Month: November 2020

Posted on

Feeding: The Impact Parenting Style May Have

feeding
Image by yalehealth from Pixabay

Feeding therapy. I always say it’s a love-hate relationship for me. It’s love because I myself love food and eating. My Italian side of the family is big into cooking, so food definitely is a large part of our culture, and many cultures.

I love seeing kids become more confident and enjoy the process of exploring new foods and flavors. I think it’s fun to be silly with them and talk about taking shark bites vs. mouse bites, seeing who can crunch a carrot the loudest, etc.

The hate side of things isn’t so much a hate as it is a frustration that stems from my impatience. I am through and through a bottom up thinker. I have a hard time not getting to the root of an issue because I feel any progress we’ll see otherwise is likely a temporary bandaid. The struggle I have with feeding therapy is that a child can make lots of progress in the clinic, but seems to have a stand still at home.

As time has gone on, I firmly see that feeding therapy is whole family therapy. That’s not a bad thing, and really every therapy should be that way! However, there are so many emotional dynamics that go into mealtime that unlike learning to cut with scissors, if you don’t somewhat address the bigger emotional dynamic, you’ll likely see very limited progress.

This week’s article is to highlight the connection between family dynamics and feeding outcomes. So while the article doesn’t tell you what to directly do, (although I did write a review that covers that subject) I wanted to review it as a means to support the idea that addressing family dynamics is crucial in feeding therapy.

Journal Eating Behaviors (SNIP score 1.106)

Article Title Mindful Feeding: A Pathway Between Parenting Style and Child Eating Behaviors

  • 1A Systematic review of homogeneous RCTs
  • 1B Well-designed individual RCT
  • 2A Systematic review of cohort studies
  • 2B Individual prospective cohort study, low quality RCT, ecological studies; and two-group, non-randomized studies
  • 3A Systematic review of case control studies
  • 3B Individual retrospective case-control studies; one-group, non-randomized pre-post test study; cohort studies
  • 4 Case series (and low-quality cohort and case control study) [This study was a cross-sectional study]
  • 5 Expert opinion without explicit critical appraisal

Methods Researchers recruited 496 parents from a sample of a larger study on the topic of feeding. Parents completed an online survey.

Measures

Mindful Feeding Study authors used the Present Centered Awareness subscale of the Mindful Feeding Questionnaire to determine parents’ mindful attention during the process of feeding their children.

feeding

Child Eating Behavior Study authors used subscales from the Child Eating Behavior Questionnaire as a means to measure children’s emotional over-eating and food fussiness per parent report.

Problematic Mealtime Behaviors The Problematic Child Mealtime Behaviors subscale of the Meals in Our Household questionnaire served as a tool to gather parent report on mealtime behaviors.

Parenting Style Investigators used the Parenting Practice Questionnaire to serve as a tool to classify parents’ parenting style as authoritative, authoritarian or permissive.

Findings

In general, the parents who self-reported more authoritative parenting reported higher levels of mindful feeding, while those reporting more authoritarian and permissive parenting reported less mindful feeding (Goodman, L.C., Roberts, L.T. & Musher-Eizenman, D.R., 2020, p. 3). Those parents who used mindful feeding strategies more often had children who they reported were less likely to be fussy, less likely to eat in response to emotions and less likely to have problematic mealtime behaviors ((Goodman, L.C., Roberts, L.T. & Musher-Eizenman, D.R., 2020, p. 4).

Authoritative Parenting Per parents’ self-reports, authoritative parenting had a direct and indirect negative impact on children’s emotional over-eating and food fussiness. Meaning, those with an authoritative parenting style had children who were less likely to be fussy and to eat as a reaction to their emotions. This style of parenting did not demonstrate a negative direct impact on problematic mealtime behaviors.

However, when authors assessed how authoritative parenting impacted mindful feeding and how that in turn impacted problematic mealtime behaviors, they did find a significant effect. So, having an authoritative parenting style doesn’t directly impact mealtime behaviors. However, an authoritative style impacts a parents’ mindful feeding habits, which in turn impacts the problematic mealtime behaviors.

Authoritarian Parenting Per parents’ self-reports, authoritarian parenting had a direct and positive impact on children’s emotional over-eating. That is, parents with an authoritarian parenting style reported their children as more likely to eat in reaction to emotions. This result was not seen for food fussiness and problematic mealtime behaviors. As authors assessed how authoritarian parenting impacted mindful feeding and how that in turn impacted problematic mealtime behaviors, food fussiness, and emotional over-eating, they did find a significant effect.

Permissive Parenting Parents who self-reported permissive parenting style had both a direct and indirect positive impact on problematic mealtime behaviors, food fussiness, and emotional over-eating. This means, parents reporting this style also reported their children as presenting with more mealtime behaviors, food fussiness and emotional over-eating.

Things to Consider

The authors mention that it would be beneficial to the research to complete a longitudinal study in which they could assess these outcomes for the same group of parents and children at multiple points in time. This would allow drawing stronger conclusions about the connection between parenting style, parents’ mindful feeding habits and children’s eating behaviors.

Of note is that the sample in this study had a majority demographic of white families (79%), which may impact the ability to generalize findings to the picky eating population. I was not able to find the race demographics for picky eaters, so I can’t conclusively say one way or another.

The study authors also mention that it would be valuable to explore the bidirectional relationship between parents’ mindful eating habits and children’s challenging behaviors, as the children’s challenging behaviors may also impact the parents’ strategies. Finally, they include that exploring other factors, such as other life stressors, that may impact this relationship between parent and child dynamics during feeding would be useful.

What does this all mean for a feeding therapist?

While this data is preliminary and low level evidence, I think it is very important to acknowledge and include families in feeding therapy intervention. I think we are doing a disservice to children and their families if we expect the child’s progress in the comfort of a therapeutic feeding session to transfer over to home without directly also educating parents and caregivers on how to interact with food, respond to their children and shift a mindset of learning to learn about food.

References

Goodman, L.C., Roberts, L.T., & Musher-Eizenman, D.R. (2020). Mindful feeding: A pathway between parenting style and child eating behaviors. Eating Behaviors 36. http://doi.org/10.1016/j.eatbeh.2019.101335

Posted on

Sensory Techniques for Children with Difficulties in Sensory Integration

Image by Cheryl Holt from Pixabay
  • 1A Systematic review of homogenous RCTs
  • 1B Well-designed individual RCT
  • 2A Systematic review of cohort studies
  • 2B Individual prospective cohort study, low quality RCT, ecological studies; and two-group, non-randomized studies
  • 3A Systematic Review of case control studies
  • 3B Individual retrospective case-control studies; one-group, non-randomized pre-post test study; cohort studies
  • 4 Case series (and low quality cohort and case control study)
  • 5 Expert opinion without explicit critical appraisal
  • * This was a systematic review which included mostly RCT’s and Level II studies. As this type of systematic review doesn’t fall into either 1A nor 2B, I chose to categorize it into a level 2A study. The evidence reviewed was higher than case studies but lower than cohort studies.

Methods

The authors of this systematic review included studies that investigated the effect of interventions that are not Ayres Sensory Integration specifically. They included studies published between 2007 and May 2015. Authors included studies on sensory-based techniques as well as sensory environmental modifications. Interventions targeted clients between 2-21 years old with sensory integration difficulties. Authors ensured that articles investigated specific sensory techniques or sensory environmental modifications.

Findings

Qi-jong massage The authors concluded there is strong evidence for young children with ASD with Qi-jong massage (Bodison, S.C. & Parham, L.D. 2017, p. 5).

Three Level I and and 1 Level II studies demonstrated improvements in self-regulation, parenting stress, tactile differences and ASD symptoms. Children were 2-7 years old and had ASD. Their parents, after being trained by occupational therapists, provided 15 minute daily massage. The studies lasted 4 and 5 months.

Important to note is that the OT’s had at least 50 hours of training in Qi-jong before training parents on its implementation. This may make it a challenge intervention for most OT’s to implement.

Weighted Vests The authors concluded there is limited evidence for the use of weighted vests for children with ADHD (Bodison, S.C. & Parham, L.D. 2017, p. 5).

A level I study did show improved attention and in-seat behavior when a group of 6-9 year olds wore vests with 10% of their body weight. The authors mention that limitations in the design of the study impacted its internal validity. This in turn caused them to interpret these findings with caution.

Study authors also noted that the evidence they found for the use of weighted vests with children with ASD had low levels of evidence, so these studies were not formally included in the review. The authors conclude the evidence for the effectiveness of weighted vests for children with ASD is insufficient at this time.

Slow Linear Swinging The authors concluded there is insufficient evidence to support the use of slow linear swinging to improve attention for children with ASD.

A level I study investigated the impact of being on-task following slow, linear swinging in a group of children with ASD. The study demonstrated no significant difference between children who swung and those in the control group (Bodison, S.C. & Parham, L.D. 2017, p. 6).

Study authors did note a limitation of this study is that the arousal level of children was not assessed prior to their participation in swinging. They posited, therefore, that if a child was in a low arousal state prior to a calming activity, this may have demonstrated no positive impact on the child’s on-task behaviors.

Sensory Enrichment in Preschool The authors concluded there is insufficient evidence supporting sensory enrichment in a preschool classroom.

This level I study investigated the impact of embedding tactile, proprioceptive and vestibular activities for 12 weeks in a preschool classroom’s daily routine. All children in the classroom participated in these activities, but one group of children also received ASI through OT sessions.

Both groups improved in their play skills, but no difference was noted between them. Study authors of this review mention that design limitations, including a very small sample size of 8, limit the implications of the study findings.

Sensory Environmental Modifications The authors concluded there is moderate evidence supporting sensory adaptations of a dental environment to assist participation for children with ASD in their routine dental cleanings (Bodison, S.C. & Parham, L.D. 2017, p. 6).

Children reported improved measures of pain intensity and sensory discomfort as well as improved participation in dental cleaning for typically developing children and those with ASD. Children received deep pressure from a decorative wrap and the auditory and visual aspects of the the dental environment (Bodison, S.C. & Parham, L.D. 2017, p. 7).

Most interesting to me is that investigators measured children’s electrodermal responses as a means to quantify impact on stress and anxiety. They found a moderate to large effect size for children with ASD after they received the intervention!

So What Do You Think?

I appreciate when studies have high standards for the research they include in their reviews. However, due to the nature of the current evidence in OT, that sometimes means there is limited information on the interventions we use most.

I’m interested in the idea of Qi-jong massage, but I will say that the skeptic in me thinks, “Well, if anyone received a 15 minute massage to start their day, I would definitely expect them to show improvements in their behaviors.” I also am curious to see if the massage was compared to other interventions such as a tailored sensory diet. If families really followed up with those every day with good fidelity, I hypothesize that we would similarly see as good if not better results in the developmental gains for children.


Reference

Bodison, S.C., and Parham, L.D. (2017). Specific Sensory Techniques and Sensory Environmental Modifications for Children and Youth with Sensory Integration Difficulties: A Systematic Review. American Journal of Occupational Therapy 72 (1). https://doi.org/10.5014/ajot.2018.029413