Nutrition Interventions for Children with Special Health Care Needs

Chapter 14 - Nutrition Interventions for Failure to Thrive
further heart failure. Many children also suffer from varying degrees of neurological
impairments that hinder their ability to focus on feeding tasks and/or may cause
adverse experiences with various tastes, textures, and environmental changes.
Finally, there are many children with feeding and growth complications who have or
have had gastroesophageal reflux. This is a significant problem that, if left untreated,
causes great discomfort with a child’s every attempt to feed. Many of these
conditions occur during the first year of life and may easily bring about a negative
association between hunger and feeding for the child. When the negative impact
related to feeding is prolonged, infants and young children learn to ignore internal
hunger cues and may continue to refuse food long after the initial problem has been
resolved (6,11). (See Chapter 9.)
The challenges parents face when their child begins to reject food and doesn’t gain
weight cannot be overstated. At the most primitive level parents fear being unable
to adequately nurture their youngster (8,12). The child’s poor growth can bring
on feelings of inadequacy, frustration, fear, and anger. In an effort to reverse their
child’s growth problem, parents may resort to feeding techniques, both forceful
and/or overwhelmingly playful (8,9). Despite the parents’ best intentions, fears
and feelings of inadequacy may cause them to override the child’s cues for hunger
and comfort (9,10,12). The stress of a child’s feeding problem and weight loss can
challenge a parent and family system and bring on complex relationship issues that
are difficult to reverse (8).
There are also a number of issues within the parents’ own experiences that may
set the stage for discord in the parent-child relationship. Consider the mother who
does not think of a meal as a pleasurable experience, but instead finds it a source of
anxiety, tension and inner conflict. Whether consciously or unconsciously, she may
avoid or minimize her time at the table (8,12). The child does not know the source of
the mother’s conflict, but will register the tension relative to the presence of food and
the act of eating. Unresolved issues from the mother’s past being played out in the
present are so common they are referred to as “ghosts in the nursery” (8). Consider
also the mother who is trying to lose weight. Her preoccupation about her own needs
and internal hunger-satiety may prevent her from seeing the child separately, and/
or distinguishing her child’s expression of hunger and satiety from other emotional
states such as distress (8,12). This mother may inadvertently limit the child’s food
choices or portions. In many cases eating becomes one of several parent-child
interactions affected by the parent’s inability to view the child as an individual with
separate needs (8). For example, a well-intended parent whose father died of a heart
attack may provide low fat foods regardless of the child’s needs for an energy-dense
diet or the child’s hunger cues resulting from a low energy intake.
152 Nutrition Interventions for Children With Special Health Care Needs