Feeding Disorder of State Regulation

Feeding Disorder of State Regulation

Diagnostic Criteria

·           Has difficulty reaching and maintaining a calm state of alert-ness for feeding; is either too sleepy or too agitated and/or distressed to feed.

·           The feeding difficulties start in the newborn period.

·           Shows significant failure to gain weight or exhibits weight loss.

Epidemiology

The most frequently used label in the pediatric literature for excessive crying in young infants is colic, which is reported to occur at rates varying from 5 to 19%. Colic is usually defined as crying for more than 3 hours per day, and frequently colic is associated with feeding difficulties during the crying periods. However, a feeding disorder of state regulation should be consid-ered only in more severe cases of colic when it is associated with growth failure.

Etiology

Both infant and maternal characteristics appear to contribute to the difficulties in the regulation of feeding. After birth, the in-fant needs to establish regular rhythms of sleep and wakefulness, and of feeding and elimination. In order to feed successfully, the infant needs to reach a state of calm alertness. However, some in-fants may be too irritable or too difficult to awaken for feedings.

Other infants may tire quickly or become distracted during feed-ing and terminate feedings without taking in adequate amounts of milk to grow. Some mothers learn to compensate for these vulnerabilities by adjusting the environment and the degree of stimulation of the infant during feeding. However, other mothers become anxious, fatigued, or depressed, and consequently they inadvertently intensify the feeding difficulties of their infants.

Diagnosis

Young infants who present with feeding difficulties and growth failure dating to the postnatal period need to be considered for the diagnosis of a feeding disorder of state regulation. The evaluation should begin by obtaining a history of the mother’s pregnancy and delivery and a report of the infant’s history of feeding, devel-opment and medical illnesses that might contribute to the feeding problems. In addition, the mother’s functioning and her social support system need to be explored. Most important, the mother and her infant should be observed during feeding and during play to assess the infant’s special characteristics, the infant’s regula-tion of state and feeding behavior, and the mother’s ability to read the infant’s signals and to respond to them in a contingent way.

Course and Natural History

During the first few months of life, the foundation for the regula-tion of feeding, sleep and emotions is laid. Infants with feeding problems during these early months usually trigger anxiety in their mothers and tend to have difficulties in self-regulation dur-ing the transition to self-feeding in the second year of life.

Treatment

Treatment can be directed toward the infant, toward the mother, and toward the mother–infant interaction. In severe cases, if the infant’s growth is seriously impaired, nasogastric tube feeding might have to be used to supplement oral feedings in an infant who tires quickly. This will allow an anxious mother to relax because her infant is receiving adequate nutrition to grow. Sub-sequently, a more relaxed mother can tune into her infant more readily and break the cycle of dyadic escalation of tension during feedings.

On the other hand, the intervention might have to be di-rected primarily toward the mother to treat her anxiety, fatigue, or depression to enable her to be more effective in dealing with her infant. In addition, most mothers can be helped by assisting them in problem solving in how to facilitate a feeding environ-ment that provides the optimal amount of stimulation for their vulnerable infants. Videotaping the feeding and observing the tape together with the mother can heighten her awareness of the infant’s reactions during feeding and enhance her ability to read the infant’s cues. The therapist can then engage the mother in a dialogue on how to respond to the infant’s cues most effectively.