Commentary: feeding problems: an ecological perspective.

teractive process that varies across children and is embedded in multiple social levels, extending from the family through cultural factors. The ecological model is based on systems theory, in which changes in any one component of the model affect all other components. Children are conceptualized as active contributors within their primary context-the family. At a broader level, feeding is influenced by the ethnotheories that families hold about feeding and by cultural norms for the timing, type, and amount of food that children should eat (Dettwyler, 1989). From a child’s perspective, feeding requires the integration of multiple systems, including temperament, physical development, and psychosocial development. For example, children are unable to eat solids before they have achieved the oral motor control necessary to move food to the back of their mouths in preparation for swallowing. When solid food is introduced too early, while feeding is still dominated by sucking, food is often pushed forward and out of the mouth, as though the child were rejecting it. Caregivers may misinterpret this action as a signal that the child is rejecting the food or rejecting the caregiver, rather than a sign that the child is not ready for the feeding challenges required of solid foods. If the caregiver responds to the perceived rejection with anger or by intensifying the pressure on the child to eat, mealtime can become stressful and unsuccessful to both the child and the caregiver. Thus, feeding problems may be avoided when clinicians strive to understand caregiver interpretations of their children’s behavior and address their perceptions through anticipatory guidance. Journal of Pediatric Psychology, Vol. 24, No. 3, 1999, pp. 217–219