THE CHILD WHO RARELY SHOWS SIGNS OF HUNGER: A PROSPECTIVE CLINICAL CASE FROM EARLY CHILDHOOD TO SCHOOL AGE

Approximately 25 percent of otherwise normally developing young children experience eating problems. These may not only be disruptive to the child’s physical and emotional development, they also may affect the whole family. Assessment of an infant’s eating difficulties should begin with an extensive clinical interview with the caregivers to evaluate the infant’s eating difficulties, the developmental, medical, and family history. This interview should be followed by direct observations of the child with the caregivers during feeding and play. Observations of play interactions enable the clinician to determine whether problematic feeding interactions reflect more fundamental problems in the infant-parent relationship. A prospective clinical case of a child who showed early lack of appetite/interest in food and malnutrition and who was followed-up during school age, will be discussed. The child’s assessment at age 2 and later at age 10 will be based on the PDM-2 framework, and the treatment model of “facilitating internal regulation of eating” will be described. This treatment model of “facilitating internal regulation of eating” helped the parents establish regular mealtimes, refrain from distractions and from coaxing the child to eat, and set limits on inappropriate mealtime behaviours, which helped the child to become more aware of internal signals of hunger and fullness, to increase her food intake and gain weight. At follow-up, at 10 years of age, the child demonstrated no eating problems, good physical and emotional health. The follow-up assessment of feeding and eating disorders is based on a multiaxial approach that includes, for children ages 0-3, the child’s emotional development and regulatory-sensory processing capacities and the quality of parent-infant relationship, and for children ages 4-11, a child’s mental functioning profile, the emerging personality and the subjective experience of child symptom patterns. Attending to these interrelated components is pivotal in conceptualizing effective treatments