Kmita Grażyna, Urmańska Wanda, Kiepura Eliza, Polak Krystyna
Early Psychological Intervention Department, Institute of Mother and Child, Warszawa.
Med Wieku Rozwoj. 2011 Jul-Sep;15(3):216-23.
The study was aimed at exploring feeding behaviour problems reported by parents of premature infants during the first 12 months corrected age.
A subsample of families enrolled in a larger, prospective project on psychological and biological predictors of self-regulation in preterm children participated in the study. The material consisted of data collected from 40 families of preterm infants in the first and fourth and then at six and twelve months corrected age. The children were divided into two groups according to their gestational age: group 1 - 22 children born before 29th week (mean gestational age 26 Hbd and mean birth weight 905 g) and group 2 - 18 children born between 29th and 34th week (mean gestational age 31 Hbd and mean birth weight 1531 g). Semi-structured interviews and daily activity diaries were used. Qualitative, exploratory analysis of parental descriptions of child's feeding behaviour was performed.
No feeding behaviour problems were reported in 31.8% infants in group 1 and 44.4% in group 2, whereas chronic feeding behaviour problems - in the case of 5 infants in group 1 (22.7%) and just in one child in group 2 (5.6%). There was a significant association between "gastrointestinal complications of prematurity" and parental reports of feeding behaviour problems at two and more evaluation times. No relationship was found with such variables as: group, child's gender, method of feeding, mother's postnatal depression, or other complications of prematurity. Six major categories of feeding problems were identified: 1) early regulatory problems, 2) pain and/ or excessive spitting, 3) insufficient weight gain, 4) poor eater, 5) difficulties introducing new taste or consistency, and 6) difficulties with introducing self-feeding. These categories occurred with varying frequencies depending on the child's gestational age and the assessment time.
The results point to an interesting diversity and dynamics of feeding behaviour difficulties in babies born preterm. It was shown that extremely low gestational age as well as gastrointestinal complications of prematurity may contribute to increased parental reports of feeding behaviour difficulties. Further research is needed to disentangle divergent underlying mechanisms of different feeding behaviour problems and describe possible challenges they may imply to the child, parents and their relationship.
本研究旨在探究早产儿父母报告的其在矫正年龄12个月内的喂养行为问题。
参与一项关于早产儿自我调节的心理和生物学预测因素的大型前瞻性项目的家庭子样本参与了本研究。材料包括从40个早产儿家庭在矫正年龄1个月、4个月、6个月和12个月时收集的数据。根据胎龄将儿童分为两组：第1组——22名在第29周前出生的儿童（平均胎龄26周，平均出生体重905克）和第2组——18名在第29周和第34周之间出生的儿童（平均胎龄31周，平均出生体重1531克）。采用半结构化访谈和日常活动日记。对父母关于儿童喂养行为的描述进行定性、探索性分析。
第1组31.8%的婴儿和第2组44.4%的婴儿未报告喂养行为问题，而慢性喂养行为问题在第1组有5名婴儿（22.7%），第2组仅有1名儿童（5.6%）。在两个及更多评估时间点，“早产的胃肠道并发症”与父母报告的喂养行为问题之间存在显著关联。未发现与以下变量有关系：组别、儿童性别、喂养方式、母亲产后抑郁或其他早产并发症。确定了六大类喂养问题：1）早期调节问题，2）疼痛和/或过度吐奶，3）体重增加不足，4）进食不佳，5）引入新口味或质地困难，6）引入自主进食困难。这些类别出现的频率因儿童的胎龄和评估时间而异。
结果表明早产儿喂养行为困难存在有趣的多样性和动态变化。研究表明，极低胎龄以及早产的胃肠道并发症可能导致父母报告的喂养行为困难增加。需要进一步研究以厘清不同喂养行为问题的不同潜在机制，并描述它们可能给儿童、父母及其关系带来的潜在挑战。
