Infant Feeding Problems Research Articles

Family therapy and systemic interventions for child‐focussed problems: The evidence base

AbstractThis 25th anniversary review updates previous similar papers published in JFT in 2000, 2009, 2014 and 2019. It presents evidence from meta‐analyses and systematic reviews for the effectiveness of systemic interventions for families of young people with common mental and physical health problems and other difficulties where children are the primary focus of concern. In this context, systemic interventions include both family therapy and other family‐based approaches such as parent training, or parent‐implemented interventions. There is now a substantial evidence base supporting the effectiveness of systemic interventions either alone or as part of multimodal programmes for infant mental health and sleep and feeding problems in infancy; recovery from child abuse and neglect; externalising and internalising problems; eating disorders; somatic problems; and psychosis.

IGF1 Haploinsufficiency: Phenotype and Response to Growth Hormone Treatment in 9 Patients.

The clinical features of bi-allelic IGF1 defects are well established, i.e., severe growth failure and microcephaly, delayed psychomotor development, and sensorineural deafness. However, information on clinical and endocrine consequences of heterozygous IGF1 variants and treatment options is scarce. We aimed at extending the knowledge base of the clinical presentation and growth response to recombinant human growth hormone (rhGH) of patients carrying such variants. Retrospective case series of patients with pathogenic heterozygous IGF1 variants. Nine patients from six families were included, harbouring five whole or partial gene deletions and one frameshift variant resulting in a premature stop codon (three de novo, one unknown inheritance). In the other two families, variants segregated with short stature. Mean (SD) birth length was -1.9 (1.3) SDS (n = 7), height -3.8 (0.6) SDS, head circumference -2.5 (0.6) SDS, serum IGF-I -1.9 (0.7) SDS, serum IGFBP-3 1.1 (0.4) SDS (n = 7), and GH peak range 5-31 μg/L (n = 4). Five patients showed feeding problems in infancy. Average height increased after 1 and 2 years of rhGH treatment by 0.8 SDS (range 0.3-1.3 SDS) and 1.3 SDS (range 0.5-2.0 SDS), respectively. Adult height in 2 patients was -2.8 and -1.3 SDS, which was, respectively, 1.3 and 2.9 SDS taller than predicted before start of treatment. Haploinsufficiency of IGF1 causes a variable phenotype of prenatal and postnatal growth failure, microcephaly, feeding difficulties, low/low-normal serum IGF-I values in contrast to serum IGFBP-3 in the upper-normal range. Treatment with rhGH increased growth in the first 2 years of treatment, and in 2 patients adult height after treatment was higher than predicted at treatment initiation.

Mother-infant feeding interactions in mothers with and without eating disorder history: Results of a structured observational study

BackgroundA growing body of evidence suggests that children of mothers with eating disorders (EDs) have a greater risk of early feeding problems. Recognizing and reacting adequately to the infant's signals during feeding is crucial for the child's development of internal and external regulatory mechanisms of food intake. Parental EDs might affect this ability. Therefore, we investigated the quality of mother-infant interactions during feeding using video recording and a structured coding system. MethodsThe data of this pilot study was collected in a prospective cohort study investigating the influence of maternal EDs on child outcomes. Twenty women with ED history and 31 control women were videotaped while feeding their infant during a main meal at ten months postpartum. The mother-infant interactions were evaluated by two raters using the Chatoor Feeding Scale. We assessed birth outcomes, the mother's ED and depression status, breastfeeding practices, infant feeding problems and infant temperament by maternal self-report. ResultsMothers with and without ED history scored very similar on the Feeding Scale, however mothers from the control group experienced more struggle for control with their infants during feeding (p = 0.046) and made more negative comments about the infant's food intake (p = 0.010). Mothers with ED history were more concerned about infant feeding at three months postpartum and reported significantly more problems with solid foods in their children. Birth outcomes were comparable between groups, except for lower weight-for-length birth percentiles in children of women with ED history. ConclusionWhilst examined mothers with ED history are more concerned about feeding their children, ED psychopathology does not affect the quality of mother-infant interaction during feeding at the transition to autonomous eating at ten months of age.

The impact of crying, sleeping, and eating problems in infants on childhood behavioral outcomes: A meta-analysis

BackgroundThere is increasing evidence that regulatory problems (RPs), such as excessive crying, sleeping or feeding problems in infancy, could be associated with the development of behavioral problems in childhood. In this meta-analysis we aimed to investigate the strength and characteristics of this association.MethodsA systematic literature search (PubMed/PsycInfo, until 15/08/2021) for longitudinal prospective studies of infants with RPs and at least one follow-up assessment reporting incidence and/or severity of behavioral problems was conducted. The primary outcomes were (i) the cumulative incidence of behavioral problems in children (2–14 years) with previous RPs and (ii) the difference between children with/without previous RPs with regard to the incidence and severity of externalizing, internalizing and/or attention-deficit/hyperactivity disorder (ADHD) symptoms. Additionally, we analyzed behavioral problems of children with previous single, multiple or no RPs and with respect to age at follow-up. Subgroup and meta-regression analyses were added.Results30 meta-analyzed studies reported on 34,582 participants (nRP = 5091, ncontrol = 29,491; age: baseline = 6.5 ± 4.5 months, follow-up = 5.5 ± 2.8 years) with excessive crying (studies = 13, n = 1577), sleeping problems (studies = 9, n = 2014), eating problems (studies = 3, n = 105), any single (studies = 2, n = 201) or multiple RPs (studies = 9, n = 1194). The cumulative incidence for behavioral problems during childhood was 23.3% in children with RPs. Behavioral problems were significantly more pronounced in infants with RPs compared to healthy controls (SMD = 0.381, 95% CI = 0.296–0.466, p < .001), particularly with multiple RPs (SMD = 0.291, p = 0.018).ConclusionsFindings suggest that RPs in infancy are associated with overall behavioral problems (externalizing or internalizing behavior and ADHD symptoms) in childhood. Our data cannot explain linked developmental trajectories and underlying factors. However, detection of affected infants may help to adapt supportive measures to the individual familial needs to promote the parent-child-relationship and prevent the development of child behavioral problems from early on.

The effect of COVID-19 pandemic on infant and child nutrition

DSÖ tarafından Mart 2020’de pandemi olarak ilan edilen Şiddetli Akut Solunum Yolu Sendromu enfeksiyonu (SARS- CoV-2) ekonomik ve sosyal krizlere yol açan eşi benzeri görülmemiş bir halk sağlığı sorunu haline gelmiştir. Teyit edilen ilk pediatrik vaka 20 Ocak’ta Çin Halk Cumhuriyetinin Shenzhen şehrinde bildirilmiş, o tarihten sonra çok fazla çocuk olgu sunumu ve olgu serisi rapor edilmiştir. Bu raporlarda çocuklarda hastalığın seyrinin asemptomatik olmasının yanında respiratuvar distres sendromu, multiorgan disfonksiyon sendromu gibi daha ciddi komplikasyonlar olabileceği belirtilmektedir. Ancak, hastalığın direk etkilerinin yanında gizlenen diğer sorunların, pandeminin indirek etkilerinin, daha ciddi sorunlara yol açtığı ve açmaya devam edeceği vurgulanmaktadır. Okulların kapanması, akran etkileşiminin azalması gibi nedenler ile birlikte pandeminin çocukların mental ve fiziksel sağlığına olan etkileri endişe yaratmaktadır. Pandemi sürecinde gıda güvensizliği sorunu daha da derinleşmiş, bebek ve çocuk beslenmesi etkilenmiştir. Bu doğrultuda bu derleme, SARS-CoV-2 pandemisi süresince bebek ve çocuk besleme sorunlarını, bu sorunlara neden olan faktörleri ve bu sorunları önlemeye yönelik stratejileri, çocuk ve ailesine yapılacak olan bilgilendirme ve danışmanlıktaki rollerimizi ortaya koymaktır.

Feeding self-efficacy and feeding outcome expectancy mediate the association between maternal depressive symptoms and responsive feeding

Previous research has demonstrated a link between maternal depressive symptoms and infant feeding behavior; however, the underlying mechanisms linking the two remain unclear. This study examined the association between maternal depressive symptoms and responsive feeding, and the potential mediating role of feeding self-efficacy and outcome expectancy. A panel study with 487 women, from pregnancy through postpartum, was conducted. Maternal depressive symptoms at one month postpartum were assessed by the Edinburgh Postnatal Depression Scale. Responsive feeding included feeding on demand and unforced feeding domains. Responsive feeding, feeding self-efficacy, and feeding outcome expectancy were assessed at three months postpartum. Maternal depressive symptoms were associated with less responsive feeding, but the association was fully mediated by feeding self-efficacy and feeding outcome expectancy. Infant feeding problems are associated with depressive symptoms in mothers. Health professionals could work with depressed mothers to enhance infant feeding by targeting feeding self-efficacy and feeding outcome expectancy.

Management of Feeding Problems in Infants with Cleft Palate and Review on Pierre-Robin Syndrome

Pierre Robin syndrome is a congenital disorder with triad of features micrognathia, glossoptosis which result in airway obstruction and feeding difficulties and cleft palate. Cleft palate is the most common congenital anomalies of craniofacial region seen in Pierre-Robin syndrome. Infants with cleft palate have to face various problems. Difficulty in feeding is the most common problem faced by cleft palate neonates that made them difficult to maintain adequate nutrition, result in failure to thrive. There are many methods given in literature to overcome this problem including special type of nursing bottles. In this case report, fabrication of feeding plate to obturate the defect in palate and its use in managing feeding problem is described. Keywords: ­Cleft palate, Feeding plate, Pierre­Robin Syndrome

A Pilot Study of Developing an Infant Sucking Tester Instrument

Objectives: Most preterm infants experience oral feeding disorder. Sucking is the most appropriate way for oral feeding, but it may be immature in preterm infants. Regarding the increased risk of feeding problems in preterm infants, investigating and monitoring their sucking patterns to present appropriate and timely intervention is recommended The current research aimed to report the design of an instrument for measuring the suction pressure in preterm infants through a pilot study. We also checked the validity and reliability of the instrument. Methods: A pilot study was conducted to measure the validity and reliability of this instrument. First, the instrument was developed, and in the next step, discriminant validity, test-retest reliability, and comparison in terms of sex were investigated by measuring the suction pressure of 20 full-term and 15 preterm infants. The Mann-Whitney U test and Wilcoxon test were used to establish the discriminant validity, comparison in terms of sex, and test-retest reliability in SPSS v. 23 software. Results: Two groups showed a significant difference in the suction pressure (P<0.001) to support the discriminant validity of the instrument. We obtained satisfactory values for the test-retest reliability in two groups (r=0.97, P<0.001). Boys and girls did not significantly differ between full-term (P=0.9) and preterm infants groups (P=0.5). Discussion: Performing the pilot study on 35 infants through an infant sucker tester proved the instrument’s discriminant validity and test-retest reliability. However, conducting the studies with a larger sample size is essential to make this instrument available commercially.

When Cleft Lip and/or Palate and Antenatal Opioid Exposure Intersect: A Tutorial

Purpose: A new clinical subpopulation of cleft lip/palate (CL/P), which includes infants and children antenatally exposed to opioids, is increasingly appearing on CL/P teams and speech-language pathology caseloads. The purposes of this tutorial are to describe neonatal opioid withdrawal syndrome (NOWS), to offer a review of the NOWS feeding and neurodevelopmental outcomes literature, and to discuss the clinical and research implications for this new clinical population. Conclusions: Recent literature has pointed to a higher prevalence of CL/P in infants with NOWS, as compared to the live birth population. In addition to the typical feeding problems of infants with CL/P, other challenges emerge during the first several days of life for opioid-exposed infants in the neonatal intensive care unit (NICU). These feeding problems are characterized by disruption of the suck–swallow–breath process and are further complicated by the infant's state during withdrawal from opioids. There are trends across studies that suggest good reason for concern about adverse neurodevelopmental outcomes in opioid-exposed children. This includes evidence that children post-NOWS are at greater risk than children with typical development for speech; language and literacy impairments; and/or other cognitive, sensory, and behavioral problems. Children with CL/P already are at risk for speech, resonance, language, and feeding disorders. A history of antenatal opioid exposure may increase and add further complications. The SLP plays a key role in the management of and attitudes toward children with NOWS and CL/P in the NICU, on CLP teams, in early intervention, and in schools. This tutorial provides clinical guidelines for intervention with this new and growing population.

Investigating the Developmental Trajectory of Long-term Oral Feeding Problems in ‘Healthy’ Preterm Infants

ABSTRACT Purpose To investigate the occurrence of oral feeding problems in preterm infants up to one year after hospital discharge. Methods Thirty-six infants born <34 weeks gestation were enrolled in a prospective exploratory longitudinal pilot study prior to hospital discharge. Parents of eligible infants completed telephone questionnaires at 3, 6, and 12 months corrected gestational age. The occurrence and type of feeding problems; medical problems; and rehabilitation services received were collected. Results A total of 26 (72.2%) parents responded, with 11 (42%) identifying feeding problems that developed within the first year of life. Avoidant behavior (including crying, agitated/fussy, and refusing to eat) was the most common feeding problem that occurred. Conclusion Feeding problems in ‘healthy’ preterm infants may occur at any point in development within the first year of life. Increased screening after hospitalization is needed for early identification and to make appropriate referrals in a timely manner to prevent and/or reduce the severity of long-term feeding problems.

Breastfeeding Promotion and Nursing Care for Infants with Cleft Palate and/or Cleft Lip in Northeastern Craniofacial Center, Thailand

Background:The common feeding problems in infants with Cleft Palate (CP) and/or Cleft Lip and Palate (CLP) are the inability to suck and swallow breastmilk. Difficulties in feeding may compromise normal growth and disrupt the bonding process.Objective:To evaluate the treatment and breastfeeding rate in infants with CP and CLP.Methods:A retrospective study of infants with CP and CLP who were admitted to the postpartum ward between July 2017 and June 2019 was conducted. Demographic data, type of feeding, nursing activities, and duration of breastfeeding after discharge were collected.Results:A total of 35 infants were included in the study. Twenty-seven cases were non-syndromic complete CLP (77.2%). On admission only 15 infants (42.8%) received breastmilk and alternative feeding techniques were applied for 26 (74.3%) infants. Breastfeeding promotion and nursing care were provided to mothers and infants by an interdisciplinary team at the Craniofacial Center. The median Length of Stay (LOS) was 8 days (range 5-9 days) and infants born at the affiliated hospital (inborn) had a significantly shorter LOS compared to infants referred from other health centers (p=0.019). None of the inborn groups received infant formula. The breastfeeding rate in all groups was 100% at discharge. Exclusive breastfeeding rates at 2-, 4-, and 6-months follow-up were 82.8%, 42.8%, and 31.4%, respectively.Conclusion:Breastfeeding promotion, education, and nursing care from an interdisciplinary team resulted in an improved ability of mothers to breastfeed infants with CLP, particularly in non-syndromic CLP. The exclusive breastfeeding rate after 6-months in this study was higher than in previous studies.

Pediatric Swallowing and Feeding Assessment and Management

“Pediatric Swallowing and Feeding Assessment and Management” by J Arvedson, L Brodsky, and M Lefton-Greif (San Diego, CA: Plural Publishing: 2020) is about new interventions for feeding problems and swallowing disorders. Its contents inform speech and language specialists on the nature of swallowing, the etiology of relevant diseases, methods to evaluate disorders, and evidence-based therapies in the interventions for feeding problems in infants and children. In addition, the book could be useful for the pediatrician, gastroenterologist, otorhinolaryngology, occupational therapist, psychiatrist, nurses, lactation consultants, and families of children with feeding/swallowing problems. Intervention approaches are illustrated with case reports. In the third edition of this book, which was published in 2020, novel approaches and evaluation methods are discussed. In Chapters three to eight, the most important screening methods and instrumental evaluation (for example FEES, VFSS and ultrasound), as well as clinical evaluation of swallowing are presented. The advantages, disadvantages, implementation of each method is discussed in the ninth to thirteenth chapters, mainly focusing on interventions.

Caregivers' Experiences of Infant Feeding Problems: The Role of Self-Compassion and Stress Management

Introduction Infant feeding problems are strongly associated with caregiver stress, which in turn is linked to poorer outcomes for children. Self-compassion is a modifiable trait strongly associated with improved mental health and greater resilience. The purpose of this study was to investigate the relationships among self-compassion, stress management practices, and caregiver stress in a sample of parents who identified feeding problems in their infants. Method Parents who identified feeding problems in their infants completed an online survey. They described the feeding problems, completed the Self-Compassion Scale and the Perceived Stress Scale, and detailed their stress management practices. Results Higher self-compassion was strongly associated with lower overall stress and more modestly associated with lower feeding-related distress. More severe feeding problems were significantly more stressful for caregivers. Participants reported a wide variety of stress management approaches. Discussion These findings indicate that higher self-compassion is associated with lower caregiver stress for parents whose infants experience feeding problems. Implications for service providers are reviewed. Supplemental Material https://doi.org/10.23641/asha.14831028.

Risk Factors Associated With Long-term Feeding Problems in Preterm Infants: A Scoping Review.

Infants who are born preterm are at a high risk of encountering feeding problems. The aim of this scoping review is to identify risk factors associated with feeding problems that persist beyond infancy in children (aged 1-6 years) who were born preterm (<37 weeks' gestation). To perform this scoping review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework was applied. To be included in this study, articles had to be published in peer-reviewed journals, had an empirical study design, examined feeding problems relating to the child's feeding ability or refusal to eat certain texture of foods, and assessed risk factors (age, weight, and medical conditions) associated with long-term feeding problems in children who were born preterm. After abstract and full-text screening, a total of 9 articles meeting the inclusion criteria were included in this study. Findings from this study identified that gestational age and birth weight are significant risk factors and that sex, duration of mechanical ventilation, and length of tube feedings are potential risk factors. This study confirms that younger and smaller infants are at a high risk of encountering oral feeding difficulties and early interventions services should be focused on these preterm infants. Evaluation of timing and intensity (dose) of early interventions strategies should be investigated to provide more targeted and effective interventions for younger and smaller preterm infants.

Problemas na alimentação infantil e sua associação com a doença do refluxo

Objective: To identify infant feeding problems associated with gastroesophageal reflux disease in childhood. Bibliographic review: Gastroesophageal reflux disease (GERD) has a multifactorial cause and corresponds to a chronic dysfunction resulting from the retrograde flow of gastric content into the esophagus. Frequent exposure of gastric contents in the esophagus can cause a defect in the lower esophageal sphincter, which acts as an anti-reflux barrier. Therefore, this dysfunction may favor the occurrence of transitory relaxations of this sphincter, causing an increased predisposition to GERD. In children, gastroesophageal reflux manifests itself in a physiological way, however, when concomitant to different symptoms and complications, usually resulting from feeding problems, it can cause the development of GERD, whose most common manifestations are heartburn and regurgitation, symptoms that can influence negatively on the quality of life of the child and his family. Final considerations: GERD manifests itself in different ways, causing very wide signs and symptoms according to the age group. Therefore, it is essential to identify risk groups, be up-to-date with the guidelines, and provide guidance on adequate nutrition in order to minimize their complications and facilitate diagnosis.

Is In-Utero Marijuana Exposure Associated With Childhood Developmental Delay? [20K

INTRODUCTION: Women are at the highest risk for developing a substance use disorder during their reproductive years. The prevalence of marijuana use in the US during pregnancy is 7%. Data is unclear regarding long-term effects of in-utero marijuana exposure. Given that the endocannabinoid system is present at around day 16 of gestation, it is plausible that maternal marijuana use could affect fetal brain development. This purpose of this study was to determine correlations between in-utero marijuana exposure and childhood developmental delay. METHODS: After IRB approval, a retrospective chart review of infants with a history of marijuana exposure in utero was conducted. A total of 230 study subjects met inclusion criteria and were analyzed. RESULTS: The majority of subjects, 84 (59.6%) were noted to have feeding problems in infancy. Forty one subjects, 17.8% showed abnormal muscle tone, 39 subjects, 17%, were noted to be small for gestational age (SGA). Speech delay was present with a frequency of 10.0%, 23 subjects. Fine motor delay was seen in 25 subjects, 10.9% and global development delay with noted in 21 subjects, 9.1%. CONCLUSION: Results from this retrospective chart review indicate possible risks of short-term (feeding problems, abnormal muscle tone, SGA) and longer-term developmental delays. Further research is necessary to determine whether these effects are due to marijuana alone, or if confounding factors are involved. In order to educate and advise the public about the effects of marijuana use in pregnancy, this relationship must first be understood.

Current breastfeeding practices in Bulgaria

AbstractThe results obtained by the national monitoring of dietary intake and nutritional status of Bulgarian infants, conducted during the last ten years, show some negative characteristics and trends associated with risk of chronic non-communicable diseases and micronutrient deficiencies later in life. The data on nutrition in infants were collected through active interviews with the mothers and information from the medical documentation of their GPs during the surveys in 2007 and 2014. Wrong practices of infant feeding and serious problems in their nutritional status, such as short duration of breastfeeding, low prevalence of exclusive breastfeeding, early and inadequate complementary feeding, high prevalence of stunting, underweight and anaemia among infants, especially in minorities, were identified. Results obtained during the survey in 2007 were: the rate of children breast-fed in the first days after their births were 90.7%. Only 1.8% was breast-fed during their first hour according to WHO and UNICEF recommendations; 12.5% of the infants were at exclusive breast-feeding. Data were compared with the results obtained for children at the same age from national surveys conducted in 2014, as the rate of infants who were breast-fed in the first days after their births was 86.3%; 9.9% were breast-fed during their first hour and 21.7% of the infants were at exclusive breast-feeding. The total duration of breast-feeding was short according to both surveys. The rate of breast-fed infants in the first days after birth is high in many European countries, however, the breast-feeding practices in Bulgaria do not comply with the international recommendations. The exclusive breast-feeding has a low prevalence rate. The breast-feeding period is very short. It is necessary to develop the national recommendations for healthy nutrition of infants that will concern all these problems and will aim to improve knowledge of the mothers regarding the best practices of healthy nutrition of their infants.

Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: a systematic review and meta-analyses.

To determine the prevalence of drooling, swallowing, and feeding problems in persons with cerebral palsy (CP) across the lifespan. A systematic review was conducted using five different databases (AMED, CINAHL, Embase, MEDLINE, and PubMed). The selection process was completed by two independent researchers and the methodological quality of included studies was assessed using the STROBE and AXIS guidelines. Meta-analyses were conducted to determine pooled prevalence estimates of drooling, swallowing, and feeding problems with stratified group analyses by type of assessment and Gross Motor Function Classification System level. A total of 42 studies were included. Substantial variations in selected outcome measures and variables were observed, and data on adults were limited. Pooled prevalence estimates determined by meta-analyses were as high as 44.0% (95% confidence interval [CI] 35.6-52.7) for drooling, 50.4% (95% CI 36.0-64.8) for swallowing problems, and 53.5% (95% CI 40.7-65.9) for feeding problems. Group analyses for type of assessments were non-significant; however, more severely impaired functioning in CP was associated with concomitant problems of increased drooling, swallowing, and feeding. Drooling, swallowing, and feeding problems are very common in people with CP. Consequently, they experience increased risks of malnutrition and dehydration, aspiration pneumonia, and poor quality of life. Drooling, swallowing, and feeding problems are very common in persons with cerebral palsy (CP). The prevalence of drooling, swallowing, and feeding problems is 44.0%, 50.4%, and 53.5% respectively. There are limited data on the prevalence of drooling, swallowing, and feeding problems in adults. Higher Gross Motor Function Classification System levels are associated with higher prevalence of drooling, swallowing, and feeding problems. There is increased risk for malnutrition, dehydration, aspiration pneumonia, and poor quality of life in CP.

Assessment of proper technique of artificial feeding among infants in Al-Hilla City

Background: Infant formula is considered an effective alternative to breast milk. Safe preparation of infant formula is a crucial goal by the World Health Organization for infants receiving some or all of their feeding using infant formula. Objectives: The objective is to find out the errors in the method of bottle-feeding which leads to feeding problems in infants in Al-Hilla city. Methods: This cross-sectional study was conducted on a convenient sample of 384 infants (who attended the general wards in Babylon Maternity and Pediatric Hospital, AL-Noor Hospital and some primary health-care centers). Results: The percentage of mothers who had followed all the recommended steps for feeding and sterilization of infant bottle was (16.90%). Conclusions: Very low percentage of mothers were found to follow all the proper steps of bottle-feeding.

Feeding problems in infancy: David Tickell at DFTB18

This talk was recorded live at DFTB18 in Melbourne, Australia. With the theme of ‘Science and Story’ we pushed our speakers to step out of their comfort zones and consider why we do what we do. Caring for children is not just about acquiring the scientific knowhow but also about taking a look beyond a… Read More »Feeding problems in infancy: David Tickell at DFTB18