations. (Chatoor 98)

Conflict & Feeding…

• Also, infants may learn to associate intense emotions with feeding.

• This feeling of emotion may mask the appropriate sensations of hunger and fullness.

• Not responding to the toddler’s cues can undermine the toddler’s ability to differentiate between hunger and emotions.

• Dyadic conflict interferes w/successful transition to self-feeding.

Dyadic Conflict…

• Can arise if the parents or caregivers possess characteristics that limit capabilities of responding sensitively and contingently to their toddler’s or infant’s feeding behaviors.

• Maternal responsiveness is influenced by one’s current environment, mother’s representations of past, & current relationships.

Distal Factors; #1Maternal Eating Attitudes

• One important distal factor is Maternal Eating Attitudes.

• Mother’s with eating disorders were more intrusive during their toddler’s mealtime as well as playtime.

• Toddler’s weight - related to both the amount of conflict during mealtimes & the extent of the mother’s concern about her own body shape.

Maternal Eating Attitudes:

• Mothers who have a great concern about their own weight and eating style also have a great difficulty managing feeding situations in their own child’s eating habits.

Maternal Eating Attitudes:

• One study observed that anorexic mothers underfeed their own children, therefore researchers hypothesized that maladaptive maternal eating attitudes are positively associated with conflicutal mother-to-toddler feeding interactions and the toddler’s malnutrition.

Distal Factor #2:Mother’s Perceptions of their earlier

Attachment Relationships

• Research suggests that adults with insecure attachment representations are less sensitive to the cues of their own children than adults with secure attachment representations.

• Insecure Attachment- apparent during feeding interactions; parents must reduce toddler’s hunger (be nurturant) and set limits (child stays in high chair, etc.)

Distal Factor #2

• Mothers who have insecure representations of attachment relationships would have the most difficulty managing the feeding situations and would show the most conflict during feeding interactions.

Distal Factor #3Spousal Relationships

• Studies show that distressed marriages are linked to maladaptive parenting.

• Marital distress may negatively impact a mothers’ capacity to respond sensitively to their child’s cues.

• This may lead to more problems and increase conflict with feeding interactions.

Interventions:

• It is important to differentiate between the various feeding disorders because what might work in one situation, might not be as effective in another.

• Treatment for infantile anorexia is to first reduce the infant to mother conflict interaction during feeding.

• It is also key to target the parents in this situation. Help them to interact in a positive and relaxed setting as well as learn what the infant might be telling them.

Summary…

• These factors play an important role between the mother and her infant child or toddler.

• Conflict may arise if any of these factors are fluent in the household.

• Studies postulate that maternal characteristics and perceptions of their toddler’s temperament are associated with infantile anorexia.

Summary…

• 2 Critical Symptoms of Infantile Anorexia:

1. Feeding Conflict

2. Toddler’s Nutritional Status

• Studies perceive that:

1. Toddler’s w/infantile anorexia are negative in mood, seek attention, & are more willful than “normal” toddlers.

Summary…

• 2. Mothers of anorexic toddlers show insecure representations of attachment, marital conflict, & difficulty regulating their own eating

• 3. Maternal perceptions of toddler temperament and maternal characteristics aid in mother-to-toddler conflict at feeding.

• 4. Severity of conflict at feeding is related to severity of toddler’s malnutrition.

THE END

References:

• Chatoor, Irene., Diagnosing Infantile Anorexia: The Observation of Mother-to-Infant Interactions.,., Journal of the American Academy of Child and Adolescent Psychiatry., June 2000.

• Chatoor, Irene., Maternal Characteristics and Toddler Temperament in Infantile Anorexia., Journal of the American Academy of Child and Adolescent Psychiatry., September, 1998.

• Chatoor, Irene., Observation of Feeding in the Diagnosis of Posttraumatic Feeding Disorder of Infancy., Journal of the American Academy of Child and Adolescent Psychiatry., May, 2001.