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Can nutrition counselling be more behavioural? Lessons learned from dietary management of cystic fibrosis

Published online by Cambridge University Press:  07 March 2007

Lori J. Stark
Lori J. Stark*
Affiliation:
Cincinnati Children's Hospital Medical Centre and University of Cincinnati College of Medicine, Division of Psychology, MLCD3015, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
*
Corresponding author: Professor Lori Stark, fax +1 513 636 3677, [email protected]
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Abstract

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Cystic fibrosis (CF) is a genetically-inherited disorder that results in energy imbalance. Undernutrition is common in children with CF and associated with poor health outcomes. To ensure optimal growth and nutrition, children with CF are recommended to consume 120–150% of the recommended daily allowance (RDA) for energy, but most studies show they typically are only able to achieve 100% of the RDA. While biological factors clearly contribute to poor dietary adherence, recent studies have documented behavioural and environmental barriers to adherence that includes parent-child interaction at mealtimes. While not ‘abnormal’, parent behaviours such as paying increased attention to the child in the form of coaxing, commanding and feeding when the child is engaged in behaviours incompatible with eating (food refusal, talking, leaving the meal) may serve to reinforce these child non-eating behaviours. Thus, dietary counselling alone, albeit necessary, is typically insufficient because of failure to specifically address these behavioural and environmental barriers to dietary treatment. Behavioural intervention that targets both nutrition education and behavioural management has been found to be effective in achieving an average increased energy intake of 4200 kJ (1000)kcal/d and weight gain of 1·48 kg over 9 weeks in children with CF. This intervention utilizes self-monitoring, goal setting and shaping to structure the delivery of treatment. It also teaches parents to utilize child behaviour-management techniques to motivate children to increase their energy intake. These behavioural strategies include differential attention (praising and ignoring), contingency management and behavioural contracting. The potential application of these techniques to dietary counselling is suggested.

Keywords

Cystic fibrosisBehavioural interventionNutrition counsellingWeight gainEnergy intake
Type
Meeting Report
Information
Proceedings of the Nutrition Society , Volume 62 , Issue 4 , November 2003 , pp. 793 - 799
Copyright
Copyright © The Nutrition Society 2003

References

Anthony, H, Paxton, S, Bines, J & Phelan, P (1999) Psychosocial predictors of adherence to nutritional recommendations and growth outcomes in children with cystic fibrosis. Journal of Psychosomatic Research 47, 623–634.CrossRefGoogle ScholarPubMed
Beker, LT, Russek-Cohen, E & Fink, RJ (2001) Stature as a prognostic factor in cystic fibrosis survival. Journal of the American Dietetic Association 101, 438–442.CrossRefGoogle ScholarPubMed
Bell, L, Durie, P & Forstner, GG (1984) What do children with cystic fibrosis eat?. Journal of Pediatric Gastroenterology and Nutrition 3, Suppl. 1, S137–S146.CrossRefGoogle ScholarPubMed
Birch, LL (1990) Development of food acceptance patterns. Developmental Psychology 26, 515–519.CrossRefGoogle Scholar
Borowitz, D, Baker, RD & Stallings, VA (2002) Consensus report on nutrition for pediatric patients with cystic fibrosis. Journal of Pediatric Gastroenterology and Nutrition 35, 246–259.Google ScholarPubMed
Bowen, AM & Stark, LJ (1991) Malnutrition in cystic fibrosis: A behavioral conceptualization of cause and treatment. Clinical Psychology Review 11, 315–331.CrossRefGoogle Scholar
Chase, HP, Long, MA & Lavin, MH (1979) Cystic fibrosis and malnutrition. Journal of Pediatrics 95, 337–347.CrossRefGoogle ScholarPubMed
Corey, M & Farewell, V (1996) Determinants of mortality from cystic fibrosis in Canada. American Journal of Epidemiology 143, 1007–1017.CrossRefGoogle ScholarPubMed
Corey, M, McLaughlin, FJ, Williams, M & Levison, H (1988) A comparison of survival, growth, and pulmonary function in patients with cystic fibrosis in Boston and Toronto. Journal of Clinical Epidemiology 41, 583–591.CrossRefGoogle ScholarPubMed
Crist, W, McDonnell, P, Beck, M, Gillespie, CT, Barrett, P & Mathews, J (1994) Behavior at mealtimes and nutritional intake in the young child with cystic fibrosis. Developmental and Behavioral Pediatrics 15, 157–161.CrossRefGoogle Scholar
Crozier, DN (1974) Cystic fibrosis – a not so fatal disease. Pediatric Clinics of North America 21, 935–950.CrossRefGoogle Scholar
Cystic Fibrosis Foundation (2002) Patient Registry 2001 Annual Data Report. Bethesda, MD: Cystic Fibrosis Foundation.Google Scholar
Daniels, L, Davidson, GP & Martin, AJ (1987) Comparison of the macronutrient intake of healthy controls and children with cystic fibrosis on low fat or nonrestricted fat diets. Journal of Pediatric Gastroenterology and Nutrition 6, 381–386.Google ScholarPubMed
Eddy, MD, Carter, BD, Kronenberger, WG, Conradsen, S, Eid, NS, Bourland, SL & Adams, G (1998) Parent relationships and compliance in cystic fibrosis. Journal of Pediatric Health Care 12, 196–202.CrossRefGoogle ScholarPubMed
Enzle, ME, Roggeveen, JP & Cook, SC (1991) Self versus other – reward administration and intrinsic motivation. Journal of Experimental Psychology 27, 468–479.Google Scholar
Epstein, LH, Wing, RR, Steranchak, L, Dickson, B & Michelson, J (1980) Comparison of family-based behavior modification and nutrition education for childhood obesity. Journal of Pediatric Psychology 5, 25–35.CrossRefGoogle ScholarPubMed
Forehand, RL & McMahon, RJ (1981) Helping the Noncompliant Child. New York: The Guilford Press.Google Scholar
Henley, LD & Hill, ID (1990) Errors, gaps, and misconceptions in the disease-related knowledge of cystic fibrosis patients and their families. Pediatrics 85, 1008–1014.CrossRefGoogle ScholarPubMed
La Greca, AM & Schuman, WB (1995) Adherence to prescribed medical regimens. In Handbook of Pediatric Psychology, 2nd ed., pp. 55–83.[Roberts, MC, editors]. New York: The Guilford Press.Google Scholar
Linscheid, TR (1983) Eating problems in children. In Handbook of Clinical Child Psychology, pp. 616–639.[Walker, CE, Roberts, MC, editors]. New York: John Wiley & Sons.Google Scholar
Linscheid, TR, Budd, KS & Rasnake, LK (1995) Pediatric feeding disorders. In Handbook of Pediatric Psychology, 2nd ed., pp. 501–515[Robert, M,editors]. New York: The Guilford Press.Google Scholar
Luder, E, Kattan, M, Thorton, JC, Koehler, KM & Bonforte, RJ (1989) Efficacy of a nonrestricted fat diet in patients with cystic fibrosis. American Journal of Diseases of Children 143, 458–464.Google ScholarPubMed
Meichenbaum, D & Turk, D (editors) (1987) Facilitating Treatment Adherence: A Practitioner's Guidebook. New York NY: Plenum Press.CrossRefGoogle Scholar
Miller, DL & Stark, LJ (1994) Contingency contracting for improving adherence in pediatric populations. Journal of the American Medical Association 271, 81–83.CrossRefGoogle ScholarPubMed
Powers, SW, Patton, SR, Byars, KC, Mitchell, MJ, Jelalian, E, Mulvihill, MM, Hovell, MF & Stark, LJ (2002) Caloric intake and eating behavior in infants and toddlers with cystic fibrosis. Pediatrics 109, 1–10.CrossRefGoogle ScholarPubMed
Ramsey, B, Farrell, P & Pencharz, P (1992) Nutritional assessment and management in cystic fibrosis: Consensus conference. American Journal of Clinical Nutrition 55, 108–116.CrossRefGoogle Scholar
Ryan, P & Lauver, DR (2002) The efficacy of tailored interventions. Journal of Nursing Scholarship 34, 331–337.CrossRefGoogle ScholarPubMed
Sanders, MR, Turner, KM, Wall, CR, Waugh, LM & Tully, LA (1997) Mealtime behavior and parent-child interaction: A comparison of children with cystic fibrosis, feeding problems, and nonclinic controls. Journal of Pediatric Psychology 22, 881–900.CrossRefGoogle ScholarPubMed
Satter, E (1987) How to Get Your Child to Eat, But Not Too Much. Palo Alto, CA: Bull Publishing Company.Google Scholar
Smith, AE & Lloyd-Still, JD (1983) Value of computerized dietary analysis in pediatric nutrition: An analysis of 147 patients. Journal of Pediatrics 103, 820–824.CrossRefGoogle ScholarPubMed
Spieth, L, Stark, LJ, Mitchell, MJ, Schiller, M, Cohen, LL, Mulvihill, MM & Hovell, M (2001) Observational assessment of family functioning at mealtime in preschool children with cystic fibrosis. Journal of Pediatric Psychology 26, 215–224.CrossRefGoogle ScholarPubMed
Stark, LJ, Bowen, AM, Tyc, VL, Evans, S & Passero, MA (1990) A behavioral approach to increasing calorie consumption in children with cystic fibrosis. Journal of Pediatric Psychology 15, 309–326.CrossRefGoogle ScholarPubMed
Stark, LJ, Jelalian, E, Mulvihill, MM, Powers, SW, Bowen, AM, Spieth, LE, Keating, K, Evans, S, Creveling, S, Harwood, I, Passero, MA & Hovell, MF (1995) Eating in preschool children with cystic fibrosis and healthy peers: A behavioral analysis. Pediatrics 95, 210–215.CrossRefGoogle Scholar
Stark, LJ, Jelalian, E, Powers, SW, Mulvihill, MM, Opipari, LC, Bowen, A, Harwood, I, Passero, MA, Lapey, A, Light, M & Hovell, MF (2000) Parent and child mealtime behaviors in families of children with cystic fibrosis. Journal of Pediatrics 136, 195–200.CrossRefGoogle ScholarPubMed
Stark, LJ, Knapp, L, Bowen, AM, Powers, SW, Jelalian, E, Evans, S, Passero, MA, Mulvihill, MM & Hovell, M (1993) Increasing calorie consumption in children with cystic fibrosis: Replication with two year follow-up. Journal of Applied Behavior Analysis 26, 435–450.CrossRefGoogle Scholar
Stark, LJ, Mulvihill, MA, Powers, SW, Jelalian, E, Keating, K, Creveling, S, Brynes-Collins, B, Miller, DL, Harwood, I, Passero, MA, Light, M & Hovell, M (1996) Behavioral intervention to improve calorie intake of children with cystic fibrosis: Treatment vs. wait-list controls. Journal of Pediatric Gastroenterology and Nutrition 22, 240–253.Google Scholar
Stark, LJ, Mulvihill, MM, Jelalian, E, Bowen, AM, Powers, SW, Tao, S, Creveling, S, Passero, MA, Harwood, I, Light, M, Lapey, A & Hovell, MF (1997) Descriptive analysis of eating behavior in school-age children with cystic fibrosis and healthy control children. Pediatrics 99, 665–671.CrossRefGoogle ScholarPubMed
Stark, LJ, Opipari, LC, Spieth, L, Jelalian, E, Quittner, AL, Higgins, L, Mackner, LM, Byars, KC, Lapey, A, Stallings, VA & Duggan, C (2003) Contribution of behavior therapy to dietary treatment in cystic fibrosis: A randomized controlled study with two-year follow-up. Behavior Therapy 34, 237–258.CrossRefGoogle Scholar
Tomezsko, JL, Stallings, VA & Scanlin, TF (1992) Dietary intake of healthy children with cystic fibrosis compared with normal control children. Pediatrics 90, 547–553.CrossRefGoogle ScholarPubMed
Zemel, BS, Jawad, AF FitzSimmons S Stallings, VA (2000) Longitudinal relationship among growth, nutritional status and pulmonary functioning in children with cystic fibrosis: analysis of the Cystic Fibrosis Foundation National CF Patient Registry. Journal of Pediatrics 137, 374–380.CrossRefGoogle ScholarPubMed