Feeding Disorders of Infancy and Early Childhood

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Herein lies a brief overview of the epidemiology, theoretical models, assessment techniques, and intervention methods as it relates to Pica (307.52), Rumination Disorder (307.53), and Feeding Disorder of Infancy and Early Childhood (307.59).

Pica is the persistent ingestion of nonnutritive substances including paint, plaster, hair, cloths, toys, feces, sand, and bugs.  (Netherton, Holmes, & Walker, 1999, p. 139)  The term pica comes from the Latin for “magpie,” a bird known for voraciously eating food and nonfood items alike.  (Stiegler, 2005, expression Abstract)  Exploration of objects by mouthing and tasting is part of normal, healthy development and is not considered pathological pica behavior. Pica is suspected only when (a) nonfood items are consumed repeatedly over the course of a month or longer, despite efforts to curtail the behavior; (b) the behavior is considered inappropriate for the individual’s developmental age (i.e., beyond the 18-month level); (c) it is not a cultural practice; and (d) the behavior is a symptom of another mental disorder and is of sufficient concern to warrant medical attention.  (American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 2000, p. 103)  On the whole, what surprised me most, what the distinct lack of aversion to food.  I would have expected that kids subject to pica would abstain or otherwise have trouble eating “real food,” but that is not the case with pica.  I was also surprised and that behavioral interventions included punishment, which is a first in my research.  It’s not that I particularly enjoy disciplining kids, but I do marvel at the novelty of having a psychologist tell me it’s perfectly acceptable… here I thought it was a lost art?

Rumination is the practice of voluntarily bringing previously ingested food back into the oral cavity and then either ejecting it or re-chewing and swallowing.  (Netherton et al., 1999, p. 140)  My first reaction was “gross!”  Evidently I wasn’t the only one since “social interactions with the infant or individual with mental retardation can be adversely affected by the unpleasant nature of this behavior.”  (Netherton et al., 1999, p. 141)  I was suitably surprised that researchers found willing parents that would subject their children to electric shock therapy.  It seems a bit extreme, but the cases were described as “life-threatening” and it proved to work.  (Netherton et al., 1999, p. 141)

The list of MR comorbid pathologies with is growing; we can add feeding disorders to the list of possible comorbid pathologies among the developmentally disabled population.  (Netherton et al., 1999, p. 143)  Aside from the specific exclusions, it would appear that MR is comorbid with just about everything?

Finally, the most intriguing aspect for me the research performed that implicated paternal influences in feeding disorders.  This is the first disorder I have experienced that would suggest “global family functioning and parental interactions may have both direct and indirect effects” on the pathological development of a disorder.  Drotar and Sturm (1987) suggested that (1) conflictual relationships between the parents, (2) inconsistent paternal support for the mother, (3) paternal psychopathology (e.g., substance abuse, domestic violence), (4) poor paternal nutritional standards, and (5) the fathers infantilization of the child may all act to interfere with the maternal-child feeding dyad.  (Netherton et al., 1999, p. 145)  As a guy, I thought it was refreshing that psychology professionals give us some credit for the development of the kids, even if it is in the negative context.  If we have potential to do harm, I hope later in the text they acknowledge our ability to nurture?

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American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Netherton, S. D., Holmes, D., & Walker, C. E. (1999). Child and adolescent psychological disorders: A comprehensive textbook. Oxford, NY: Oxford University Press.

Stiegler, L. N. (2005, Spring). Understanding pica behavior: A review for clinical and education professionals. Focus on Autism and Other Developmental Disabilities, 20(1), 27-39. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=809692351&sid=1&Fmt=4&clientId=4683&RQT=309&VName=PQD

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