Age-based norm-reference values for the Pediatric Eating Assessment Tool

Alterations in Child Feeding Behavior: An Underrecognized Clinical Complication of Food Allergy

BACKGROUND

Food allergy (FA) affects around 5.6 million children in the United States, conferring risk for negative impacts on growth and psychosocial functioning. While evidence suggests a higher prevalence of feeding difficulties in children with FA, the link between FA and feeding dysfunction remains unclear.

OBJECTIVE

To investigate feeding problems in children with parent-reported IgE-mediated FA and/or pediatric feeding disorder (PFD) compared with healthy children in a community-based sample and explore factors associated with feeding problems in children with FA.

METHODS

A matched cross-sectional cohort study used survey data from 352 parents of children aged 6 months to 7 years who reported a diagnosed IgE-mediated FA and/or PFD (50 with FA only, 67 with FA and PFD, and 235 with PFD only). Healthy children were matched based on age, sex, race, and socioeconomic factors. Feeding problems were assessed using the Pediatric Eating Assessment Tool. Matched-pairs generalized linear regressions compared each cohort and explored factors associated with feeding problems in children with FA.

RESULTS

Children with FA exhibited significantly higher feeding problems compared with healthy children. Children with a diagnosed PFD had more severe feeding problems, irrespective of comorbid FA. Factors linked with feeding problems in children with FA included older age, non-White race, increased medical comorbidity, and limited dietary variety.

CONCLUSIONS

This study adds to evidence indicating a higher prevalence of feeding problems in children with FA. Clinicians treating FA patients should routinely screen for feeding and growth concerns and consider referral to multidisciplinary feeding programs as needed.

Prevalence of Parent-Reported Problematic Eating Behaviors and Skills at 8-24 Months of Age in Infants Born at Less Than 34 Weeks Gestation

PURPOSE

The purpose of this study was to describe the evolution and prevalence of parent-reported problematic feeding behaviors and eating skills in infants born prior to 34 weeks at the time of eating solid foods between 8 and 24 months of age, and to explore the associations between problematic feeding and the impact on the parent and family.

METHOD

Parents of eligible children (N = 35) completed an online survey when their child was 8, 10, 12, 18, and 24 months corrected age. The survey included the Pediatric Eating Assessment Tool (PediEAT), Child Oral and Motor Proficiency Scale (ChOMPS), and the Feeding Impact Scales-Family and Parent.

RESULTS

The prevalence of problematic feeding behaviors, as measured by the PediEAT, decreased from 63% at 8 months to 29% at 24 months. The prevalence of problematic eating skills, as measured by the ChOMPS, ranged from 30% to 56% between 8 and 24 months, with the highest prevalence between 10 and 18 months. The impact of feeding on the family and parent, as measured by the Feeding Impact Scales, was higher in families of children with problematic feeding than those without problematic feeding; however, given the small sample size, this was only statistically significant at 10 and 24 months.

CONCLUSIONS

The prevalence of problematic feeding in this population of infants under 34 weeks was 43%-44% over the first 2 years of life. Infants born preterm should be considered at elevated risk for problematic feeding and monitored closely with timely referrals. Identifying prevention strategies in the neonatal intensive care unit will be critical.

Dysphagia Service Delivery in the Educational Setting: Pediatric Feeding Disorder and the Culturally Responsive Clinician

PURPOSE

This article addresses considerations for the speech-language pathologist to ensure culturally competent dysphagia management in the school setting for children with oral motor, swallowing, and pediatric feeding disorders (PFDs). There is also discussion of the multifactorial cultural and linguistic influences that impact collaborative educational decisions when establishing and implementing school-based dysphagia services.

CONCLUSIONS

The consideration of cultural and linguistic factors for the child with oral motor, swallowing, and/or PFDs is essential when diagnosing, treating, and planning for dysphagia service delivery. By recognizing and including culturally appropriate interventions and recommendations, speech-language pathologists enhance opportunities for positive outcomes and treatment efficacy when providing pediatric dysphagia services in the educational setting for children from culturally and linguistically diverse backgrounds.

Baby food pouches and Baby-Led Weaning: Associations with energy intake, eating behaviour and infant weight status

Although concern is frequently expressed regarding the potential impact of baby food pouch use and Baby-Led Weaning (BLW) on infant health, research is scarce. Data on pouch use, BLW, energy intake, eating behaviour and body mass index (BMI) were obtained for 625 infants aged 7-10 months in the First Foods New Zealand study. Frequent pouch use was defined as ≥5 times/week during the past month. Traditional spoon-feeding (TSF), "partial" BLW and "full" BLW referred to the relative proportions of spoon-feeding versus infant self-feeding, assessed at 6 months (retrospectively) and current age. Daily energy intake was determined using two 24-h dietary recalls, and caregivers reported on a variety of eating behaviours. Researchers measured infant length and weight, and BMI z-scores were calculated (World Health Organization Child Growth Standards). In total, 28% of infants consumed food from pouches frequently. Frequent pouch use was not significantly related to BMI z-score (mean difference, 0.09; 95% CI -0.09, 0.27) or energy intake (92 kJ/day; -19, 202), but was associated with greater food responsiveness (standardised mean difference, 0.3; 95% CI 0.1, 0.4), food fussiness (0.3; 0.1, 0.4) and selective/restrictive eating (0.3; 0.2, 0.5). Compared to TSF, full BLW was associated with greater daily energy intake (BLW at 6 months: mean difference 150 kJ/day; 95% CI 4, 297; BLW at current age: 180 kJ/day; 62, 299) and with a range of eating behaviours, including greater satiety responsiveness, but not BMI z-score (6 months: 0.06 (-0.18, 0.30); current age: 0.06 (-0.13, 0.26)). In conclusion, neither feeding approach was associated with weight in infants, despite BLW being associated with greater energy intake compared with TSF. However, infants who consumed pouches frequently displayed higher food fussiness and more selective eating.

Feeding at 6-12 months in infants with CHD

BACKGROUND

Feeding difficulty is common in infants with CHD.

OBJECTIVE

The purpose of this study was to describe the feeding skills and behaviours of infants with CHD at 6-12 months of age and explore relationships between feeding, gastrointestinal distress, and gastroesophageal reflux.

METHODS

Parents of 30 infants with CHD completed online surveys when their infant was 6, 8, 10, and 12 months old. Surveys included parent-report measures of feeding skills (Child Oral and Motor Proficiency Scale), feeding behaviours (Pediatric Eating Assessment Tool), symptoms of gastrointestinal distress (Infant Gastrointestinal Symptoms Questionnaire), and gastroesophageal reflux (Infant Gastroesophageal Reflux Questionnaire-Revised).

RESULTS

We found that 95, 32, 67, and 30% of infants were delayed in their feeding skill development at 6, 8, 10, and 12 months, respectively. Symptoms of problematic feeding behaviours were similarly high, with 90, 62, 29, and 38% of infants meeting criteria for problematic feeding at 6, 8, 10, and 12 months, respectively. Feeding skills and behaviours were related but unique contributors. Feeding behaviours were related to both gastrointestinal distress and gastroesophageal reflux, but feeding skills were rarely related to either.

CONCLUSIONS

Delayed acquisition of feeding skills and problematic feeding were common in infants with CHD. Infants with more gastrointestinal and gastroesophageal reflux symptoms had more symptoms of problematic feeding behaviours.

CLINICAL IMPLICATIONS

Comprehensive assessment, targeted interventions, and early involvement of feeding specialists are important to support feeding in infants with CHD through at least the first year of life.

Translation and validation of the Spanish version of the Pedi-EAT-10 questionnaire for screening of dysphagia

INTRODUCTION

The Pedi-EAT-10 is a quick and simple validated tool for screening for dysphagia in the paediatric age group. The objective of our study was to translate and adapt the scale to Spanish and assess its psychometric properties, level of difficulty and speed of completion.

PATIENTS AND METHODS

Following the forward and back translation and the approval by the research team of the Spanish version of the Pedi-EAT-10, we carried out a prospective study in a group of patients with dysphagia and a group of children who were healthy or had minor disease. Their legal guardians completed the questionnaire and reported the duration and difficulty of the test.

RESULTS

The study included 87 cases of dysphagia and 91 controls. The Cronbach alpha for internal consistency was 0.87. Most correlations between single item scores and the total scale score were greater than 0.65 (P < .001). The Pedi-EAT-10 scores were significantly higher in patients with dysphagia in every age group (P < .001), evincing a high sensibility and specificity for the screening of dysphagia. In the control group, the mean time taken to complete the questionnaire was 2.18 ± 1.98 min, and all participants found it easy.

CONCLUSIONS

We verified the validity, reliability and internal consistency of the Spanish version of the Pedi-EAT-10. It is an easy and quick instrument that can be used for screening of dysphagia in paediatric clinical practice.

Orofacial functions and oral health: An analysis on children aged 5-8 years old

The aim of this study is to assess the orofacial function performance and oral health status of healthy children as well as their potential correlations. In this descriptive study, the oral functions of four hundred systemically healthy children who applied for the pediatric dentistry clinic were evaluated. Three scales, namely Karaduman Chewing Performance Scale (KCPS), Pediatric version of the Eating Assessment Tool (PEDI-EAT-10), and Nordic Orofacial Test Screening (NOT-S) protocol, are used to collect the data. These children's carious lesions were evaluated by using the decayed, missing, filled tooth/surface (DMFT/S, dmft/s) indices, the International Caries Detection and the Assessment-II System (ICDAS-II). In total, 400 (6.5 years [78.02 months]) children were participated in the study. Their KCPS scores indicate that 58.0% of the children were at level 0 and 35.8% were at level 1. The results of the KCPS levels and the DMFT, dmft, DT, dt, MT, mt (as =0 and ≥1) were found to be statistically significant; p = .044, p = .009, p = .008, p = .000, p = .032, and p = .003, respectively. The total PEDI-EAT-10 score of 13.4% of the children was found to be 3 or higher, suggesting that they experience a problem in swallowing. According to the NOT-S, the most affected domains were "habits" (51.0%), "facial expression" (49.3%), and "chewing and swallowing" (45.3%). Among healthy children without a defined problem in swallowing and orofacial functions, the oral health status may affect orofacial functions. Decayed (particularly, extensive caries existence) or missing tooth may have critical importance for adequate chewing in children. Especially in the presence of so many decayed or missing teeth, evaluating the orofacial functions through different scales may considerably contribute to early diagnosis of functional problems.

Tools available to screen for child feeding dysfunction: A systematic review

INTRODUCTION

The aim of this systematic review is to identify existing pediatric feeding screening tools that have been shown to be valid and reliable in identifying feeding dysfunction in children.

METHOD

A database search produced 5862 relevant articles to be screened based on pre-determined inclusion/exclusion criteria. After full text review of 183 articles, 64 articles were included in the review.

RESULTS

Forty-four studies detailed development and validation of unique feeding screening tools for the pediatric population. The remaining twenty studies were validations studies of already developed screening tools.

DISCUSSION

Multiple screening tools identified were effective in determining feeding dysfunction in children. Several tools employed excellent techniques to measure reliability and validity for diverse pediatric populations. Careful consideration of the tools listed in this review will help practitioners determine the best method for feeding screening in their facility.

Nutritional Implications of Baby-Led Weaning and Baby Food Pouches as Novel Methods of Infant Feeding: Protocol for an Observational Study

BACKGROUND

The complementary feeding period is a time of unparalleled dietary change for every human, during which the diet changes from one that is 100% milk to one that resembles the usual diet of the wider family in less than a year. Despite this major dietary shift, we know relatively little about food and nutrient intake in infants worldwide and virtually nothing about the impact of baby food "pouches" and "baby-led weaning" (BLW), which are infant feeding approaches that are becoming increasingly popular. Pouches are squeezable containers with a plastic spout that have great appeal for parents, as evidenced by their extraordinary market share worldwide. BLW is an alternative approach to introducing solids that promotes infant self-feeding of whole foods rather than being fed purées, and is popular and widely advocated on social media. The nutritional and health impacts of these novel methods of infant feeding have not yet been determined.

OBJECTIVE

The aim of the First Foods New Zealand study is to determine the iron status, growth, food and nutrient intakes, breast milk intake, eating and feeding behaviors, dental health, oral motor skills, and choking risk of New Zealand infants in general and those who are using pouches or BLW compared with those who are not.

METHODS

Dietary intake (two 24-hour recalls supplemented with food photographs), iron status (hemoglobin, plasma ferritin, and soluble transferrin receptor), weight status (BMI), food pouch use and extent of BLW (questionnaire), breast milk intake (deuterium oxide "dose-to-mother" technique), eating and feeding behaviors (questionnaires and video recording of an evening meal), dental health (photographs of upper and lower teeth for counting of caries and developmental defects of enamel), oral motor skills (questionnaires), and choking risk (questionnaire) will be assessed in 625 infants aged 7.0 to 9.9 months. Propensity score matching will be used to address bias caused by differences in demographics between groups so that the results more closely represent a potential causal effect.

RESULTS

This observational study has full ethical approval from the Health and Disability Ethics Committees New Zealand (19/STH/151) and was funded in May 2019 by the Health Research Council (HRC) of New Zealand (grant 19/172). Data collection commenced in July 2020, and the first results are expected to be submitted for publication in 2022.

CONCLUSIONS

This large study will provide much needed data on the implications for nutritional intake and health with the use of baby food pouches and BLW in infancy.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12620000459921; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379436.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/29048.

Prevalence of problematic feeding in young children born prematurely: a meta-analysis

BACKGROUND

Difficulties related to eating are often reported in children born preterm. The objective of this study was to quantitatively synthesize available data on the prevalence of problematic feeding in children under 4 years of age who were born preterm.

METHODS

Literature was identified from PubMed, CINAHL, and PsycInfo. The search was limited to English language and publication years 2000-2020. To be included in the meta-analysis, the article had to report the prevalence of problematic oral feeding within a population of children born prematurely (< 37 weeks' gestation), and the child age at the time of study had to be between full-term corrected age and 48 months. For studies meeting inclusion criteria, the following data were extracted: sample size and subsamples by gestational age and/or child age at time of study; definition of problematic feeding; measures used for assessment of feeding; gestational age at time of birth of sample; child age at time of study; exclusion criteria for the study; and prevalence of problematic feeding. Random-effects meta-analyses were performed to estimate the prevalence of problematic feeding across all studies, by gestational age at birth, and by child age at time of study.

RESULTS

There were 22 studies that met inclusion criteria. Overall prevalence of problematic feeding (N = 4381) was 42% (95% CI 33-51%). Prevalence was neither significantly different across categories of gestational age nor by child age at the time of study. Few studies used psychometrically-sound assessments of feeding.

CONCLUSION

Problematic feeding is highly prevalent in prematurely-born children in the first 4 years of life regardless of degree of prematurity. Healthcare providers of children born preterm should consider screening for problematic feeding throughout early childhood as a potential complication of preterm birth.

SYSTEMATIC REVIEW REGISTRATION NUMBER

Not applicable.

CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE MONTREAL CHILDREN'S HOSPITAL FEEDING SCALE INTO BRAZILIAN PORTUGUESE

OBJECTIVE

To cross-culturally adapt and validate the Montreal Children's Hospital Feeding Scale (MCH-FS) into Brazilian Portuguese.

METHODS

The MCH-FS, originally validated in Canada, was validated in Brazil as Escala Brasileira de Alimentação Infantil (EBAI) and developed according to the following steps: translation, production of the Brazilian Portuguese version, testing of the original and the Brazilian Portuguese versions, back-translation, analysis by experts and by the developer of the original questionnaire, and application of the final version. The EBAI was applied to 242 parents/caregivers responsible for feeding children from 6 months to 6 years and 11 months of age between February and May 2018, with 174 subjects in the control group and 68 ones in the case group. The psychometric properties evaluated were validity and reliability.

RESULTS

In the case group, 79% of children were reported to have feeding difficulties, against 13% in the control group. The EBAI had good internal consistency (Cronbach's alpha=0.79). Using the suggested cutoff point of 45, the raw score discriminated between cases and controls with a sensitivity of 79.4% and specificity of 86.8% (area under the ROC curve=0.87).

CONCLUSIONS

The results obtained in the validation process of the EBAI demonstrate that the questionnaire has adequate psychometric properties and, thus, can be used to identify feeding difficulties in Brazilian children from 6 months to 6 years and 11 months of age.

Parent-delivered interventions used at home to improve eating, drinking and swallowing in children with neurodisability: the FEEDS mixed-methods study

BACKGROUND

Eating, drinking and swallowing difficulties are common in young children with neurodisability. These difficulties may lead to inadequate calorie intake, which affects a child's nutrition, growth and general physical health.

OBJECTIVE

To examine which interventions are available that can be delivered at home by parents to improve eating, drinking and swallowing in young children with neurodisability and are suitable for investigation in pragmatic trials.

DESIGN

This was a mixed-methods study that included focus groups, surveys, an update of published systematic reviews of interventions, a systematic review of measurement properties of existing tools, evidence mapping, evidence synthesis, a Delphi survey and stakeholder workshops.

SETTING

The study was carried out in NHS hospitals, community services, family homes and schools.

PARTICIPANTS

Parents of children who had neurodisability and eating, drinking and swallowing difficulties. Professionals from health and education. Young people with eating, drinking and swallowing difficulties or young people who had previously experienced eating, drinking and swallowing difficulties.

DATA SOURCES

Literature reviews; national surveys of parents and professionals; focus groups with parents, young people and professionals; and stakeholder consultation workshops.

REVIEW METHODS

An update of published systematic reviews of interventions (searched July-August 2017), a mapping review (searched October 2017) and a systematic review of measurement properties using COnsensus-based Standards for the Selection of health status Measurement INstruments (COSMIN) methodology (searched May 2018).

RESULTS

Significant limitations of the available research evidence regarding interventions and tools to measure outcomes were identified. A total of 947 people participated: 400 parents, 475 health professionals, 62 education professionals and 10 young people. The survey showed the wide range of interventions recommended by NHS health professionals, with parents and professionals reporting variability in the provision of these interventions. Parents and professionals considered 19 interventions as relevant because they modified eating, drinking and swallowing difficulties. Parents and professionals considered 10 outcomes as important to measure (including Nutrition, Growth and Health/safety); young people agreed that these were important outcomes. Stakeholder consultation workshops identified that project conclusions and recommendations made sense, were meaningful and were valued by parents and professionals. Parents and health professionals were positive about a proposed Focus on Early Eating, Drinking and Swallowing (FEEDS) toolkit of interventions that, through shared decision-making, could be recommended by health professionals and delivered by families.

LIMITATIONS

The national surveys included large numbers of parents and professionals but, as expected, these were not representative of the UK population of parents of children with eating, drinking and swallowing difficulties. Owing to the limitations of research evidence, pragmatic decisions were made about interventions that might be included in future research and outcomes that might be measured. For instance, the reviews of research found only weak or poor evidence to support the effectiveness of interventions. The review of outcome measures found only limited low-level evidence about their psychometric properties.

CONCLUSIONS

Opportunities and challenges for conducting clinical trials of the effectiveness of the FEEDS toolkit of interventions are described. Parents and professionals thought that implementation of the toolkit as part of usual NHS practice was appropriate. However, this would first require the toolkit to be operationalised through development as a complex intervention, taking account of constituent interventions, delivery strategies, implementation and manualisation. Subsequently, an evaluation of its clinical effectiveness and cost-effectiveness could be undertaken using appropriate research methods.

FUTURE WORK

Initial steps include FEEDS toolkit development and evaluation of its use in clinical practice, and identification of the most robust methods to measure valued outcomes, such as Nutrition and Growth.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN10454425.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 22. See the NIHR Journals Library website for further project information.

The Impact of Feeding on the Parent and Family Scales (Feeding Impact Scales): Development and Psychometric Testing

Background and Purpose:

Families of children with feeding disorder face significant challenges in supporting their child’s feeding, growth, and development. The Feeding Impact Scales were developed to assess how child feeding impacts parent and family.

Methods:

Items were adapted from an existing scale. Parents of children with feeding difficulty completed the online survey. Item response theory (IRT) analyses were used to evaluate and reduce items. Internal consistency reliability, convergent validity, and readability were tested.

Results:

IRT analyses (n = 317) identified 12 items for the Parent Impact and 13 items for the Family Impact. Internal reliability for the scales were acceptable. Convergent validity was supported.

Conclusions:

The Feeding Impact Scales have evidence of reliability and validity. They can be utilized in practice and research.

Neonatal Eating Assessment Tool-Breastfeeding: Reference Values for Infants Less Than 7 Months old

BACKGROUND

The Neonatal Eating Assessment Tool-Breastfeeding is a valid and reliable 62-item parent-report assessment of symptoms of problematic breastfeeding behavior intended for infants less than 7 months old.

RESEARCH AIM

The aim of this study was to describe the Neonatal Eating Assessment Tool-Breastfeeding total score and subscale scores within a sample of full-term, healthy, typically-developing infants under 7 months old.

METHODS

Parents of healthy, full-term breastfeeding infants (N = 475) less than 7 months old completed the Neonatal Eating Assessment Tool - Breastfeeding through an online survey. Descriptive statistics were calculated for the total score and seven subscale scores within each age group: 0-2, 2-4, 4-6, and 6-7 months.

RESULTS

Neonatal Eating Assessment Tool-Breastfeeding total scores were highest (i.e., more problematic symptoms) at 0-2 months and decreased in older infant age groups. All subscale scores also had a downward trajectory in symptoms of problematic breastfeeding except the subscale Compelling Symptoms of Problematic Feeding, which was very low across age groups. Scores on the Infant Regulation subscale remained elevated for the first 6 months of life, then declined markedly in the 6-7 month age group.

CONCLUSION

The Neonatal Eating Assessment Tool-Breastfeeding now has reference values to facilitate interpretation of scores and guide decision-making, personalization of interventions, and assessment of response to interventions. For research, the Neonatal Eating Assessment Tool-Breastfeeding can be used to follow longitudinal development of breastfeeding as well as to test efficacy of breastfeeding interventions.

Symptoms of Feeding Problems in Preterm-born Children at 6 Months to 7 Years Old

OBJECTIVES

Describe symptoms of feeding problems in children born very preterm (<32 weeks gestation) and moderate to late preterm (32-37 weeks gestation) compared to children born full-term; explore the contribution of medical risk factors to problematic feeding symptoms.

METHODS

The sample included 57 very preterm, 199 moderate to late preterm, and 979 full-term born children ages 6 months to 7 years. Symptoms of feeding problems were assessed using the Pediatric Eating Assessment Tool and compared between groups after accounting for the child's age and/or sex. With the sample of preterm children, we further analyzed 11 medical factors as potential risk factors affecting a child's feeding symptoms: feeding problems in early infancy and conditions of oxygen requirement past 40 weeks of postmenstrual age, congenital heart disease, structural anomaly, genetic disorder, cerebral palsy, developmental delay, speech-language delay, sensory processing disorder, vision impairment, or symptoms of gastroesophageal reflux.

RESULTS

Compared to children born full-term, both very preterm and moderate to late preterm born children had significantly higher scores on the Pediatric Eating Assessment Tool total scale and all 4 subscales. More severe symptoms were noted in very preterm children, particularly in the areas of Physiologic Symptoms and Selective/Restrictive Eating. Among preterm children, all 11 medical factors were found to be associated significantly with increased symptoms of feeding problems.

CONCLUSION

Compared to children born full-term, preterm born children demonstrated greater symptoms of feeding problems regardless of their current age, suggesting children born preterm may require more careful monitoring of feeding throughout childhood.

Symptoms of problematic feeding in children with CHD compared to healthy peers

Children with CHD often experience difficulty with oral feeding, which contributes to growth faltering in this population. Few studies have explored symptoms of problematic feeding in children with CHD using valid and reliable measures of oral feeding. The purpose of this study was to describe symptoms of problematic feeding in children with CHD compared to healthy children without medical conditions, taking into account variables that may contribute to symptoms of problematic feeding. Oral feeding was measured by the Pediatric Eating Assessment Tool, a parent report assessment of feeding with evidence of validity and reliability. This secondary analysis used data collected from web-based surveys completed by parents of 1093 children between 6 months and 7 years of age who were eating solid foods by mouth. General linear models were used to evaluate the differences between 94 children with CHD and 999 children without medical conditions based on the Pediatric Eating Assessment Tool total score and four subscale scores. Covariates tested in the models included breathing tube duration, type of CHD, gastroesophageal reflux, genetic disorder, difficulty with breast- or bottle-feeding during infancy, cardiac surgery, and current child age. Children with CHD had significantly more symptoms of problematic feeding than healthy children on the Pediatric Eating Assessment Tool total score, more physiologic symptoms, problematic mealtime behaviours, selective/restrictive eating, and oral processing dysfunction (p &lt;0.001 for all), when taking into account relevant covariates. Additional research is needed in children with CHD to improve risk assessment and develop interventions to optimise feeding and growth.