Maternal characteristics and toddler temperament in infantile anorexia

Diagnosis and Treatment of Pediatric Feeding Disorders: A Narrative Literature Review

Background/Objectives: The definitions of feeding disorders of infants and young children were historically based on a dichotomic organic/non-organic vision. Since 2019, a new definition of pediatric feeding disorders (PFDs) has reshaped the understanding of these disorders with a global vision. The aim of this study is to obtain a better understanding of the diagnostic criteria for general practice, both by exploring the evolution of classifications and by clearing the actual definition of PFDs and their possible treatments. Methods: We conducted a narrative review of the literature, including 36 articles about PFDs, excluding adolescents, anorexia nervosa, bulimia, pica, rumination, and specific neurodevelopmental or chronic pediatric disorders. We summarized these studies in three parts: the specific classifications for children before puberty, the current definition, and the clinical guidelines. Results: Concerning the history of the classifications, we summarized the studies of Chatoor and Kerzner and the older pediatric vision of failure to thrive. For the definition of pediatric feeding disorders, we presented this new category involving at least one out of four domains: medical, nutritional, feeding skills, or psychosocial. For the main clinical guidelines, we presented recommendations for both severe and common PFDs in each altered domain for use in daily practice. Conclusions: The new definition promotes a transdisciplinary vision of childhood feeding disorders, which considers each of the intricate domains of PFDs. Using common terminology for PFDs could help all healthcare providers, families, and researchers to better understand and address PFDs.

Mother-infant feeding interactions in mothers with and without eating disorder history: Results of a structured observational study

BACKGROUND

A growing body of evidence suggests that children of mothers with eating disorders (EDs) have a greater risk of early feeding problems. Recognizing and reacting adequately to the infant's signals during feeding is crucial for the child's development of internal and external regulatory mechanisms of food intake. Parental EDs might affect this ability. Therefore, we investigated the quality of mother-infant interactions during feeding using video recording and a structured coding system.

METHODS

The data of this pilot study was collected in a prospective cohort study investigating the influence of maternal EDs on child outcomes. Twenty women with ED history and 31 control women were videotaped while feeding their infant during a main meal at ten months postpartum. The mother-infant interactions were evaluated by two raters using the Chatoor Feeding Scale. We assessed birth outcomes, the mother's ED and depression status, breastfeeding practices, infant feeding problems and infant temperament by maternal self-report.

RESULTS

Mothers with and without ED history scored very similar on the Feeding Scale, however mothers from the control group experienced more struggle for control with their infants during feeding (p = 0.046) and made more negative comments about the infant's food intake (p = 0.010). Mothers with ED history were more concerned about infant feeding at three months postpartum and reported significantly more problems with solid foods in their children. Birth outcomes were comparable between groups, except for lower weight-for-length birth percentiles in children of women with ED history.

CONCLUSION

Whilst examined mothers with ED history are more concerned about feeding their children, ED psychopathology does not affect the quality of mother-infant interaction during feeding at the transition to autonomous eating at ten months of age.

Risk factors for and developmental relation of delayed oral nutrition in infants with congenital diaphragmatic hernia

PURPOSE

To identify risk factors for delayed oral nutrition in infants with a congenital diaphragmatic hernia (CDH) and its impact on developmental delay at 18 months of age.

METHODS

This retrospective single-center cohort study compared the clinical parameters in patients with isolated CDH born and treated at our hospital between 2006 and 2020. We evaluated clinical features significantly related to delayed oral nutrition (defined as taking ≥ 30 days from weaning from mechanical ventilation to weaning from tube feeding).

RESULTS

Twenty-six of the 80 cases had delayed oral nutrition. Univariate analyses showed significant differences. Multivariate analyses were performed on the three items of preterm delivery, defect size (over 50% to nearly entire defect), and ventilation for ≥ 9 days. We identified the latter two items as independent risk factors. The adjusted odds ratios were 4.65 (95% confidence interval, 1.27-7.03) and 6.02 (1.65-21.90), respectively. Delayed oral nutrition was related to a significantly higher probability of developmental delay at 18 months (crude odds ratio 4.16, 1.19-14.5).

CONCLUSION

In patients with CDH, a large defect and ventilatory management over 9 days are independent risk factors for delayed oral nutrition, which is a potent predictor of developmental delay that requires active developmental care.

Failure to thrive in toddlers with lack of interest in eating and food and their cognitive development during later childhood

Background

Experiencing Failure to Thrive or malnutrition in early years has been associated with children later displaying low Intelligence Quotient (IQ). The current study's aim was to examine whether Failure to Thrive in Toddlers with Lack of Interest in Eating and Food, a subtype of Avoidant/Restrictive Food Intake Disorder as defined by DSM-5, which has also previously been identified as Infantile Anorexia (IA), was associated with poor cognitive development outcomes during later childhood.

Methods

The IQs and growth parameter of 30 children (53% female) previously diagnosed and treated for IA at 12 to 42 months of age, were reevaluated at a mean age of 10.0 years (SD = 2.1 years) and compared to 30 matched control children. Children's growth was assessed using Z-scores and their cognitive development was measured using the Wechsler Intelligence Scale for Children-4th Edition.

Results

None of the growth parameters were significantly related to IQ. Further, IQ scores of children previously diagnosed with IA and control children were not significantly different. However, the education level of children's fathers had a significantly positive effect on IQ.

Conclusions

Our study highlights the disjunction between growth parameters and IQ within our sample. Overall, our findings suggest that the primary target of intervention for these children should be the parent-child conflict around the feeding relationship, rather than a focus on the child's weight itself. Finally, our results confirm the relevance to include fathers in the intervention of these children.

Psychological and social impact on parents of children with feeding difficulties

OBJECTIVES

The prevalence of feeding disorders (FDs) and picky eating in children is high in our region, based on the parents' perceptions. Although organic disease or a nutritional impact is rarely observed in these children, the problem frequently has an effect on family dynamics. We aimed to estimate the impact of these disorders on the stress level, quality of life and psychological health of families.

METHODS

Study of cases (FDs) and controls (healthy controls and controls with digestive disorders or other illness). We assessed parental stress and the risk of psychological distress in these families using validated scales (Parent Stress Index Short Form [PSI-SF] and Goldberg's General Health Questionnaire [GHQ-28]) and a parental opinion survey.

RESULTS

We collected a total of 238 surveys, 102 corresponding to healthy controls, 88 to controls with digestive disorders and 48 to children with FDs. We found that 45.8% of parents in the FD group felt neglected by their paediatricians and 47.9% did not agree with the paediatrician's recommendations. In addition, 54.2% reported limitations to their social life, 25% problems in their relationship, 47.9% feeling judged by others (12.5% by their own partner) for how they managed mealtimes, and 37.5% having sought or considered seeking psychological support. All these problems were significantly more frequent compared to controls. Based on the GHQ-28, the risk of anxiety and depression was more frequent in parents in the FD group: 54.2% compared to the reference (adjusted odds ratio [aOR] compared to controls, 4.18; 95% confidence interval [CI], 1.96-8.87; OR compared to sick controls, 6.25; 95% CI, 2.79-13.98) and 33.3% compared to the healthy control group. They also had higher stress scores (PSI-SF) compared to the healthy control group (adjusted mean difference [AMD], 21; 95% CI, 12.19-29.81) and the sick control group (AMD, 20; 95% CI, 9.81-30.19).

CONCLUSIONS

Parents of children with FDs have a high level of stress and risk of anxiety and depression, with repercussions at the social, family, couple and work levels. The relationship with the paediatrician may also be affected.

Symptoms of Avoidant/Restrictive Food Intake Disorder among 2-10-Year-Old Children: The Significance of Maternal Feeding Style and Maternal Eating Disorders

The aim of the present study was to investigate whether the feeding style and core behavioral features of eating disorders of mothers are related to the symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID) among their children. This study involved 207 mothers of children aged 2 to 10 years (Mage = 5.82 ± 2.59 years), of which 19.32% were children with neurodevelopmental disorders and 22.71% were children with chronic diseases (e.g., allergy, asthma, diabetes). The mothers were asked to complete the ARFID Parents Questionnaire-Parents Report (ARFID-Q-PR), the Parental Feeding Style Questionnaire (PFSQ) and the Eating Disorder Examination Questionnaire (EDE-Q). Our findings revealed that both the maternal feeding style and core behavioral features of eating disorders were associated with ARFID symptoms among their 2-10-year-old children. While biological factors increase the risk of feeding/nutrition difficulties, the maternal attitude towards feeding and eating behavior may play a relevant role in children's eating behavior.

Anorexia nervosa and familial risk factors: a systematic review of the literature

Anorexia Nervosa (AN) is a psychological disorder involving body manipulation, self-inflicted hunger, and fear of gaining weight.We performed an overview of the existing literature in the field of AN, highlighting the main intrafamilial risk factors for anorexia. We searched the PubMed database by using keywords such as “anorexia” and “risk factors” and “family”. After appropriate selection, 16 scientific articles were identified. The main intrafamilial risk factors for AN identified include: increased family food intake, higher parental demands, emotional reactivity, sexual family taboos, low familial involvement, family discord, negative family history for Eating Disorders (ED), family history of psychiatric disorders, alcohol and drug abuse, having a sibling with AN, relational trauma. Some other risk factors identified relate to the mother: lack of maternal caresses, dysfunctional interaction during feeding (for IA), attachment insecurity, dependence. Further studies are needed, to identify better personalized intervention strategies for patients suffering from AN.

Weaning children from prolonged enteral nutrition: A position paper

Enteral nutrition (EN) allows adequate nutritional intake in children for whom oral intake is impossible, insufficient or unsafe. With maturation and health improvements, most children ameliorate oral skills and become able to eat orally, therefore weaning from EN becomes a therapeutic goal. No recommendations currently exist on tube weaning, and practices vary widely between centres. With this report, the French Network of Rare Digestive Diseases (FIMATHO) and the French-Speaking Group of Paediatric Hepatology, Gastroenterology and Nutrition (GFHGNP) aim to develop uniform clinical practice recommendations for weaning children from EN. A multidisciplinary working group (WG) encompassing paediatricians, paediatric gastroenterologists, speech-language therapists, psychologists, dietitians and occupational therapists, was formed in June 2018. A systematic literature search was performed on those published from January 1, 1998, to April 30, 2020, using MEDLINE. After several rounds of e-discussions, relevant items for paediatric tube weaning were identified, and recommendations were developed, discussed and finalized. The WG members voted on each recommendation using a nominal voting technique. Expert opinion was applied to support the recommendations where no high-quality studies were available.

Oral Aversion in Infants With Congenital Heart Disease: A Single-Center Retrospective Cohort Study

OBJECTIVES

Neonates undergoing cardiac surgery are at risk for oral aversion (OA). OA is not well described outside of the index hospitalization and impacts patients and families. We evaluated the prevalence of OA at 1 year old after neonatal cardiopulmonary bypass (CPB) surgery.

DESIGN

Retrospective cohort study.

SETTING

Single quaternary care hospital.

SUBJECTS

Our cohort included 157 neonates who underwent CPB surgery from 2014 to 2017 and had follow-up data available at 1 year old.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Three feeding experts reviewed the medical record to define children with OA; 30% of charts were evaluated in triplicate for validation. Neonates with and without OA were compared in univariate analysis, and risk factors for OA were explored in a limited multivariable analysis. OA was present at 1 year in 37 patients (23.6%) and other feeding difficulties were present in an additional 29 patients (18.5%). Thirty-eight patients (24.2%) had a feeding tube, including 12 (7.6%) with a gastrostomy tube. Factors associated with OA at 1 year included total ICU days, duration of mechanical ventilation, total number of nil per os days, and number of postoperative days (PODs) until oral feeding initiation (all p < 0.0001). Number of POD until oral feeding initiation remained independently associated with OA at 1 year in multivariable analysis (adjusted odds ratio, 1.08; 95% CI, 1.04-1.12; p < 0.0001). Infants with any oral intake at discharge had lower odds of OA at 1 year (0.21; 95% CI, 0.08-0.5; p = 0.0003). At hospital discharge, 132 patients (84.1%) were taking some oral feeds, and 128 patients (81.5%) received tube feeding.

CONCLUSIONS

OA and other feeding difficulties are common at 1 year old in neonates undergoing CPB surgery. Delayed exposure to oral intake may be a modifiable risk factor for OA and efforts to improve early oral feeding could lead to better functional outcomes.

Mother-child interactions during feeding: A study on maternal sensitivity in dyads with underweight and normal weight toddlers

During the second year of life, mother's sensitivity in encouraging child autonomy supports children's emotional-affective individuation. In the feeding context, there is a clear transition from dependence on the mother to an emerging autonomy. Several studies have found an association between children's poor growth which is not related to organic pathologies, and maladaptive mother-child interactions that are characterized by poor maternal sensitivity. Despite this evidence, no studies have investigated maternal sensitivity to specific child's cues, such as demands for autonomy, during feeding interactions between mothers and their underweight children. This study aimed to assess how mothers' psychopathological risk and toddler's dysregulation profile are associated with mother-toddler interactional quality during feeding, with particular attention to mothers' sensitivity to child's specific cues (e.g. need of autonomy, requests for cooperation, request to stop the interaction, etc.). One hundred fifty mother-toddler dyads (N = 73 with underweight children and N = 77 with normal weight children) with children aged between 18 and 30 months, were recruited. Mother-toddlers feeding interactions were assessed through specific rating scales applied to the video-recorded interactions and mothers filled out questionnaires on children's emotional-behavioral functioning and their own psychopathological risk. Results showed a significant association between the quality of mother-toddler feeding interaction and children's weight. Underweight children showed less demand for autonomy and request for cooperation than normal weight children. Moreover, mothers of underweight children were less sensitive to toddler's cues of wanting to stop the interaction and demands for autonomy compared to mothers of normal weight children. Lower facilitations were associated with toddler's more dysregulated profile and with mother's higher psychopathological risk, and high toddler's dysregulation profile was associated with lower maternal sensitivity to child's cues of wanting to interrupt interactions and with worse mother's mood. Assessing maternal sensitivity in relation to toddler's specific cues might be particularly relevant in the feeding context. It might help to detect some dysfunctional interactive patterns and allow the implementation of prevention and treatment programs.

Emotional-Behavioral Functioning, Maternal Psychopathologic Risk and Quality of Mother-Child Feeding Interactions in Children with Avoidant/Restrictive Food Intake Disorder

The literature on food intake disorder (ARFID) in early childhood has evidenced psychopathologic difficulties in both children and their mothers and a poor quality of feeding interactions. Only a few studies have focused on three different ARFID subtypes: irritable/impulsive (I/I), sensory food aversions (SFA) and post traumatic feeding disorder (PTFD). The aim of this study was to explore possible differences between the three groups in children’s emotional-behavioral functioning, maternal psychopathologic risk and the quality of mother–child feeding interactions, comparing these clinical groups with a control group. The sample consisted of 100 child–mother dyads, of which 23 children with I/I, 25 children with SFA, 27 children with PTFD and 27 children with no diagnosis. The mothers primarily filled out questionnaires assessing their psychopathologic symptoms and children’s emotional-behavioral functioning. Then, all dyads were videotaped during a main meal. Results revealed significant differences between the study groups in relation to children’s emotional–adaptive functioning, mothers’ psychological profile and mother–child interactions during feeding. These findings are relevant for the development of target intervention programs to treat specific ARFID disorders.

Young adult nutrition and weight correlates of picky eating during childhood

OBJECTIVE

To identify whether picky eating during childhood is associated with dietary intake, weight status and disordered eating behaviour during young adulthood.

DESIGN

A population-based study using data from young adults who responded online or by mail to the third wave of the Project EAT (Eating and Activity in Teens and Young Adults) study in 2008-2009. Participants retrospectively reported the extent to which they were a picky eater in childhood, sociodemographic characteristics, disordered eating behaviours, usual dietary intake, and weight and height.

SETTING

Participants were initially recruited in the Minneapolis/St. Paul metropolitan area of Minnesota, USA, in 1998-1999.

PARTICIPANTS

The analytic sample included 2275 young adults (55 % female, 48 % non-Hispanic White, mean age 25·3 (sd 1·6) years).

RESULTS

Young adults who reported picky eating in childhood were found to currently have lower intakes of fruit, vegetables and whole grains, and more frequent intakes of snack foods, sugar-sweetened beverages and foods from fast-food restaurants. No associations were observed between picky eating in childhood and young adults' weight status, use of weight-control strategies or report of binge eating.

CONCLUSIONS

While young adults who report picky eating during childhood are not at higher risk for disordered eating, those who were picky eaters tend to have less healthy dietary intake. Food preferences and dietary habits established by picky eaters during childhood may persist into adulthood.

Application of the Scale for the Assessment of Feeding Interaction (SVIA) to Children With Autism Spectrum Disorder

Background and Objectives: Feeding problems occur more frequently among children with Autism spectrum disorder (ASD). The aim of this study was to analyse eating difficulties of ASD children through the direct observation of the caregiver-child co-regulation system. Methods: We compared 60 ASD children with a control group of 50 typically developing Italian children on the Scale for the Assessment of Feeding Interaction (SVIA). The Brief Autism Mealtime Behaviour Inventory (BAMBI) was used to define the presence of an eating disorder. Results: The ASD group showed higher scores on all dimensions of the SVIA compared to the control group. The SVIA and the BAMBI showed significant correlations. In a second step, the ASD sample was divided into two subgroups, children with and without feeding difficulties. The comparison between the ASD subgroups with the control group on the SVIA scales showed significant differences on all dimensions. Finally, significant differences emerged between the two ASD subgroups in three SVIA dimensions. Conclusion: These data suggest the importance of direct observation of feeding in the assessment of children with ASD. The SVIA seems to be able to point out some feeding difficulties in these subjects and to discriminate ASD with and without an eating disorder. Critical aspects of the application of SVIA to autistic children are discussed.

A Narrative Review of Childhood Picky Eating and Its Relationship to Food Intakes, Nutritional Status, and Growth

A main characteristic of children perceived as picky eaters is their tendency to avoid certain foods or food groups. The goal of this narrative review is to provide an overview of published studies that have examined whether picky eating in childhood is in fact associated with measurable differences in food and/or nutrient intakes and growth. While picky eaters appear to consume less vegetables compared to non-picky eaters, no consistent differences were observed for the intakes of other food groups or the intakes of energy, macronutrients and dietary fiber. Although, in some studies, picky eaters had lower intakes of certain vitamins and minerals, the levels consumed generally exceeded the recommended values, suggesting nutritional requirements are being met. No consistent relationship between childhood picky eating and growth status was observed, although significant differences in body weight/growth between picky and non-picky eaters were most discernible in studies where multiple defining criteria were used to identify picky eating. The research area would benefit from the adoption of a uniform definition of picky eating. More longitudinal assessments are also required to understand the long-term impact of picky eating on nutritional status and growth.

Avoidant/Restrictive Food Intake Disorder: A Longitudinal Study of Malnutrition and Psychopathological Risk Factors From 2 to 11 Years of Age

Aim: To evaluate different types and degrees of malnutrition over time in a sample of children diagnosed with Infantile Anorexia (IA), based on the DC:0-3R criteria, and recently defined by DSM-5 as the first subtype of Avoidant/Restrictive Food Intake Disorder (ARFID), and to investigate the relationship between children's severity of malnutrition and emotional/behavioral development, and mothers' long-term psychopathological symptoms. Methods: A total of 113 children (58 boys, 55 girls), originally diagnosed with IA, and their mothers, were evaluated at four assessment points at the children's mean age of 2, 5, 7, and 11 years. Several measures were used to assess the children's growth and level of malnutrition, mothers' psychopathological symptoms and eating attitudes, as well as their children's emotional/behavioral functioning. Results: A steady improvement in the severity of malnutrition over time emerged, but 73% of children still had ongoing mild to moderate to severe malnutrition at 11 years of age. Moreover, the children showed increasing internalizing and externalizing emotional/behavioral problems, and their mothers' psychopathological symptoms and eating problems worsened as well over time. At 11 years of age, the girls' emotional/behavioral problems and their mothers' psychopathology and disturbed eating attitudes were more severe than that of the boys and their mothers. Finally, during the last assessment, significant associations between the mothers' psychopathology and disturbed eating attitudes, the severity of the children's malnutrition, and their emotional/behavioral problems emerged. Discussion: Our longitudinal study points out that the developmental course of children, originally diagnosed with IA and who received limited psychosocial treatment, is characterized by an enduring risk of malnutrition and increasing psychopathological symptoms in both, the children and their mothers, up to the sensitive period of pre-puberty.

Parent-Child Discrepancy on Children's Body Weight Perception: The Role of Attachment Security

The discrepancies between parents and their children on the description of the behavior and representations of their children have been shown in various studies. Other researchers have reported the parents' difficulty in correctly identifying the weight status of their children. The purpose of our study was to investigate the parent's attributional accuracy on their children's body weight perception in relation to the children attachment security. It was hypothesized that insecure children's parents have a greater discrepancy with their children compared to secure children with their parents. The research participants were 217 children, aged between 5 and 11 years of both genders, and their parents. The attachment pattern was measured by the SAT of Klagsbrun and Bowlby, with the Italian version of Attili. The children were also shown a set of figure body-drawings with which to measure the perception of their weight status. Parents answered a questionnaire to find out the parental attribution of their children's perception. The results show that the body weight perception of insecure children's parents have a greater discrepancy with their children's body weight perception compared with parentally secure children. In particular, parents of insecure children tend to underestimate the perception of their children. This result is most evident in disorganized children. In addition, the perception of insecure children's parents show a greater correlation with children's actual weight rather than with their children's perception. These results suggest that the discrepancies on the perception of children's body weight between parents and children may be influenced by the poor parental attunement to their children's internal states, which characterizes the insecure parent-child attachment relationship.

Infantile Anorexia and Co-parenting: A Pilot Study on Mother-Father-Child Triadic Interactions during Feeding and Play

Infantile Anorexia (IA), defined by the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood Revised (DC: 0-3R, Zero To Three, 2005), occurs when the child (a) refuses to eat adequate amounts of food for at least 1 month, and shows growth deficiency, (b) does not communicate hunger and lacks interest in food, and (c) the child’s food refusal does not follow a traumatic event and is not due to an underlying medical illness. IA usually emerges during the transition to self-feeding, when the child issues of autonomy are played out daily in the feeding situation. Studies evidence that the feeding interactions between children with IA and their mothers are characterized by low reciprocity, greater interactional conflict and negative affects (Chatoor et al., 2000; Ammaniti et al., 2010, 2012). Moreover, these studies pointed out that maternal depression and eating disorders are frequently associated with IA (Cooper et al., 2004; Ammaniti et al., 2010; Lucarelli et al., 2013). To date, research has focused almost exclusively on the mother–child dyad, while fathers’ involvement, co-parental and family interactions are poorly studied. The current study is a pilot research that investigated mother–father–child triadic interactions, during feeding and play, in families with children diagnosed with IA, in comparison to families with normally developing children. Until now, at the study participated N = 10 families (five with a child with IA diagnosis and five with lack of child’s IA diagnosis, matched for child’s age and gender). The parents–child triadic interactions were assessed in feeding and play contexts using the Lausanne Trilogue Play (Fivaz-Depeursinge and Corboz-Warnery, 1999), adapted to observe father-mother-infant primary triangle in the feeding context, compared to the play context (Lucarelli et al., 2012). Families of the IA-group showed difficulties in expressing and sharing pleasure and positive affects, and in structuring a predictable and flexible context. Children showed little autonomy and difficulty in being actively engaged and tune with parents. Dysfunctional family interactions are a critical issue for IA that affects co-parental and family subsystems, stressing the importance of an articulated diagnostic assessment in order to target effective treatment approaches.

Effectiveness of differing levels of support for family meals on obesity prevention among head start preschoolers: the simply dinner study

Background

Despite slight decreases in obesity prevalence in children, nearly 25% of preschool-aged children are overweight or obese. Most interventions focused on promoting family meals as an obesity-prevention strategy target meal planning skills, knowledge and modeling of healthy eating without addressing the practical resources that enable implementation of family meals. There is a striking lack of evidence about what level of resources low-income parents need to implement family meals. This study will identify resources most effective in promoting family meals and, subsequently, test associations among the frequency of family meals, dietary quality and children’s adiposity indices among children enrolled in Head Start.

Methods

The Multiphase Optimization Strategy, employed in this study, is a cutting-edge approach to maximizing resources in behavioral interventions by identifying the most effective intervention components. We are currently testing the main, additive and interactive effects of 6 intervention components, thought to support family meals, on family meal frequency and dietary quality (Primary Outcomes) as compared to Usual Head Start Exposure in a Screening Phase (N = 512 low-income families). Components yielding the most robust effects will be bundled and evaluated in a two-group randomized controlled trial (intervention and Usual Head Start Exposure) in the Confirming Phase (N = 250), testing the effects of the bundled intervention on children’s adiposity indices (Primary Outcomes; body mass index and skinfolds). The current intervention components include: (1) home delivery of pre-made healthy family meals; (2) home delivery of healthy meal ingredients; (3) community kitchens in which parents make healthy meals to cook at home; (4) healthy eating classes; (5) cooking demonstrations; and (6) cookware/flatware delivery. Secondary outcomes include cooking self-efficacy and family mealtime barriers. Moderators of the intervention include family functioning and food security. Process evaluation data includes fidelity, attendance/use of supports, and satisfaction.

Discussion

Results will advance fundamental science and translational research by generating new knowledge of effective intervention components more rapidly and efficiently than the standard randomized controlled trial approach evaluating a bundled intervention alone. Study results will have implications for funding decisions within public programs to implement and disseminate effective interventions to prevent obesity in children.

Trial registration

Clincaltrials.gov Identifier NCT02487251; Registered June 26, 2015.

Development, prevention, and treatment of feeding tube dependency

Enteral nutrition is effective in ensuring nutritional requirements and growth. However, when tube feeding lasts for a longer period, it can lead to tube dependency in the absence of medical reasons for continuation of tube feeding. Tube-dependent children are unable or refuse to start oral activities and they lack oral skills. Tube dependency has health-, psychosocial-, and economy-related consequences. Therefore, the transition to oral feeding is of great importance. However, this transition can be very difficult and needs a multidisciplinary approach. Most studies for treatment of tube dependency are based on behavioral interventions, such as family therapy, individual behavior therapy, neuro-linguistic programming, and parental anxiety reduction. Furthermore, oral motor therapy and nutritional adjustments can be helpful in tube weaning. The use of medication has been described in the literature. Although mostly chosen as the last resort, hunger-inducing methods, such as the Graz-model and the Dutch clinical hunger provocation program, are also successful in weaning children off tube feeding.

CONCLUSION

The transition from tube to oral feeding is important in tube-dependent children but can be difficult. We present an overview for the prevention and treatment of tube dependency. What is known: • Longer periods of tube feeding can lead to tube dependency. • Tube weaning can be very difficult. What is new: • Weaning as soon as possible and therefore referral to a multidisciplinary team are recommended. • An overview of treatment options for tube dependency is presented in this article.

[Early restrictive feeding disorders: Quantitative assessment of parent/infant feeding interactions]

INTRODUCTION

Interest in the study of early feeding disorders (FD) has steadily increased during recent decades. During this period, research described the importance of the transactional relationships and the complex interplay between caregiver and child over time. On the basis of the previous studies, our study tried to explore the associations between the characteristics of the parents and the temperamental characteristics of the infants with early FD.

GOALS

A first aim of the present study was to show if parental perception of child temperament (including ability for arousal self-regulation) and parental characteristics (emotional and eating attitudes) are associated with early FD. A second aim was to identify emotional/behavioral difficulties in children with early FD by comparing children with a normal development and children with a diagnosed FD, and to investigate whether there are any correlations between parental emotional and feeding characteristics and a child's eating and emotional-behavioral development. A final aim was to explore if feeding conflict is bound to both infant ability for arousal self-regulatation and caregiver emotional status during meals.

METHOD

Participants: 58 clinical dyads (children aged 1-36 months) and 60 in the control group participated in the study. The sample of 58 infants and young children and their parents was recruited in a pediatric hospital. They were compared to healthy children recruited in several nurseries.

PROCEDURE

all parent-child pairs in the clinical sample were observed in a 20-minute video-recording during a meal using the procedure of the Chatoor Feeding Scale. After the videotaping, parents completed a battery of self-report questionnaires assessing their child's and their own psychological symptom status.

MEASURES

Child's malnutrition assessment was based on the Waterlow criteria. The Child Behavior Checklist (CBCL 1½-5) was used to assess a child's emotional/behavioral functioning. The Infant Behavior Questionnaire-Revised (IBQ-R), a widely used parent-report measure of infant temperament, was used to identify the structure of infant temperament. The Eating Attitude Test-40, a self-report symptom inventory, was used to identify concerns with eating and weight in the adult population. The Chatoor Feeding Scale was used to assess mother-child feeding interactions during a meal based on the analysis of the videotaped feeding session.

RESULTS

Analyses revealed that children with FD did not have a difficult temperament, especially no disability for arousal of self-regulatation, but their emotional-behavioral functioning is characterized by internalizing problems. Analyses of the EAT-40 showed that mothers of the children diagnosed with FD had significantly higher scores than mothers of the control sample; it means these mothers showed more dysfunctional eating attitudes. In addition, meals were characterized by negative effects in parents in the clinical group. When compared to the control sample, the feeding interactions between children with FD and their parents were characterized by low dyadic reciprocity, high maternal non-contingency, great interactional conflict and struggles with food. However, no significant correlation emerged either between the severity of malnutrition in infants or the conflict during feeding.

CONCLUSION

Our study confirms the relations established in previous research. Finally, future longitudinal studies are needed to further clarify and investigate others factors that may be involved in early feeding disorders.

Association of Picky Eating and Food Neophobia with Weight: A Systematic Review

BACKGROUND

Picky eating and food neophobia are common during childhood. Childhood eating behaviors are often predictive of adult eating behaviors.

OBJECTIVES

Determine if childhood picky eating or food neophobia is associated with childhood weight status, or with becoming underweight, overweight, or obese later in childhood.

DATA SOURCES

We identified relevant studies from searches of PubMed, PsycINFO, and NEOHAL, as well as citations from identified studies. Study Eligibility Criteria and Participants: Inclusion criteria were original research articles examining a relationship between picky eating and/or food neophobia with childhood weight status. We summarized definitions and prevalence of picky eating or food neophobia and association with weight status.

STUDY APPRAISAL

Two independent investigators assessed bias and confounding using the Agency for Healthcare Research and Quality's RTI Item Bank.

RESULTS

Forty-one studies met inclusion criteria. Picky eating was defined inconsistently, and a large variation in prevalence was found (5.8%-59%). Food neophobia was consistently defined as an unwillingness to try new foods, with a prevalence between 40% and 60%. No association existed between childhood weight status and food neophobia, and results were unclear for picky eating.

LIMITATIONS

Risk of bias and confounding were moderate. Parental report was commonly used to assess picky eating, height, and weight and parental weight, feeding styles, and community characteristics were infrequently considered.

CONCLUSIONS AND IMPLICATIONS

Heterogeneous definitions used for picky eating led to a wide range of reported prevalence and an unclear relationship with weight. Consistent definitions and an improved understanding of such a relationship could help clinicians provide appropriate anticipatory guidance.

[Mental health disorders in the first years of life: disorders mostly related with psychogenic factors]

In the literature review the authors present current data on the clinical features, prevalence and general approaches to treatment and prevention of mental disorders related with environmental factors in early childhood. A quite new class of the disorders, which are specific for early childhood: attachment disorders, clinical specifics of posttraumatic stress disorder, clinical manifestations of sleep disorders and feeding disorders is considered. It is emphasized that disturbed parent-child relations can be one of the predictors of early mental disorders in children. The modern models of psychotherapy for children of early age are presented.

Neurodevelopmental Profile, Growth, and Psychosocial Environment of Preterm Infants with Difficult Feeding Behavior at Age 2 Years

OBJECTIVE

To examine the association of difficult feeding behaviors in very preterm infants at age 2 years with growth and neurodevelopmental outcomes and family factors and functioning.

STUDY DESIGN

Eighty children born ≤30 weeks gestation were studied from birth until age 2 years. Feeding difficulties were assessed using the Eating Subscale of the Infant-Toddler Social Emotional Assessment at age 2 years, along with growth measurement and developmental testing. Maternal mental health and family factors were assessed using standardized questionnaires. ANOVA and χ(2) analyses were performed to determine associations between feeding difficulties and growth, neurodevelopmental outcomes, and family characteristics.

RESULTS

Twenty-one children (26%) were at risk for feeding difficulties, and an additional 18 (23%) had definite feeding difficulties at age 2 years. Those with feeding difficulties were more likely to be subject to a range of neurodevelopmental problems, including impaired cognition (P = .02), language (P = .04), motor (P = .01), and socioemotional (P < .007) skills. Compared with the parents of children with fewer feeding difficulties, parents of the children with feeding difficulties had higher parenting stress (P = .02) and reported more difficulty managing their child's behavior (P = .002) and more frequent parent-child interaction problems (P = .002). No associations were found between difficult feeding behaviors and growth, maternal mental health, or family factors.

CONCLUSION

Difficult feeding behaviors in children born very preterm appear to be highly comorbid with other developmental and family challenges, including neurodevelopmental impairment and parent-child interaction difficulties. Focusing on improving feeding skills, in conjunction with supporting positive parent-child interactions, may be beneficial for improving outcomes.

Genetic and Environmental Contributions to Behavioral Stability and Change in Children 6-36 months of Age Using Louisville Twin Study Data

The Infant Behavior Record (IBR) from the Bayley Scales of Infant Development has been used to study behavioral development since the 1960s. Matheny (1983) examined behavioral development at 6, 12, 18, and 24 months from the Louisville Twin Study (LTS). The extracted temperament scales included Task Orientation, Affect-Extraversion, and Activity. He concluded that monozygotic twins were more similar than same-sex dizygotic twins on these dimensions. Since this seminal work was published, a larger LTS sample and more advanced analytical methods are available. In the current analyses, Choleksy decomposition was applied to behavioral data (n = 1231) from twins 6-36 months. Different patterns of genetic continuity vs genetic innovations were identified for each IBR scale. Single common genetic and shared environmental factors explained cross-age twin similarity in the Activity scale. Multiple shared environmental factors and a single genetic factor coming on line at age 18 months contributed to Affect-Extraversion. A single shared environmental factor and multiple genetic factors explained cross-age twin similarity in Task Orientation.

Maternal depression and attachment: the evaluation of mother-child interactions during feeding practice

Internal working models (IWMs) of attachment can moderate the effect of maternal depression on mother–child interactions and child development. Clinical depression pre-dating birthgiving has been found to predict incoherent and less sensitive caregiving. Dysfunctional patterns observed, included interactive modes linked to feeding behaviors which may interfere with hunger–satiation, biological rhythms, and the establishment of children’s autonomy and individuation. Feeding interactions between depressed mothers and their children seem to be characterized by repetitive interactive failures: children refuse food through oppositional behavior or negativity. The aim of this study was to investigate parenting skills in the context of feeding in mothers with major depression from the point of view of attachment theory. This perspective emphasizes parents’ emotion, relational and affective history and personal resources. The sample consisted of 60 mother–child dyads. Mothers were divided into two groups: 30 with Major Depression and 30 without disorders. Children’s age ranged between 12 and 36 months The measures employed were the Adult Attachment Interview and the Scale for the Evaluation of Alimentary Interactions between Mothers and Children. Insecure attachment prevailed in mothers with major depression, with differences on the Subjective Experience and State of Mind Scales. Groups also differed in maternal sensitivity, degrees of interactive conflicts and negative affective states, all of which can hinder the development of adequate interactive patterns during feeding. The results suggest that IWMs can constitute an indicator for the evaluation of the relational quality of the dyad and that evaluations of dyadic interactions should be considered when programming interventions.

Pattern of mother-child feeding interactions in preterm and term dyads at 18 and 24 months

Literature on mother-child feeding interactions during the transition to self-feeding in preterm populations is lacking, particularly through observational methods. The present research study aims to look at the longitudinal patterns of mother-toddler feeding interactions, comparing preterm and full term dyads. To this end, a multi-method approach was used to collect data from 27 preterm to 20 full-term toddlers and their mothers. For each dyad, mother-child interactions were observed during the snack time at 18 and 24 months of age and then assessed through the Italian version of the Feeding Scale. Higher scores on the scale indicate a less healthy pattern of interaction. Additionally, at both points in time, mothers completed the BDI-II questionnaire as a screen for maternal depression and the child's developmental stage was assessed using the Griffiths Scales. A series of repeated measures Analysis of Variances were run to detect differences in feeding interactions between the two groups at the time of assessment. Our results show that preterm dyads report overall higher levels of maternal negative affection, interactional conflicts, and less dyadic reciprocity during the meal compared to full-term dyads. Additionally, longitudinal data show that dyadic conflict decreases in both groups, whereas the child's food refusal behaviors increase in the preterm group from 18 to 24 months. No differences were reported for both the BDI-II and the child's development for the two groups. The results reveal that regardless of maternal depression and the child's developmental stage, the two groups show different trajectories in the pattern of feeding interactions during the transition to self -feeding, at 18 and 24 months, with overall less positive interactions in preterm mother-child dyads.

How to Improve Eating Behaviour during Early Childhood

Eating behaviour disorder during early childhood is a common pediatric problem. Many terminologies have been used interchangeably to describe this condition, hindering implementation of therapy and confusing a common problem. The definition suggests an eating behaviour which has consequences for family harmony and growth. The recent Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition does not cover the entire spectrum seen by pediatricians. Publications are substantive but level of evidence is most of the time low. This purpose of this review is to clarify terminology of eating behaviour problems during early childhood; including benign picky eating, limited diets, sensory food aversion, selective eating, food avoidance emotional disorder, pervasive refusal syndrome, tactile defensiveness, functional dysphagia, neophobia and toddler anorexia. This tool is proposed only to ease the clinical management for child care providers. Diagnostic criteria are set and management tools are suggested. The role of dietary counselling and, where necessary, behavioural therapy is clarified. It is hoped that the condition will make its way into mainstream pediatrics to allow these children, and their families, to receive the help they deserve.

Prenatal and postnatal maternal representations in nonrisk and at-risk parenting: exploring the influences on mother-infant feeding interactions

The aim of this study was to investigate the mother-infant relationship in depressive, psychosocial, and cumulative-risk parenting by assessing prenatal and postnatal maternal representations and mother-infant interactions during feeding at 4 months of age. The sample consisted of 167 mother-infant pairs: 41 nonrisk women, 40 depressive-risk women, 40 psychosocial-risk women, and 46 cumulative-risk women. During pregnancy, the women were interviewed about psychosocial-risk variables. Maternal representations and depressive symptoms were evaluated during pregnancy and again when the infants were 3 and 4 months old, respectively. All mother-infant pairs were observed in 20-min video recordings during breast-feeding. Maternal Integrated/balanced representations were more frequent in the nonrisk group whereas the maternal Nonintegrated/ambivalent category was more represented in the cumulative-risk group during pregnancy and after the infant's birth. At 4 months, the cumulative-risk group of mothers and infants showed a lack of reciprocity, conflictual communicative exchanges, and higher food refusal behavior. Moreover, at 4 months, differences between the quality of mother-infant feeding interactions and the quality of prenatal and postnatal maternal representations emerged, showing less adequate maternal scaffolding in the Nonintegrated/ambivalent and Restricted/disengaged women. This study has rich implications for intervention to support the affective and communicative caregiving system and to prevent infant feeding problems and mother-infant relational disturbances in childhood.

Associations between birth characteristics and eating disorders across the life course: findings from 2 million males and females born in Sweden, 1975-1998

Birth characteristics predict a range of major physical and mental disorders, but findings regarding eating disorders are inconsistent and inconclusive. This total-population Swedish cohort study identified 2,015,862 individuals born in 1975-1998 and followed them for anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified until the end of 2010. We examined associations with multiple family and birth characteristics and conducted within-family analyses to test for maternal-level confounding. In total, 1,019 males and 15,395 females received an eating disorder diagnosis. Anorexia nervosa was independently predicted by multiple birth (adjusted hazard ratio = 1.33, 95% confidence interval: 1.15, 1.53) for twins or triplets vs. singletons) and lower gestational age (adjusted hazard ratio = 0.96, 95% confidence interval: 0.95, 0.98) per extra week of gestation, with a clear dose-response pattern. Within-family analyses provided no evidence of residual maternal-level confounding. Higher birth weight for gestational age showed a strong, positive dose-response association with bulimia nervosa (adjusted hazard ratio = 1.15, 95% confidence interval: 1.09, 1.22, per each standard-deviation increase), again with no evidence of residual maternal-level confounding. We conclude that some perinatal characteristics may play causal, disease-specific roles in the development of eating disorders, including via perinatal variation within the normal range. Further research into the underlying mechanisms is warranted. Finally, several large population-based studies of anorexia nervosa have been conducted in twins; it is possible that these studies considerably overestimate prevalence.

Growth failure in children: a symptom or a disease?

One of the most important aspects of a well-child examination is an assessment of a child's growth. Children who are failing to grow are often labeled "failure to thrive." However, close examination of the pattern of growth on standardized growth charts often allows the caregiver to characterize the growth failure as failure to grow, failure to gain weight, or failure to grow and gain weight. Such refinement of the pattern of growth failure allows for a more specific differential diagnosis and helps to focus laboratory and radiographic evaluation.

[Feeding disorders in infants and toddlers: advantages of a joint consultation with pediatrician and psychologist]

Feeding disorders and food refusal can be found in 25% of infants, a minority of these disorders has an organic explanation. Failure to thrive and/or severe malnutrition is found in 3-5% of infants in the general population. The authors describe the various phases of the interdisciplinary therapeutic intervention by underlining the advantages and the objectives to integrate therapeutic approaches across professional boundaries. Caregiver-infant relationship disturbances are certainly the most important factor, but the induced psychosomatic conditions also have a multifactorial etiology. This article points out the specificities of the disorders of infant feeding behaviors and explains the advantages of a joint pediatrician-psychologist consultation compared to separate consultations in pediatrics and child psychiatry.

Feeding disorders of early childhood: an empirical study of diagnostic subtypes

OBJECTIVE

The aim of this study was to examine the differences among three subtypes of feeding disorders (FD), defined through the criteria of the DC:0-3R: "Infantile Anorexia" (IA), "Feeding Disorder Associated with Insults to the Gastrointestinal Tract" (FDIGT), and "Sensory Food Aversions" (SFA), by exploring mother-child interactions during feeding, children's temperament and emotional-adaptive functioning, and mothers' psychological profile and eating attitudes.

METHOD

The sample consisted of 146 Italian mother-child pairs, of which 51 children with IA, 47 children with FDIGT, and 48 mothers and their children with SFA. All dyads were videotaped during feeding; mothers completed questionnaires assessing their psychological profiles and eating attitudes, as well as their children's temperament and emotional/behavioral functioning.

RESULTS

Analyses revealed significant differences between the diagnostic groups of FD in relation to mother-child interactions during feeding, children's temperament and emotional-adaptive functioning, and mothers' psychological profile and eating attitudes.

DISCUSSION

Both interactional and individual variables may contribute differently to specific FD and outcomes during childhood. Definitions by FD subtypes, using operational diagnostic criteria, and the assessment of mother-child interactions are relevant to target interventions strategies to treat specific disorders.

Feeding disorders of infancy: a longitudinal study to middle childhood

OBJECTIVE

To evaluate over time feeding behavior and emotional-behavioral functioning in a sample of children diagnosed with Infantile Anorexia (IA) and a group of typically developing children; and to investigate the relationship between maternal psychological functioning and the children's feeding patterns and emotional-behavioral functioning.

METHOD

Seventy-two children diagnosed with IA and 70 children in the control group were prospectively evaluated through several measures at two, five, and eight years of age.

RESULTS

Our findings revealed partial improvement in the nutritional status of the children with IA. However, they continued to show ongoing eating problems and, in addition, anxiety/depression and withdrawal, as well as rule-breaking behaviors and social problems. There were significant correlations between the children's eating problems and their emotional difficulties and their mothers' increased emotional distress and disturbed eating attitudes.

DISCUSSION

Our longitudinal study points out that the natural course of untreated IA is characterized by the persistence of difficulties in eating behavior and emotional-behavioral adjustment in both, the children and their mothers.

[How much food for a soul? Psychosomatic treatment of infantile feeding disorders]

Severe feeding disorders often require inpatient treatment and need a holistic assessment and treatment approach. This article introduces some of the current literature concerning feeding disorders in infants and toddlers. The philosophy of the Department of Infant Psychosomatics at the University Children's Hospital Zürich emphasizes interdisciplinary teamwork, the application of psychodyamic tools in pediatric liaison psychiatry and utilization of group settings. Clinical approach and course of treatment are illustrated by three case reports, highlighting specific psychotherapeutic interventions with the parent-infant relationship in the context of a paediatric clinic.

Coexistence of sleep and feeding disturbances in young children

OBJECTIVE

Behavioral insomnia and feeding difficulties are 2 prevalent conditions in healthy young children. Despite similarities in nature, etiology, prevalence, and age distribution, the association between these 2 common disorders in young children has not been examined thus far.

PATIENTS AND METHODS

Children aged 6 to 36 months with either behavioral insomnia or feeding disorders were recruited. Children aged 6 to 36 months who attended the well-care clinics were recruited and served as controls. Sleep and feeding were evaluated by using a parental questionnaire.

RESULTS

Six hundred eighty-one children were recruited. Fifty-eight had behavioral insomnia, 76 had feeding disorders, and 547 were controls. The mean age was 17.0 ± 7.6 months. Parents of children with feeding disorders considered their child's sleep problematic significantly more frequently compared with controls (37% vs 16%, P = .0001 [effect size (ES): 0.66]). They reported shorter nocturnal sleep duration and delayed sleep time compared with controls (536 ± 87 vs 578 ± 88 minutes, P = .0001) and 9:13 ± 0.55 PM vs 8:26 ± 1.31 PM, P = .003). Parents of children with behavioral insomnia described their child's feeding as "a problem" more frequently compared with controls (26% vs 9%, P = .001 [ES: 0.69]). They reported being more concerned about their child's growth (2.85 ± 1.1 vs 2.5 ± 1.0, P = .03) and reported higher scores of food refusal compared with controls (3.38 ± 0.54 vs 3.23 ± 0.44, P = .04).

CONCLUSIONS

Problematic sleep and feeding behaviors tend to coexist in early childhood. Increased awareness of clinicians to this coexistence may allow early intervention and improve outcome.

Comorbidity in specific language disorders and early feeding disorders: mother-child interactive patterns

OBJECTIVE

This empirical study has its main object in highlighting the role of mother-child interactive experiences in the development of affective and communicative exchanges in infancy.

METHODS

The study analyzed four groups of mother-child couples with children who presented a Specific Language Disorder (SLD) the first, a Feeding Disorder (FD) the second, the third an association of SLD and FD, and a fourth non clinical group. Diagnostic assessments were done through: a specific linguistic protocol, the Italian version of the Feeding Scale-Observational Scale for Mother-Infant Interactions during Feeding, specific psychodiagnostic questionnaires for mothers and children.

CONCLUSION

A distortion in the communication area can significantly weigh upon the quality of infant-caregiver relationship: our data on mothers of children with a SLD/FD comorbidity confirm this finding by describing their children as prone to isolation and withdrawal, thus directing their efforts and worries to a specifically communicative and relational factor.

A clinical study of the intergenerational transmission of eating disorders from mothers to daughters

Clinicians and researchers have long recognized the existence of eating disorders in very young children, including infants whose mothers have eating disorders. This paper combines reviews of the literature relevant to the study of eating disorders from the perspectives of both research and psychoanalytic theory in order to explore the psychodynamics of the intergenerational transmission of eating-disordered pathology from mother to child. A developmental pathway as well as several mechanisms that illuminate the pathogenesis of the intergenerational transmission of eating disorders are proposed and described. Clinical-observational data from a therapeutic play nursery for mothers with eating disorders and their children are presented, and this material is examined in relation to the proposed psychodynamic pathways of transmission.

Maternal psychopathology and child risk factors in infantile anorexia

OBJECTIVE

This study examines a transactional and multirisk model for Infantile Anorexia (IA) and investigates the contributions of the parent, the child, and dyadic interactional variables related to this feeding disorder.

METHOD

The sample consisted of 371 mother-child pairs (children aged 6-36 months), of which 187 pairs of mothers and normally developing children (ND-group), and 184 mothers and IA children. All dyads were videotaped during feeding; mothers completed questionnaires assessing their psychological profiles and eating attitudes, as well as their children's temperament and emotional/ behavioral functioning.

RESULTS

Analyses revealed that the IA-group showed higher scores in symptomatic characteristics both of the mother and of the child, and dysfunctional interactions during feeding as compared with the ND-group. Further analyses revealed that both child and maternal characteristics are significant predictors of dyadic interactional conflict.

DISCUSSION

Results confirm that a multidimensional assessment is critical in the evaluation of IA.

Feeding and eating disorders in childhood

OBJECTIVE

To review the literature related to the current DSM-IV-TR diagnostic criteria for feeding disorder of infancy or early childhood; pica; rumination disorder; and other childhood presentations that are characterized by avoidance of food or restricted food intake, with the purpose of informing options for DSM-V.

METHOD

Articles were identified by computerized and manual searches and reviewed to evaluate the evidence supporting possible options for revision of criteria.

RESULTS

The study of childhood feeding and eating disturbances has been hampered by inconsistencies in classification and use of terminology. Greater clarity around subtypes of feeding and eating problems in children would benefit clinicians and patients alike.

DISCUSSION

A number of suggestions supported by existing evidence are made that provide clearer descriptions of subtypes to improve clinical utility and to promote research.