THE IMPACT OF

FEEDING PROBLEMS
ON CHILD
DEVELOPMENT
Ariani
Divisi Tumbuh Kembang & Pediatri Sosial
FKUB/ RSSA Malang
 OUTLINES
FEEDING PROBLEMS IN CHILDREN

THE IMPACT OF FEEDING PROBLEM ON

CHILD DEVELOPMENT

WHAT CAN WE DO?

EPIDEMIOLOGY
● Eating problem in early childhood, characterized by food refusal, eating a limited
variety of food, an unwillingness to try new food (food neophobia)
and aberrant eating behaviors, such as low enjoyment of food, slowness in eating
and higher satiety responsiveness.

The prevalence:
Highest (14–50%) in preschool children and declines (7–27%) in later childhood.
Incidence also declines after preschool age.
The high prevalence and incidence are an indication that picky eating in the preschool
age is often part of normal development.

Rome ES. Eating Disorder. Pediatrics in Review. 2016.

Cardona Cano, Hoek, & Bryant-Waugh, 2015a; Micali et al., 2011; Mascola et al.,2010; Dovey et al., 2008; Carruth, Ziegler, Gordon, & Barr, 2004
Factors influencing children’s eating behaviours

Scaglioni et al. Factors Influencing Children’s Eating Behaviours. Nutrients 2018, 10, 706
Biopsychosocial model of sex effects on children’s eating behavior

Keller et al. A Biopsychosocial Model of Sex Differences in Children’s Eating Behaviors. Nutrients 2019, 11, 682.
 OUTLINES
FEEDING PROBLEM IN CHILDREN

THE IMPACT OF FEEFING PROBLEM

ON CHILD DEVELOPMENT

WHAT CAN WE DO?

THE IMPACT ON CHILD DEVELOPMENT

● Caloric intake and diet composition have large effects on cognition and emotion
expecially during critical periode in development. The brain has a very high demand for
nutrients in this early period and nutritional imbalances affect normal
neurodevelopment resulting in lasting cognitive deficits

● Early life stress due to feeding problem alter brain function via metabolic and
nutritional factors, to increase vulnerability to develop emotional and cognitive
disorders.
● The hippocampus, a brain region key for cognitive functions, is permanently altered in
its structure and function. The hippocampus is in fact particularly sensitive to the early-
life environment as it continues its development into the postnatal period.

Spencer et al. Food for thought: how nutrition impacts cognition and emotion.npj Science of Food (2017) 1:7
 DAMPAK TERHADAP PERKEMBANGAN ANAK
Jangka Pendek
● Buruknya variasi makanan –
nutritional disorder (rickets, scurvy,
kwarshiorkor)
● Intake Besi dan Zinc yang rendah
● Intake diet berserat yang rendah --
konstipasi
● Konsumsi susu berlebihan -
konstipasi
● Inadekuat kalori –undernutrition,
failure to thrive
Jangka Panjang
● Dampak pada tumbuh kembang
anak
● Berpengaruh terhadap kognitif,
emosional, perilaku, atensi, memori,
sekolah.
● Buruknya interaksi orangtua-anak
● Chronic aversion yang berlanjut
mengganggu perilaku dan emosi
 1327 anak usia 5-7 tahun
20% orangtua melaporkan masalah makan anak usia 2th

Emotional Disorder 2,2%

Behavioral disorder 2,2%
Pervasive Developmental Disorder1,2 %
Functional Somatic Symptoms 1,2 %

Picky eating: 7% anak berhubungan dengan psikopatologi

(perilaku, emosi, gangguan somatik fungsional dan gangguan pervasif)

Micali et al.2011. J Dev Behav Pediatr 32:572-580

How nutrition influences
cognition and emotion?

Due to neuroinflamation processes

including role of microglia, also play
role in how stress during
development alters long term
physiology.

Hyperactivated microglia can lead to

cognitive dysfunction through excess
pro inflammatory cytokine production
causing impaired long term
potentiation inductioin reduced
production of plasticity related
molecules (BNDF, IGF-1), and reduced
synaptic plasticity

Spencer et al. Food for thought: how nutrition impacts cognition and emotion.npj Science of Food (2017) 1:7
 Good appetite/Overeating berhubungan
Emotional undereating berhubungan dengan Emotional Disorder OR 4.4
dengan emotional disorder OR 2,3 (1.1-5.1)
Picky eating berhubungan dengan semua area
psikopatologi
Behavioral disorder OR 4.2 (1.9-10.2)
Emotional disorder OR 3.3 (1.2-8.9)
Micali et al.2011. J Dev Behav Pediatr 32:572-580
Pervasive Developmental Disorder OR 4.3 (1.2-16.2)
Skor Cognitive Empathy pada Anorexia Nervosa lebih rendah dibanding kontrol (d -0,34 (0.56,-0.11)
Skor Affective Empathy tidak ada perbedaan

Cognitive emphaty: kemampuan mengenali dan memahami kondisi mental orang lain
Affective empathy: kemampuan mengungkapkan perasaan tanpa emosi
Kerr-Gaffney J, Psychiatry 2019;10:102
● 917 anak usia 24-71 bulan
● Moderate SE : 17,7%
● Severe SE: 3% Anak lebih berisiko terhadap gangguan
psikiatri dan food avoidance karena
Simpulan: Sensory Sensitivity
-Moderate & Severe Selective Eating(SE): Lebih sulit meregulasi emosi atau
berisiko mengalami gejala depresi,anxiety mengatur fokus perhatian
hipersensitif bau, tekstur, bentuk menyebabkan gangguan afektif
makanan, gangguan oral motor
-Anak memiliki ibu dgn anxiety,
-Keluarga bermasalah dengan makanan

Zucker N et al. PEDIATRICS 2015; 136;3.

Moderate SE:
Depressive symptoms (2.0; 95% CI: 1.4–2.7; P ,.001),
Separation Anxiety Disorder (1.4; 95% CI: 1.1–2.0; P = .03),
Generalized Anxiety Disorder (1.4; 95% CI: 1.1–1.8; P = .02)
Social Anxiety disorder(1.8; 95% CI: 1.0–3.2; P = .05)
ADHD (1.6; 95% CI: 1.2–2.1; P = .001)

Severe SE :
Depressive symptoms (1.4; 95% CI: 1.1–1.8; P = .01),
Generalized Anxiety Disorder (1.3;95% CI: 1.1–1.6; P
= .004)
Social Anxiety disorder (1.9; 95% CI: 1.3–2.9; P = .002).

SE: Selective Eating

Zucker N et al. PEDIATRICS 2015; 136;3.

Cano SC. Journal of Child Psychology and Psychiatry. 2016.
 dd

8594 remaja di US, Prevalensi

13-21%
Paling sering :
EDNOS 3% usia 9-12 tahun,
15% usia 19-22 tahun
PD 2 - 2,5%
BED 2 - 2,5%
BN 1,5%

19,8% overweight
24,9% Use Drugs
36,3% Binge drink AN--Anorexia Nervosa; BN—bulimia nervosa;PD—purging disorder;
BED—binge eating disorder; EDNOS—eating disorder not otherwise specified
27,4% depresive symptom

Alison et al. Pediatrics 2012;130:e289–e295

AN--Anorexia Nervosa; BN—bulimia nervosa;PD—purging disorder; BED—binge eating disorder; EDNOS—eating disorder
not otherwise specified
Purging Disorder & Binge Eating
Binge eating
Bulimia Nervosa lebih Disorder 2x berisiko
Disorder & EDNOS
berisiko Use Drugs / High depressive
lebih berisiko
Binge Drink
overweight/obese
Alison et al.. Pediatrics 2012;130:e289–e295
 MASALAH PERKEMBANGAN
Picky eating was associated with higher levels of behavioral, emotional, and
pervasive developmental problems in childhood and was suggested to be a
precursor for anorexia nervosa.
Picky eating in children of school age: a risk factor or marker for general psychopathology,
rather than a precursor of eating disorders.
(Micali et al., 2011a; Jacobi et al., 2008; Nicholls et al., 2001)

Picky eating problems are also specifically associated with pervasive developmental
disorders. (Bandini et
al., 2010)

Feeding problems and eating disorders are associated with anxiety problems and distorted
child–parent interactions are suggested to play an important role in feeding problems.
(Davies et al., 2006; Galloway, Lee, & Birch, 2003; Swinbourne & Touyz,2007)
 OUTLINES
FEEDING PROBLEM IN CHILDREN

THE IMPACT OF FEEDING PROBLEM ON

CHILD DEVELOPMENT

WHAT CAN WE DO?

 PRINSIP MANAJEMEN
● Terapi kurang menjanjikan, sedangkan konsekuensi kesehatan lebih berat
● Pentingnya pencegahan dan deteksi dini
● Pencegahan primer fokus pada mencegah derajat beratnya masalah makan
● Terapi berbeda tergantung beratnya gangguan
● Tenaga kesehatan di pelayanan primer harus waspada mengenai gangguan
makan supaya anak yang perlu diterapi dapat diidentifikasi segera

Alison et al. Pediatrics 2012;130:e289–e295

 APA YANG DAPAT
DILAKUKAN?
● Interdisipliner dan kerjasama keluarga dengan
tim dokter.
● Dokter anak sebagai ketua tim, dokter spesialis kedokteran fisik dan Patient
rehabilitasi, dokter spesialis kedokteran jiwa yang berpengalaman
menangani masalah makan pada anak, psikolog dan dietisien anak.
● Masalah medis yang mendasari masalah makan juga harus ditangani
dengan benar.
 Manajemen Anak dengan Gangguan Sosioemosional
1.Psychotherapy
2.Medical care & monitoring
3.Nutritional counseling
4.Medication (antidepressants,
antipsychotics, mood stabilizer)
Dilakukan pendekatan holistik
-Mis. Social skill groups untuk
memperbaiki komunikasi, social
anxiety, dan fungsi sosialnya
-CREST : Cognitive Remediation &
Emotion Skill Training untuk perbaiki
emosi dan menghilangkan gangguan
social, Cognitive Behavioral approach
BEHAVIORAL METHOD
FOR PARENT TRAINING

Sesuai untuk di rumah

Sesuai untuk di rumah dengan konsultasi rutin dengan tim
Tidak sesuai dilakukan di rumah, harus dengan pengawasan tim
Silverman AH. Behavioral Management of Feeding Disorders of Childhood. Ann Nutr Metab 2015;66(suppl 5):33–42
 TAKE HOME MESSAGES
● Masalah makan yang menetap berkisar 7-27%.
● Berpengaruh terhadap kognitif, emosional, perilaku, atensi, memori, sekolah, perilaku
berisiko.
● Pencegahan dan Deteksi Dini direkomendasikan untuk mencegah dampak negatifnya.
● Psikoterapi, penanganan masalah medis dan konseling nutrisi dilakukan tim
interdisipliner.
TERIMA KASIH