Wednesday, July 26, 2000

CONTACT: Patricia Enright


Physicians at Children's National Medical Center pinpoint predictors of feeding conflict and low weight associated with infantile anorexia

Washington, DC (July 26, 2000) -- Research presented in Montreal today at the 7th World Congress of the World Association for Infant Mental Health shows that irregular or difficult toddler temperament, parental insecurity (stemming from the childhood relationships with their own parents) and parental pursuit of thinness contribute to food refusal and picky eating in toddlers, and are related to a severe feeding disorder called infantile anorexia.

By pinpointing the factors associated with picky eating and infantile anorexia, researchers have identified new areas of treatment focus, namely that parents can improve their toddlers' eating habits by better understanding their children's temperament and how to cope with their toddlers' behaviors during mealtime. A treatment study (supported by the NIMH) testing this model, is being conducted at Children's National Medical Center (CNMC) at present.

Infantile anorexia is a severe feeding disorder that typically occurs during the toddler years. Criteria for diagnosis include: toddler food refusal for at least one month; acute and/or chronic malnutrition; and intense parent-toddler conflict and/or distraction and talking during feeding. The study, entitled "Maternal Characteristics and Toddler Temperament in Infantile Anorexia," examined the extent that mothers' characteristics and perceptions of their toddlers' moods/behaviors were associated with feeding conflict and difference in ideal weight. The study was designed to gain a better understanding of the factors that affect and may worsen symptoms of this feeding disorder.

A total of 102 toddlers between the ages of 12 and 37 months participated in the study. There were three groups of toddlers who were either diagnosed with infantile anorexia, as being picky eaters, or as being healthy, normal eaters. Mothers were interviewed and completed questionnaires that assessed their own eating attitudes and relationships (secure, insecure, dismissive, preoccupied) as well as their toddlers' moods/behaviors (irregular, difficult, sober, unstoppable). Mothers and toddlers were also videotaped during a feeding session, and toddlers were weighed and measured.

Mothers of anorexic toddlers rated their toddlers as more difficult, negatively adaptive, dependent, unstoppable and irregular than healthy eaters. In addition, mothers of toddlers with anorexia showed greater insecure relationships with their own parents than mothers of healthy eaters. However, mothers' eating habits did not show a significant difference between groups. There was no difference in eating attitudes between mothers of anorexic toddlers and mothers of healthy eaters.

The combination of mothers' experience with relationships and toddler mood/behavior ratings significantly predicted severity of feeding conflict and toddlers' weight. Mothers' secure relationships with their own parents protected them from engaging in conflict with their own toddlers during feeding, whereas, mothers' insecure relationships with their own parents was associated with feeding conflict. Thirty-nine percent (39%) of difference in feeding conflict was explained by toddlers' diagnosis of infantile anorexia, mood/behavior ratings and mothers' characteristics, while twenty-one (21%) of difference in toddlers' weights was explained by toddler mood/behavior and feeding conflict. Higher feeding conflict was associated with lower weight.

"Evidence shows that mothers' insecure relationships and toddlers' temperaments combined have the most negative effect on feeding interactions and ideal weight," said Dr. Irene Chatoor, lead author and vice-chair of the Department of Psychiatry at Children's National Medical Center in Washington, D.C. "Thus, we can now focus on a new way of treatment -- helping parents to better deal with their toddlers' moods and behaviors during feeding."

This study focused on factors which contribute to symptoms of infantile anorexia in an effort to enhance treatment. The study appears in the June 2000 issue of the print version of the Journal of the American Academy of Child & Adolescent Psychiatry.

Children's National Medical Center, located in Washington, D.C., is a leader in the development of innovative new treatments for childhood illness and injury. Among the top 15 pediatric hospitals in America, CNMC has been serving the nation's children for over 125 years. CNMC's newly developed Centers of Excellence programs include: Neurosciences and Behavioral Medicine; Cancer and Blood Disorders; Heart and Kidney Disease; Community Pediatric Health; Complex Diseases; Hospital Based Specialties, and Surgery. The Centers of Excellence program and an internationally recognized team of pediatric health care professionals allow Children's National Medical Center to care for thousands of families throughout the region, the nation, and the world. In addition, Children's serves as the regional referral center for pediatric emergency, trauma care, cancer, burn, neonatology, and critical care.

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For additional information on the Centers of Excellence program at Children's National Medical Center, please contact Patricia Enright at 202-452-9511 or via e-mail at: [email protected].