1. INFANTILE ANOREXIA Adrienne Trennepohl NSCI 5373 Dr. Kennedy October 31, 2002 HAPPY HALLOWEEN!

2. 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.

3. 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.

4. Definition… Infantile Anorexia can be defined as a serious feeding disorder that develops during the infant’s transaction to spoon- and self- feeding stage, which can lead to acute & chronic malnutrition. This can endanger the infant’s overall development, Mal- adaptive interactional patterns between the mother &/or caregiver.

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

6. Diagnostic Criteria… 2. Acute &/or chronic malnutrition 3. Parental concern about the toddler’s 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

7. Diagnostic Criteria… 4. Intense parent-to-toddler conflict, which is expressed by the toddler’s/infant’s food refusal and the parents or caregivers negative affect or comments about the toddler’s/infant’s refusal to eat.

8. 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 toddler’s sympathetic nervous system & suppress hunger sensations. (Chatoor 98)

9. 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 toddler’s cues can undermine the toddler’s ability to differentiate between hunger and emotions. Dyadic conflict interferes w/successful transition to self-feeding.

10. Dyadic Conflict… Can arise if the parents or caregivers possess characteristics that limit capabilities of responding sensitively and contingently to their toddler’s or infant’s feeding behaviors. Maternal responsiveness is influenced by one’s current environment, mother’s representations of past, & current relationships.

11. Distal Factors; #1 Maternal Eating Attitudes One important distal factor is Maternal Eating Attitudes. Mother’s with eating disorders were more intrusive during their toddler’s mealtime as well as playtime. Toddler’s weight - related to both the amount of conflict during mealtimes & the extent of the mother’s concern about her own body shape.

12. 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 child’s eating habits.

13. 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 toddler’s malnutrition.

14. Distal Factor #2: Mother’s 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 toddler’s hunger (be nurturant) and set limits (child stays in high chair, etc.)

15. 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.

16. Distal Factor #3 Spousal Relationships Studies show that distressed marriages are linked to maladaptive parenting. Marital distress may negatively impact a mothers’ capacity to respond sensitively to their child’s cues. This may lead to more problems and increase conflict with feeding interactions.

17. 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.

18. 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 toddler’s temperament are associated with infantile anorexia.

19. Summary… 2 Critical Symptoms of Infantile Anorexia: 1. Feeding Conflict 2. Toddler’s Nutritional Status Studies perceive that: 1. Toddler’s w/infantile anorexia are negative in mood, seek attention, & are more willful than “normal” toddlers.

20. 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 toddler’s malnutrition.

21. THE END

22. 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.