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      Trastornos de regulación en la primera infancia: identificación y lineamientos para la prevención y manejo Translated title: Regulatory disorders in early childhood: identification, prevention and treatment guidelines

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          Abstract

          Resumen: Los trastornos de regulación son definidos de acuerdo a las guías y sistemas de clasificación actuales como desórdenes en la interacción entre los bebés y sus padres, siendo caracterizados por una tríada sintomática que incluye aspectos del niño, características de los padres y de la interacción parento- filial. Este trastorno puede generar desequilibrio familiar y a largo plazo ser factor de riesgo para tras tornos internalizantes y externalizantes, así como de maltrato infantil. El manejo propuesto incluye trabajo con el sistema familiar, anticipando su aparición, considerando las condiciones parentales. Ante un trastorno de regulación se debe tener siempre el foco en la triada sintomática. Los padres o cuidadores de niños y niñas con trastornos de regulación necesitan guía para mejorar su sensibilidad y reacciones hacia las demandas de sus hijos o hijas durante el primer año y así romper la trayectoria del desarrollo de estos trastornos y disminuir su propio estrés para lograr una parentalidad intuitiva exitosa. Se presenta una revisión narrativo-descriptivo de éste, sus asociaciones causales, consecuen cias y lineamientos para el tratamiento a la luz del conocimiento actual.

          Translated abstract

          Abstract: Regulation disorders are defined according to current guidelines and classification systems as disor ders in the interaction between infants and their parents, being characterized by a symptomatic triad that includes aspects of the child, parental characteristics and parent-child interaction. This disorder may generate family imbalance and in the long term to be a risk factor for internalizing and externa lizing disorders, as well as child abuse. The proposed management includes working with the family system, anticipating its appearance, considering the parental conditions. When faced with a regula tion disorder, the focus should always be on the symptomatic triad. Parents or caregivers of children with regulation disorders need guidance to improve their sensitivity and reactions to the demands of their children during the first year and thus break the trajectory of the development of these disorders and reduce their own stress to achieve a successful intuitive parenting. A narrative-descriptive review of the disorder, its causal associations, consequences and treatment guidelines in light of current knowledge is presented.

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          Most cited references44

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          Early skin-to-skin contact for mothers and their healthy newborn infants.

          Mother-infant separation post birth is common. In standard hospital care, newborn infants are held wrapped or dressed in their mother's arms, placed in open cribs or under radiant warmers. Skin-to-skin contact (SSC) begins ideally at birth and should last continually until the end of the first breastfeeding. SSC involves placing the dried, naked baby prone on the mother's bare chest, often covered with a warm blanket. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neuro-behaviors ensuring fulfillment of basic biological needs. This time frame immediately post birth may represent a 'sensitive period' for programming future physiology and behavior.
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            Development of food acceptance patterns in the first years of life.

            As young omnivores, children make the transition from the exclusive milk diet of infancy to consuming a variety of foods. They must learn to accept a set of the foods available in their environmental niche, and they 'come equipped' with a set of predispositions that facilitate the development of food acceptance patterns, constrained by predisposition and limited by what is offered to them. While children are predisposed to like sweet or salty foods and to avoid sour or bitter foods, their preferences for the majority of foods are shaped by repeated experience. The predispositions that shape food acceptance patterns also include neophobia and the predisposition to learn to prefer and accept new foods when they are offered repeatedly. In addition, the predisposition for associative conditioning affects children's developing food acceptance patterns, resulting in preferences for foods offered in positive contexts, while foods presented in negative contexts will become more disliked via the learning of associations with the social and environmental contexts. Children also learn to prefer energy-dense foods when consumption of those foods is followed by positive post-ingestive consequences, such as those produced when high-energy-density foods are eaten when hungry. Although children are predisposed to be responsive to the energy content of foods in controlling their intake, they are also responsive to parents' control attempts. We have seen that these parental control attempts can refocus the child away from responsiveness to internal cues of hunger and satiety and towards external factors such as the presence of palatable foods. This analysis suggests that taking a closer look at what children are learning about food and eating may provide clues regarding the formation of children's food acceptance patterns, and that this approach also suggests potential causative factors implicated in the aetiology of obesity and the emergence of weight concerns. Current data, although limited, suggest that child-feeding practices play a causal role in the development of individual difference in the controls of food intake, and perhaps in the aetiology of problems of energy balance, especially childhood obesity. These relationships should be pursued in future research.
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              Role of parents in the determination of the food preferences of children and the development of obesity.

              D Benton (2004)
              The role of parental behaviour in the development of food preferences is considered. Food preferences develop from genetically determined predispositions to like sweet and salty flavours and to dislike bitter and sour tastes. Particularly towards the second year of life, there is a tendency to avoid novel foods (neophobia). Food aversions can be learnt in one trial if consumption is followed by discomfort. There is a predisposition to learn to like foods with high-energy density. However, from birth genetic predispositions are modified by experience and in this context during the early years parents play a particularly important role. Parental style is a critical factor in the development of food preferences. Children are more likely to eat in emotionally positive atmospheres. Siblings, peers and parents can act as role models to encourage the tasting of novel foods. Repeated exposure to initially disliked foods can breakdown resistance. The offering of low-energy-dense foods allows the child to balance energy intake. Restricting access to particular foods increases rather than decreases preference. Forcing a child to eat a food will decrease the liking for that food. Traditionally, educational strategies have typically involved attempts to impart basic nutritional information. Given the limited ability of information to induce changes in behaviour, an alternative strategy would be to teach parents about child development in the hope that an understanding of the characteristic innate tendencies and developmental stages can be used to teach healthy food preferences.
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                Author and article information

                Journal
                andesped
                Andes pediatrica
                Andes pediatr.
                Sociedad Chilena de Pediatría. (Santiago, , Chile )
                2452-6053
                April 2022
                : 93
                : 2
                : 159-166
                Affiliations
                [4] Santiago orgnameInstituto Milenio para el Estudio de la Depresión y Personalidad Chile
                [1] La Serena orgnameServicio de Salud Coquimbo Chile
                [2] Santiago Santiago de Chile orgnameUniversidad Alberto Hurtado orgdiv1Facultad de Psicología Chile
                [3] Santiago orgnameComité de Lactancia Sociedad Chilena de Pediatría Chile
                Article
                S2452-60532022000200159 S2452-6053(22)09300200159
                10.32641/andespediatr.v93i2.4147
                5cd6d662-68bd-4121-8b92-230968c97173

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 24 November 2021
                : 13 February 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 44, Pages: 8
                Product

                SciELO Chile

                Categories
                Actualidad

                Salud Mental,Llanto,Sueño,Trastornos de Alimentación,Infante,Mental Health,Crying,Sleep,Eating Disorders,Infant

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