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Malnutrition and Dysfunctional Mother-Child Feeding Interactions: Clinical Assessment and Research Implications

Department of Dynamic and Clinical Psychology (M.A., L.L.), University La Sapienza, Clinical Nutrition Service, Rome
Department of Developmental Psychology (S.C.), University La Sapienza, Clinical Nutrition Service, Rome
Pediatric Hospital Bambino Gesù IRCCS (A.M.A.), Rome
Department of Psychology, II University of Naples (F.D’O.), Naples, ITALY

Address reprint requests to: Dr. Loredana Lucarelli, Dipartimento di Psicologia Dinamica e Clinica, Facoltà di Psicologia 1, Università degli Studi di Roma La Sapienza, Via dei Marsi 78 - 00185 Roma, ITALY. E-mail: loredana.lucarelli{at}uniromal.it

Objectives: To evaluate the effects of age and the presence of feeding pathologies on the relational modes during meals in a sample of mother-child pairs (n = 333), comparing groups of children in the first three years of life with normal development (ND-group, n = 211) and clinical groups of children who presented a diagnosis of feeding disorder and failure to thrive (FD-group, n = 122), and to show an association between specific symptomatic characteristics of the mother, of the child and the dysfunctional modes of their relationship during meals in a subgroup of mother-child pairs (n = 50), selected at random from the total clinical sample and paired with a control group chosen for this study.

Methods: All mother-child pairs in the sample were observed in twenty-minute video-recordings during a meal, using the procedure of the Feeding Scale in the Italian version. A subgroup of mothers, selected at random from the total clinical sample, and paired with a control group, were given two self-reporting instruments for the evaluation of their psychological symptom status: the Eating Attitude Test and the Symptom Checklist-90-Revised, as well as two instruments for the evaluation of the infant temperament and emotional/behavioral functioning: the Baby and Toddler Behavior Questionnaires (from 1 to 18 months) and the Child Behavior Checklist 1-5 (from 18 to 36 months).

Results: Analysis of variance showed that the FD-group present interactional dysfunctional patterns during feeding and raise higher scores in symptomatic characteristics both of the mother and of the child, compared to ND-group. A set of correlation analyses (Pearson coefficients) showed an association among specific symptomatic characteristics of the mothers (dysfunctional eating attitudes, anxiety, depression, hostility), of their children (in particular, anxiety/depression, somatic complaints and aggressive behavior) and of their dysfunctional relational modes during feeding (p < 0.05).

Conclusions: Our study confirms that analysis of the individual characteristics of the child, of the mother and of their relationship during the development of feeding patterns in the first three years of the child’s life is extremely important in the clinical assessment of early feeding disorders, in order to establish a valid diagnostic methodology and formulate strategies for targeted and effective intervention. Furthermore, the results emphasize the clinical utility of our research in early identification of infants and toddlers at risk for feeding problems.

Key words: early feeding disorders, malnutrition, non-organic failure to thrive, dysfunctional mother-child interactions, feeding scale