The feeding relationship: problems and interventions.

The feeding relationship is the complex of interactions that take place between parent and child as they engage in food selection, ingestion, and regulation behaviors. Effective feeding supports a child's developmental tasks of homeostasis, attachment, and separation. Feeding of the newborn infant is most successful when parents allow the infant to determine timing, amount, preference, pacing, and eating capability. During the attachment phase, such infant-controlled behaviors allow parents to engage affectively with the child. Successful regulation of state and attachment provides the groundwork for the separation-individuation phase. In feeding, effective parents provide opportunities to explore but also provide structure and limits. Feeding and growth problems often stem from distorted dynamics around feeding, which can be indicative of distorted parent-child interactions. Incidence estimates range from 1% to 2% for severe and prolonged problems to 25% to 35% for common difficulties such as food refusal and "overeating." An evaluation of feeding dynamics should always be made as part of the diagnostic study of a child who is eating or growing inappropriately. To prevent problems in feeding, practitioners may teach and support positive feeding dynamics as part of primary care, refer parents for instruction in positive approaches to feeding, and detect and refer attitudinal and behavioral problems early.