Diagnosing infantile anorexia: the observation of mother-infant interactions.
OBJECTIVE
This study has three objectives: (1) to delineate the diagnostic criteria for infantile anorexia, including the onset of persistent food refusal during the infant's transition to spoon- and self-feeding, acute and/or chronic malnutrition, parental concern about the infant's poor food intake, and mother-infant conflict, talk, and distraction during feeding; (2) to determine the interrater agreement of child psychiatrists when diagnosing infantile anorexia based on these criteria; and (3) to describe the use of the Feeding Scale as a diagnostic tool.


METHODS
One hundred two toddlers, ranging in age from 12 to 37 months, were assessed by two child psychiatrists and assigned the diagnosis of infantile anorexia, picky eater, or good eater. In addition, observers who were masked to the toddler's diagnosis rated mother-infant interactions with the Feeding Scale to permit objective evaluation of those interactions.


RESULTS
Two child psychiatrists were able to assign toddlers to infantile anorexia, picky eating, and healthy, good eating groups with a high level of agreement. The objective scale for rating mother-infant interactions showed a high level of agreement between two masked raters and a good level of agreement between masked raters and the child psychiatrists' diagnostic assessment.


CONCLUSIONS
Infantile anorexia can be diagnosed with high reliability by child psychiatrists. Evaluation of mother-infant interactions is a useful diagnostic tool.
Chatoor
I
I
Department of Psychiatry, Children's National Medical Center, Washington, DC 20010, USA.
Hirsch
R
R
Ganiban
J
J
Persinger
M
M
Hamburger
E
E
D000328:Adult; D000704:Analysis of Variance; D000855:Anorexia / Q000175:diagnosis*; D002675:Child, Preschool; D016001:Confidence Intervals; D003663:Decision Trees; D003937:Diagnosis, Differential; D005247:Feeding Behavior / Q000145:classification*; D005260:Female; D006801:Humans; D007223:Infant; D018730:Infant Behavior / Q000145:classification*; D008297:Male; D008425:Maternal Behavior; D009034:Mother-Child Relations; D015596:Nutrition Assessment; D019370:Observation / Q000379:methods; D015588:Observer Variation; D011569:Psychiatric Status Rating Scales / Q000592:standards; D012680:Sensitivity and Specificity