Failure to Thrive and Cognitive Development in Toddlers With Infantile Anorexia

Abstract

ABSTRACT. Objective. The goal of this study was to examine the relative contributions of growth deficiency and psychosocial factors to cognitive development in toddlers with infantile anorexia.Methods. Eighty-eight toddlers, ranging in age from 12 to 33 months, were enrolled in this study. Toddlers were evaluated by 2 child psychiatrists and placed into 1 of 3 groups: infantile anorexia, picky eater, and healthy eater. All 3 groups were matched for age, race, gender, and socioeconomic status (SES). Toddlers underwent nutritional evaluations and cognitive assessments with the Bayley Scales of Infant Development. Toddlers and their mothers were also videotaped during feeding and play interactions, which later were rated independently by 2 observers.Results. On average, toddlers with infantile anorexia performed within the normal range of cognitive development. However, the Mental Developmental Index (MDI) scores of the healthy eater group (MDI ‫؍‬ 110) were significantly higher than those of the infantile anorexia (MDI ‫؍‬ 99) and picky eater (MDI ‫؍‬ 96) groups. Within the infantile anorexia group, correlations between MDI scores and the toddlers' percentage of ideal body weight approached statistical significance (r ‫؍‬ .32). Across all groups, the toddlers' MDI scores were associated with the quality of mother-child interactions, SES level, and maternal education level. Collectively, these variables explained 22% of the variance in MDI scores.Conclusions. This study demonstrated that psychosocial factors, such as mother-toddler interactions, maternal education level, and SES level, are related to the cognitive development of toddlers with feeding problems and explain more unique variance in MDI scores than nutritional status. Pediatrics 2004;113:e440 -e447. URL: http://www.pediatrics.org/cgi/content/full/113/ 5/e440; failure to thrive, feeding disorder, infantile anorexia, cognitive development, growth deficiency, mothertoddler interactions.ABBREVIATIONS. FTT, failure to thrive; SES, socioeconomic status; MDI, Mental Developmental Index; BSID, Bayley Scales of Infant Development. F ailure to thrive (FTT) describes children who exhibit growth deficiency, as indexed by faltering or stunted growth. Several studies suggest that FTT is associated with poorer cognitive development, learning disabilities, and long-term behavioral problems. [1][2][3] More recently, Corbett et al 4 detected a significant association between the severity of growth deficiency and IQ, whereas Raynor and Rudolf 5 found that 55% of the infants who were failing to thrive exhibited developmental delay. In addition, a study by Reif et al 6 reported that children with a history of FTT were found to have more learning difficulties and evidenced developmental delay at follow-up 5 years after the initial presentation.These findings from the pediatric literature have led many to believe that FTT alone is sufficient to cause developmental delays. However, a critical problem with many previous studies is that FTT is frequently confounded with psychoso...

A Practical Approach to Classifying and Managing Feeding Difficulties

“…A hallmark is conflict between parent and child, which if unresolved may hinder the child's ability to reach his or her optimal cognitive potential. 34 This reflects conflict in the home environment, rather than low nutrient intake. 35 The Apathetic, Withdrawn Child These children are inactive, disinterested both in eating and their environment, and communicate poorly with their caregivers.…”

“…1,2 The major concern for them is not their nutrition, 1,3,46 but family discord centered around coercive feeding and subsequent behavioral consequences. Chatoor et al 34 reported that conflict around feeding resulted in a lower Bayley Mental Developmental Index independent of the child's nutritional status. In a study of children defined by their parents as picky, Jacobi et al 2 showed a higher incidence of subsequent behavioral problems, including anxiety, depression, aggression, and delinquency.…”

Coexistence of Sleep and Feeding Disturbances in Young Children

“…4,7 Problematic eating and feeding behaviors are sources of concern for parents, and if prolonged can lead to weight loss or failure to gain weight and cognitive and developmental delay. [8][9][10] Feeding difficulties in healthy children are linked to a variety of causes, including environmental disruption, parental incompetence, the child's temperament, and psychological factors. It has been shown that certain characteristics of the infant combined with certain vulnerabilities in the parent lead to negative responses and conflict in their interactions.…”

Laboratory-Based Studies of Eating Among Children and Adolescents

“…Seventeen feeding (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) studies with infant samples were identified (Table 1). Previouslypublished reviews have described methods commonly used to analyze eating behavior in infancy, both subsequent to (40) and during the weaning period (41).…”

“…Chatoor and colleagues have used feeding paradigms to identify specific aberrant eating patterns. Their methodology involves mother-child feeding interactions that are videotaped and then coded by researchers to assess positive and negative feeding behaviors exhibited by both the mother and infant (32)(33)(34)(35). For example, a researcher may code a mother-infant feeding interaction as "dyadic reciprocity," a term that reflects positive mother-infant exchanges, or as "struggle for control," which is represented by the mother overriding the child's cues or child rejecting the food.…”