Infant Toddler Mealtime Behaviors PREVENT Curriculum Objectives Describe

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Infant & Toddler Mealtime Behaviors PREVENT Curriculum

Infant & Toddler Mealtime Behaviors PREVENT Curriculum

Objectives • Describe common behavioral feeding concerns in infants and toddlers • Identify how

Objectives • Describe common behavioral feeding concerns in infants and toddlers • Identify how to address these common concerns

Feeding is a Behavior! Behavior is controlled by 2 things: A = Antecedent(s) B

Feeding is a Behavior! Behavior is controlled by 2 things: A = Antecedent(s) B = Behavior C = Consequence • Antecedents are events that occur before the behavior happens. • A consequence is any change in the environment that occurs after the behavior occurs.

Case #1 “My 9 -month-old baby wakes up 3+ times overnight for her bottle

Case #1 “My 9 -month-old baby wakes up 3+ times overnight for her bottle and I need to sleep. ” • • • Why is she doing this? !? Can I leave the bottle in her crib? How can I fix this?

Understanding & Managing • A = Antecedent(s) • Regular nighttime feedings are normal in

Understanding & Managing • A = Antecedent(s) • Regular nighttime feedings are normal in early infancy • Established pattern • C = Consequence (s) • Reinforcement! • Positive (gets bottle) • Intermittent (family tried to stop) • Reinforced use of bottle for soothing instead of development of self-soothing skills

Understanding & Managing • C = Consequence(s): Need to change! • Shaping (gradually wean

Understanding & Managing • C = Consequence(s): Need to change! • Shaping (gradually wean nighttime feeds) • Decrease the amount in the bottle • Decrease the total number of nighttime feeds • Increase structure of daytime feeds • Cold turkey (completely eliminate feeds) • General advice: • Family stage of change must be planning/action. • Consistency is key. • Remember extinction burst! • Caregiver self-care helps maintain changes.

Case #2 “My 2 -year-old never eats. ” [Growth chart indicates no concerns. ]

Case #2 “My 2 -year-old never eats. ” [Growth chart indicates no concerns. ] Can I get a prescription for Pediasure?

Understanding & Managing • A = Antecedent(s) • Constant grazing • From 1 -4

Understanding & Managing • A = Antecedent(s) • Constant grazing • From 1 -4 years, children’s feeding patterns and nutritional needs will change; the quantity of food intake can vary significantly from day to day • Open access to snack foods and milk/juice • C = Consequence(s) • Reinforcement! • Positive (gets food, juice, milk, or Pediasure ) • Often exacerbated by caregiver anxiety/lack of developmental feeding knowledge

Addressing: Constant Grazer • Education: • Common pattern • Realistic expectations about portion size

Addressing: Constant Grazer • Education: • Common pattern • Realistic expectations about portion size • Modeling: • Set a good example at mealtimes • Routines: • Must sit in “chair” • Structured meal and snack times • Consequences: • If child does not eat, remove the food/juice/snacks until the next designated time • Prepare for extinction burst!

Case #3 “Jose will not eat vegetables at all. All he wants is chicken

Case #3 “Jose will not eat vegetables at all. All he wants is chicken nuggets and French fries. ” What can I do?

Understanding & Managing • A = Antecedent(s) • Avoidance • Makes taste buds less

Understanding & Managing • A = Antecedent(s) • Avoidance • Makes taste buds less accustomed to flavor of foods, especially bitter foods like vegetables • Stress/coercion around meals • Constant nagging, anxiety, forcing to eat foods can lead to a power struggle • C = Consequence(s) • Reinforcement! • Positive (gets preferred food) • Often driven by caregiver anxiety/lack of developmental feeding knowledge

Addressing Picky Toddlers • Control the A = Antecedent(s) • Prepare a few foods

Addressing Picky Toddlers • Control the A = Antecedent(s) • Prepare a few foods that everyone will like • Avoid preparing the one (or two) foods the child hates • Keep mealtimes pleasant – have family conversations that are not about the food • Control the C = Consequence(s) • Do not become a short order cook • No bribes to eat – but you may decide to use a structured reinforcement system for trying new foods (avoid using dessert/other foods as a reinforcer)

Addressing Toddler Food Refusal • Modeling: Set a good example of eating healthy foods

Addressing Toddler Food Refusal • Modeling: Set a good example of eating healthy foods important to your family (not every vegetable) • Shaping: praise after every step! 1. Tolerate small amount on plate 2. Take a bite (can spit it out) 3. Take a bite and swallow it • Consistency: Remember, it takes many tries to develop tastes for various foods • Consider the pros/cons of using a structured reinforcement system

General Tips • Start talking about healthy feeding routines early • Even in infancy,

General Tips • Start talking about healthy feeding routines early • Even in infancy, children can start to regulate the intake of food • Talk about feeding cues and developmental expectations (frequency, quantity, length of feed) at different ages • Discuss the roles and responsibilities of parents and children • e. g. , Parent is responsible for making a healthy plate; toddler decides how much of their plate to eat • Giving structured choices (what vegetable to buy, how much fruit to put on the plate, etc. ) may decrease mealtime stress

Cognitive, Cultural, and Other Considerations • Cultures differ on perceptions of what a “healthy”

Cognitive, Cultural, and Other Considerations • Cultures differ on perceptions of what a “healthy” body type looks like • BMI and percentiles are often confusing to families, especially those with lower health literacy • Consider the impact of social determinants of health • Risk factors for obesity include food insecurity, trauma, etc. • Consider the role of food in the family - soothing, symbolic, etc. • Caregivers are continually modeling feeding practices; some interventions may require caregivers to change their behavior

Teach Back • Tell me one thing you learned from today’s talk • Tell

Teach Back • Tell me one thing you learned from today’s talk • Tell me one thing you will apply to patient care