OBSERVATION AND COMPARISON OF MEALTIME BEHAVIORS IN A SAMPLE OF CHILDREN WITH AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDERS AND A CONTROL SAMPLE OF CHILDREN WITH TYPICAL DEVELOPMENT.

Despite widespread use of behavioral observations to evaluate child feeding behaviors in research and clinical practice, few studies have comprehensively characterized mealtimes or identified features that differentiate children with and without disordered feeding; these were the aims of the current study. Mealtime observations were conducted for 18 children with avoidant restrictive food intake disorder (ARFID) and 21 typically developing children. Observations were coded inductively, and associations between disorder and observed mealtime actions were examined. Most behaviors were observed across both clinical and nonclinical mealtimes, and many did not differ in frequency between children with and without ARFID. However, significant group differences were observed in the frequencies of behaviors relating to food intake, visual and physical engagement with feeding, and movement during mealtimes. The comparability of behaviors across clinical and nonclinical groups suggests that eating behaviors exist on a continuum from "normal" to "abnormal," with group differences relating to frequency rather than type of behavior. The behavioral differences observed in this study suggest that identification of children with ARFID should focus on child engagement with food and restlessness during mealtimes. Reliance on emotional and escape-maintained behaviors will lead to underrecognition of families in need of clinical support.

Screening Avoidant/Restrictive Food Intake Disorder (ARFID) in children: Outcomes from utilitarian versus specialist psychometrics.

This study assessed the specificity and sensitivity of two commonly used psychometric methods to assess ARFID in children. To achieve this, a sample of 329 mothers and one father completed the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) and the Child Food Neophobia Scale (CFNS). A Receiver Operating Characteristic (ROC) analysis indicated that both measures were able to successfully differentiate a known clinical sample from those of typically developing population. Although the BPFAS was more accurate at differentiating ARFID from the general population, the CFNS was acceptable and on some metrics better than its longer counterpart. The ability of a food neophobia scale to differentiate clinical and population samples, and detect gradation of food avoidance within the population sample, suggests that the multitude of psychometric measures available may be measuring similar constructs. Therefore, confidence can be expected in cross-site comparisons despite each using different psychometric measures of food avoidance in children.

RELATIVE CONTRIBUTIONS OF PARENT-PERCEIVED CHILD CHARACTERISTICS TO VARIATION IN CHILD FEEDING BEHAVIOR.

Few studies have examined the relative impact of co-occurring child characteristics on problematic feeding behavior. The aim of the current study was to assess the relative contributions of parent-perceived child characteristics in multivariable models of child feeding behavior. One hundred sixty-one mothers reported on their child's feeding behavior and a number of key child characteristics. These characteristics were entered into controlled multivariable models of child feeding behavior, using child and parent frequency domains of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS; W. Crist et al., 1994) as outcome measures. Child feeding problems were positively associated with food neophobia and external behavioral and social issues, but not with most domains of temperamental difficulty or sensory sensitivity. Feeding problem frequency was associated with externalizing symptoms whereas parental perceptions of problems and coping were associated with social-interaction problems in the child. Population feeding problems appear to be external and interactive problems rather than driven by innate or internalizing factors. The association with externalizing symptoms suggests that feeding problems at this level may fall within a wider profile of challenging behavior; however, the existence of problematic feeding behaviors may constitute a challenge for parents only when the child's social interactions also are seen to be deficient.

Screening for feeding disorders. Creating critical values using the behavioural pediatrics feeding assessment scale.

The aim of the current study was to discriminate between clinical and non-clinical samples on the Behavioural Pediatrics Feeding Assessment Scale (BPFAS). The objective was to present a cut-off value, that was derived statistically, which could be used to screen for feeding disorders. A sample of five hundred and seventy-three families with a target child ranging in age from 20 to 85 months took part in the current study. Sixty-four children had a known diagnosis of a feeding disorder and were embedded into a typically developing sample of families that had not sought professional intervention. All families completed the BPFAS in order to provide a known database to measure discriminative statistics. The Receiver Operating Characteristic (ROC) analysis indicated that the cut off value for the BPFAS was a Child Frequency score of 61 and a Child Problem score of six. This offered an 87% accuracy rate at these values. The current study offered definitive evidence that the BPFAS was accurate (both sensitive and specific) to determine differences between clinical and non-clinical samples in the United Kingdom. It is therefore advocated that BPFAS should be adopted in future studies exploring the impact of feeding disorders and problems in both clinical and research settings.

Measuring oral sensitivity in clinical practice: a quick and reliable behavioural method.

This article aims to offer a behavioural assessment strategy for oral sensitivity that can be readily applied in the clinical setting. Four children, ranging in age and with a variety of developmental and medical problems, were used as test cases for a task analysis of tolerance to touch probes in and around the mouth. In all cases, the assessment was sensitive to weekly measures of an intervention for oral sensitivity over a 3-week period. Employing an inexpensive, direct, specific to the individual, replicable, reliable, and effective measure for a specific sensory problem would fit better with the edicts of evidence-based practice. The current method offered the initial evidence towards this goal.

Feeding disorders of infancy or early chilhood: A review / Trastornos de la ingestión alimentaria de la infancia o la niñez: Una revisión

Feeding disorders of infancy or early childhood are a common presenting problem at health clinics. However, they are often mistaken with eating disorders, such as Anorexia Nervosa or Bulimia Nervosa, in spite of remaining as different diagnostic categories in both the DSM-IV-TR and the ICD-10. Children's feeding disorders are also understudied in comparison with eating disorders. The lack of a clear definition of feeding disorders, the diversity in prevalence figures and the challenges in the classification of these disorders affects the identification of feeding disorders in the clinical practice. This article aims to review the available literature in order to contribute to a better understanding of feeding disorders of infancy or early childhood.

Los Trastornos de la Ingestión Alimentaria de la Infancia o la niñez (TIAI) son de común presentación en las consultas de profesionales de la salud. Sin embargo, a menudo son confundidos con los Trastornos de la Conducta Alimentaria (TCA), Anorexia Nerviosa y Bulimia Nervosa, aunque estos permanecen como entidades diagnósticas separadas tanto en el DSM-IV-TR como en el ICD-10. En comparación con los TCA y con otros trastornos del comportamiento infanto-juvenil, los TIAI están escasamente investigados. Los términos utilizados para su descripción, la diversidad en la prevalencia, y las dificultades en la clasificación, afectan la identificación de estos problemas en la práctica clínica. Por ello, este artículo tiene como objetivo el repasar la literatura disponible sobre estos trastornos para así contribuir a una mejora en el entendimiento de los TIAIs.

A quantitative psychometric evaluation of an intervention for poor dietary variety in children with a feeding problem of clinical significance.

Few studies have been published that offer a quantitative evaluation of interventions for feeding problems of clinical significance. Twenty-four children referred to the service for clinically significant feeding problems were administered the Behavioral Pediatric Feeding Assessment Scale (BPFAS; W. Crist & A. Napier-Phillips, 2001) and the Child Feeding Assessment Questionnaire (CFAQ; G. Harris & I.W. Booth, 1992) before and after a duel targeted 16-week therapeutic intervention to improve dietary variety. Dietary variety was assessed through a food diary where only items that were accepted on more than one occasion were deemed to be part of the child's habitual diet. Results indicated that all subscales of the BPFAS and the CFAQ were responsive to the intervention, with scores falling from those of clinical significance to those more representative of non-feeding-problem children. Regression analysis indicated that children's problem scores on the BPFAS predicted 15% of the variance in increased dietary variety following the intervention. The outcome of this evaluation indicated that improving dietary variety in children with clinically significant feeding problems is challenging. With the right approach, however, large improvements can be observed relatively quickly.

Identifying clinically relevant feeding problems and disorders.

This paper outlines what is currently understood, and what can be hypothesized about paediatric feeding dysfunctions. The paper highlights the current lack of awareness of psychological factors implicated in infant and child feeding, and promotes a behavioural approach to the identification, referral and treatment of non-organic derived feeding problems and disorders. Potential risk factors to poor feeding development are outlined, and characteristic child and caregiver behaviours which may signify problems with feeding are suggested. The aim of this paper is to promote early identification of these symptoms in frontline healthcare in the hope of increasing early intervention before physical complaints, medical complications and/or disorders arise.