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Psychological Considerations in Nutrition and Growth

Explore the intricate relationship between psychological factors and nutrition in children with medical conditions, understanding the impact on growth, development, autonomy, and caregiver dynamics. Examine challenges like fear, iatrogenic resistance, parental disagreements, and long-term consequences for both children and parents. Investigate the psychosocial effects of gastrostomy feeding and navigate child protection issues related to nutrition care priorities and ethical dilemmas.

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Psychological Considerations in Nutrition and Growth

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  1. Psychological Considerations inNutrition and Growth

  2. Medical conditions increase the risk of feeding problems… • Interruption of normal feeding • History of physical discomfort during and following eating (Mathisen et al., 1999) • Effects development of self-efficacy, tolerance for texture, oro-motor control • Removes opportunities to develop autonomy and negotiate dependence in relation to caregiver

  3. Fear Through Aversive Experiences • Choking due to limited tongue and jaw mobility, oesophageal strictures • Regurgitation and pain via reflux • Pain from trauma to skin • Bone and tooth pain • Unfamiliarity with textures

  4. Iatrogenic Resistance • Supplements/medicines taste bad • Unpleasant treatments eg n-g tubes • Complicated regimes • Appetite loss through treatment side-effects • Hopelessness through repeated failures • Reclaiming control

  5. Parental Disagreement with Professional Advice • Different priorities (adaptive non-adherence) • Trying but not believed • Desire to maintain “normal” feeding

  6. Consequences of Ongoing Feeding Difficulties • Chewing and swallowing difficulties • Loss of family routine • Unfavourable comparisons with siblings and other children • Relationship between professionals and family • Different rules and boundaries

  7. Consequences for parents • Parental guilt/failure • Parental stress • Parenting difficulties • Loss of parenting confidence

  8. Consequences for patient • Sense of difference • Delays in growth and motor development • Mood • Appearance; small, thin, pre-pubertal • Physical ability; weak, lack of endurance, sleepiness at school -> Low self esteem, low self-efficacy, poor social integration Long term consequences

  9. Psychosocial Effect of Gastrostomy Feeding in EB • No studies in EB • Studies looking at other conditions : - carers’ feelings of inadequacy - insufficient attention to carers’ psychosocial needs - and consequent poor compliance with the feeding regimen Pederson et al (2004), Enrione et al (2005)

  10. Child Protection Issues • Consent: Is child capable for making an informed decision? • Neglect: “Failure of child to grow within normal limits” • Abuse: “Force feeding” “Deliberate failure to follow medically recommended regimes” “Misapplication of programmes/regimes”

  11. Where does/should nutrition lie in the list of priorities for care of severely-affected children? • How hard should we push severely-affected children (or adults) who don’t want to eat when life expectancy is short regardless of what we do?

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