INFANTILE ANOREXIA

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INFANTILE ANOREXIA

• Adrienne Trennepohl
• NSCI 5373
• Dr. Kennedy
• October 31, 2002
• HAPPY HALLOWEEN!

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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.

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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.

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Definition

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

• This can endanger the infants overall
  development, Mal-adaptive interactional patterns
  between the mother /or caregiver.

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Specific Diagnostic Criteria

• The specific diagnostic criteria for this
  disorder are categorized in 4 areas
• Food Refusal for at least 1month- may involve
  primarily solid foods, which worsened or started
  during the transition to spoon to self-feeding

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Diagnostic Criteria

• 2. Acute /or chronic malnutrition
• Parental concern about the toddlers 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

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Diagnostic Criteria

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

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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 toddlers sympathetic
  nervous system suppress hunger sensations.
  (Chatoor 98)

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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 toddlers cues can
  undermine the toddlers ability to differentiate
  between hunger and emotions.
• Dyadic conflict interferes w/successful
  transition to self-feeding.

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Dyadic Conflict

• Can arise if the parents or caregivers possess
  characteristics that limit capabilities of
  responding sensitively and contingently to their
  toddlers or infants feeding behaviors.
• Maternal responsiveness is influenced by ones
  current environment, mothers representations of
  past, current relationships.

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Distal Factors 1Maternal Eating Attitudes

• One important distal factor is Maternal Eating
  Attitudes.
• Mothers with eating disorders were more
  intrusive during their toddlers mealtime as well
  as playtime.
• Toddlers weight - related to both the amount of
  conflict during mealtimes the extent of the
  mothers concern about her own body shape.

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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 childs eating habits.

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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 toddlers
  malnutrition.

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Distal Factor 2Mothers 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 toddlers
  hunger (be nurturant) and set limits (child stays
  in high chair, etc.)

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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.

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

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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.

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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 toddlers temperament
  are associated with infantile anorexia.

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Summary

• 2 Critical Symptoms of Infantile Anorexia
• 1. Feeding Conflict
• 2. Toddlers Nutritional Status
• Studies perceive that
• 1. Toddlers w/infantile anorexia are
  negative in mood, seek attention, are more
  willful than normal toddlers.

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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 toddlers malnutrition.

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THE END
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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.