Source: Urology  |  Posted 5 years ago

By Paula Moyer

SAN DIEGO, CA -- November 1, 2006 ?--A parent-education program aimed at reduce stress and control issues around mealtimes appears to be significantly more effective in reducing mealtime conflict and eating-related struggles in children infantile anorexia, according to research presented here at the 53[^]rd[] annual meeting of the American Academy of Child and Adolescent Psychiatry (AACAP).

"A treatment that focuses on helping toddlers with internal regulation of eating can decrease mother-toddler conflict and struggle for control during feeding and improve weight gain in such children," said principal investigator Irene Chapoor, MD, director, infant psychiatry and eating disorders program, Children's National Medical Center, Washington, DC.

In earlier research, Dr. Chapoor and co-investigators identified infantile anorexia as the outcome of a toddler with poor hunger regulation and caregiver parents who have difficulties setting limits and issues regarding their own regulation of eating.

Infantile anorexia, unlike so-called "picky eating," is a subtype of infantile feeding disorder, and is characterized by failure to gain weight or weight loss over at least 1 month, rare interest in food or expression of hunger, an age of onset before the child is 3 years old, and the exclusion of trauma to the oropharyngeal area or other medical conditions.

In their earlier research, Dr. Chapoor and colleagues identified a psychotherapeutic intervention with 3 components: 1) parent education regarding the toddler temperament; 2) addressing the parents' issues regarding eating and the setting of limits for the child; and 3) several specific guidelines for feeding.

Dr. Chapoor said the feeding guidelines consisted of feeding the child at regular times with 3 to 4 hours between meals and snacks, with only water between meals; putting smaller portions on the child's plate and allowing the child to ask for repeat helpings until filled; refraining from praising or criticizing the child based on food intake; insisting that the child sit at the table until the parents are finished; using time-out for behaviors that interfere with eating.

In the current study, presented on October 27[^]th[], Dr. Chapoor and her team compared the efficacy of their intervention strategy against the previous established approach, which focused on educating parents regarding general early child development, rather than addressing the specific child's poor appetite and difficult temperament and the specific parents' background.

The investigators enrolled 70 toddlers who were 12 to 42 months of age who had been diagnosed with infantile anorexia and randomly assigned them to the experimental intervention program or to the control program. Four social workers of similar clinical experience administered the interventions, 2 in each study arm.

Each intervention program involved 3 sessions of 2 hours spaced 1 week apart and 3 sessions of 1 hour spaced 2 to 3 weeks apart. The social workers administered the interventions with both the mother and father. The children were not present during the sessions.

The investigators followed the subjects at 2 weeks, 4 months, and 8 months after the end of the treatment program. Among these, 60 children were available for the final data analysis; 8 were dropped from the study because they had been used for the social workers' training, 2 because they had comorbid food allergies, and 2 because they had moved out of the geographic area.

Before treatment, children in the control group were an average of 85% of their ideal body weight; those in the experimental group were 86% of the ideal. At the first follow-up, the children in both groups were an average of 88% of their ideal body weight.

The time spent in conflict at mealtimes had decreased significantly in the experimental group compared to the controls ([]P[] < .01) as had eating-related struggles for control ([]P[] < .05).

The study was funded by the National Institute for Mental Health.

[Presentation title: Facilitating Internal Regulation of Eating in Toddlers With Infantile Anorexia. Abstract 24B]