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The psychology behind growth faltering

European Journal of Clinical Nutrition volume 64, pages S14–S16 (2010)Cite this article

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Infants and children can regulate their intake reasonably well from an early age to accord with their growth requirements (Fomon et al., 1975). Young children whose growth is faltering have been shown to have a significantly lower energy intake at meal times than control-group children (Drewett et al., 2004). Therefore, when children do not maintain growth at the expected rate and, if there are no medical reasons for growth failure, we might look at various psycho-physiological factors to explain why they are not taking in sufficient food. These factors would be past pain or vomiting associated with eating, poor appetite regulation, missed sensitive periods for food introduction, oral-motor dysfunction, developmental stages in preference acquisition, such as the onset of the neophobic or disgust response, child sensory sensitivity, and parental feeding strategies.

Infants who have experienced pain associated with illness (Harris et al., 2000), or who suffer from gastro-oesophageal reflux (Berwick et al., 1982), are more likely to be food refusers and to show growth faltering. In these cases, food refusal and a consequent reduction in intake are clearly related to a physiological problem. Similarly, there are infants who are described as ‘contented’ after very small feeds, and who do not wake up for feeds, who also fail to thrive (Davies, 1979). These infants are similar to those who fail to show compensation in their energy intake when given a high-calorie preload before a meal (Kasese-Hara et al., 2002). Such children show poor appetite regulation and for this reason fail to take in sufficient calories to accord with growth requirements. Thus, the factors pain and appetite regulation are clear predictors of poor intake; however, there are also more subtle interactions that can be observed, which take into account both child and parental factors. The first of these is sensitive periods in the introduction of food.

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  1. Department of Paediatric Clinical Psychology, Children's Hospital Birmingham, School of Psychology, University of Birmingham, Birmingham, UK

    G Harris

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  1. G Harris
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Correspondence to G Harris.

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G Harris has received lecture fees and grant support from Danone and Nutricia.

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Harris, G. The psychology behind growth faltering. Eur J Clin Nutr 64 (Suppl 1), S14–S16 (2010). https://doi.org/10.1038/ejcn.2010.42

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