Food Refusal Research Articles

Parental Pre and Postnatal Depression: The Longitudinal Associations with Child Negative Affectivity and Dysfunctional Mother-Child Feeding Interactions.

Many studies have shown the influence of maternal perinatal depression on a child's emotional and behavioral regulation ability; yet there is scarce research on the impact of the father's perinatal depression on the caregiver-infant relationship and the child's development. Through a longitudinal study, we investigated maternal and paternal depression and its association with infants' emotionality and mother-infant feeding interactions The sample was constituted of 136 first-time parents (68 couples, and their full-term babies at 3 and 6 months old). At T1 (28th week of pregnancy), T2 (three months old), and T3 (at six months age) parents responded to the Edinburgh Postpartum Depression Scale. At Times 2 and 3, mothers and fathers completed the Infant Behavior Questionnaire, and recorded mother-infant interactions were coded by means of the Feeding Scale. Statistical analyses indicated stability of maternal and paternal depression over time. Correlations emerged between mother's higher depression scores, negative affective state during interactions at three months age, infant food refusal and mother-infant interactional conflict at six months age. Paternal higher depressive scores were associated with the mother-child interactional conflict. To finish, higher parental depression scores were related with infant negative emotionality. The current study confirms the relevance of embracing a cumulative risk model to support the child's development with early caregiver-child interventions.

Food Selectivity in Children with Autism: Guidelines for Assessment and Clinical Interventions

Autisms Spectrum Disorders (ASD) are characterized by core symptoms (social communication and restricted and repetitive behaviors) and related comorbidities, including sensory anomalies, feeding issues, and challenging behaviors. Children with ASD experience significantly more feeding problems than their peers. In fact, parents and clinicians have to manage daily the burden of various dysfunctional behaviors of children at mealtimes (food refusal, limited variety of food, single food intake, or liquid diet). These dysfunctional behaviors at mealtime depend on different factors that are either medical/sensorial or behavioral. Consequently, a correct assessment is necessary in order to program an effective clinical intervention. The aim of this study is to provide clinicians with a guideline regarding food selectivity concerning possible explanations of the phenomenon, along with a direct/indirect assessment gathering detailed and useful information about target feeding behaviors. Finally, a description of evidence-based sensorial and behavioral strategies useful also for parent-mediated intervention is reported addressing food selectivity in children with ASD.

Eosinophilic esophagitis – epidemiology, clinical manifestations and current therapy menagement

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease, which in recent years has shown a clear upward trend of incidence and prevalence in the general population. The symptoms of EoE are very heterogeneous as well as therapy management of this entity which often causes problems in the clinical approach to the patient. Adults most often suffer from dysphagia, while children usually present non-specific symptoms such as food refusal, vomiting, nausea, etc.. Currently, we have many therapeutic paths that change the course of the disease, but high expectations are also placed on new biological drugs. This publication attempts to summarize the current state of knowledge about epidemiology, age-related clinical presentation, and therapeutic strategy of eosinophilic esophagitis.

Mycotoxin deoxynivalenol-induced intestinal flora disorders, dysfunction and organ damage in broilers and pigs

Deoxynivalenol (DON) is a common environmental contaminant that causes food refusal and growth retardation in animals. DON targets the intestine and is hazardous to animal, however, it is not clear whether its effect on animals is consistent. Chickens and pigs are the two main animals affected by DON exposure with different susceptibilities. In this study, we found that DON inhibited animal growth and caused damage to the intestine, liver and kidney. DON caused intestinal flora disorders in both chickens and pigs, such as changes of flora diversity and the relative abundance of dominant phyla. Functional analysis showed that changes in the intestinal flora induced by DON were mainly related to metabolic and digestive functions, indicated that the intestinal flora may be associated with the DON-induced intestinal dysfunction. Comparative analysis of differentially altered bacteria suggested that Prevotella may play an important role in maintaining intestinal health, and the presence of differentially altered bacteria in the two animals suggested that DON may have different toxicity modes in animals. In summary, we confirmed the multi-organ toxicity of DON in two major livestock and poultry animals, and speculated that the intestinal flora may be related to the toxic damage caused by DON through species comparison analysis.

Prevalence of neuropsychiatric disorders in internally displaced persons with dementia during wartime in Ukraine

IntroductionDuring the second wave of Russia-Ukraine war, around 8 million were internally displaced. Negative mental health impact of the war cannot be underestimate. Among internally displaced persons (IDPs), particularly vulnerable category is people with neurocognitive deficits. Stress associated with displacement may cause a change not only in cognitive functions, but also affect the onset or evaluation of behavioral and psychological symptoms.Objectivesto study the prevalence of neuropsychiatric disorders in hospitalized patients with dementia, who were internally displaced and to compare with general population frequency.Methods64 IDPs with dementia (moderate and severe neurocognitive deficits) who were examined during March-September 2022. Cases of newly arrived persons were taken into account, after 1 to 30 days had passed since their relocation. The diagnosis was verified based on the ICD-10 criteria (F00-F01). The degree of neurocognitive deficit was determined using the MMSE and MoCA tests. Affective pathology was studied using the HAM-D, HAM-A, PHQ-9, AES scales. Psychotic symptoms and behavioral disorders were studied based on clinical examination and medical records. The study was conducted in Lviv Regional Psychiatric Hospital.Resultsamong the examined patients, 60 (94% of all examined) had neuropsychiatric disorders. Among this sample, neuropsychiatric symptoms (an isolated symptom or a combination of two or more symptoms) occurred with the following frequency: apathy 16 (26.7%), anxiety49 (81.7%), depressive symptoms 32 (53.3%), agitation and aggression 41 (68.3%), hallucinatory symptoms 8 (13.3%), delusional disorders 34 (56.7%), wandering and disorientation 18 (30%), refusal of food and medicine 12 (20%)Image:ConclusionsIn this study the frequency of occurrence of certain neuropsychiatric syndromes among IDPs with dementia differed from the studied average frequency of occurrence of the same symptomatology among the general population. In particular, anxiety symptoms among IDPs with dementia occurred 42% more often than on average among patients with dementia in the general population (with a frequency of 81% vs 39%), agitation and aggression - 28% more often (68% vs 40%), and delusions - 16% more often (57% vs 31%). At the same time, symptoms such as apathy (by 19%) and refusal to eat (by 14%) were observed less often among IDPs with dementia than among dementia patients from the general populationDisclosure of InterestNone Declared

Post Cerebrovascular Stroke Catatonic Psychosis: A Case Report

IntroductionCatatonia due to cerebrovascular stroke is a rare condition that needs further observation and research.ObjectivesTo review the opinions of psychotic disorders experts worldwide as to this issue based on evidence and clinical experience and to consider strategies for future investigations.MethodsThis case shows a 64 years old female who suddenly developed wish for isolation, followed 10 days later by discontinuity of ideas, hallucinatory behavior and food refusal. She had verbal and physical aggression due to a fixed belief that family members are conspiring somehow to harm her.ResultsOn examination she was mute with waxy flexibility and negativism. Extensor plantar reflex was evident. MRI Brain showed small vessel disease and right basal ganglia acute ischemic infarction. On IV midazolam 7.5 mg, patient’s mutism, negativism and waxy flexibility improved. Lower limb Venous Duplex revealed acute right popliteal and left soleal veins thrombosis. CT angiography showed Bilateral pulmonary embolism with no pulmonary infarction. D dimer was positive.ConclusionsEarly diagnosis and intervention improves outcome if psychiatric teams gives attention and has enough awareness with warning symptoms and prompt necessary interventions.Disclosure of InterestNone Declared

Lesões na cavidade oral decorrentes de pontas excessivas de esmalte dentário em cavalos de tração em município do extremo oeste maranhense

Excessive enamel dental points, resulting from irregular tooth wear, are considered the most frequent disorder in equine dentistry. The objective was to evaluate the oral cavity of traction horses, diagnosing the excessive points of dental enamel on the premolars and molars, identifying the main injuries caused by them and their impacts. The procedures were carried out in the city of Imperatriz - MA, where 40 traction horses were evaluated. Information was collected from the owners, a general physical examination of the animals was carried out, followed by a dental evaluation and an evaluation of the entire oral cavity. The main clinical signs detected as indicative of dental irregularity were refusal of food offered, acceptance of only half of the amount of food provided, food falling out of the mouth during mastication, decreased lateral excursion of the mandible, refusal to use bits and loss of weight. In this way, it becomes evident that the evaluation of the oral cavity of horses is of great importance, since the presence of excessive points of dental enamel can cause lesions in the oral mucosa, which cause pain, alteration of the biomechanics of mastication, discomfort during work, a decrease in performance and, consequently, a decrease in the quality of life of these animals.

Social disappointment and partner presence affect long-tailed macaque refusal behaviour in an 'inequity aversion' experiment.

Protest in response to unequal reward distribution is thought to have played a central role in the evolution of human cooperation. Some animals refuse food and become demotivated when rewarded more poorly than a conspecific, and this has been taken as evidence that non-human animals, like humans, protest in the face of inequity. An alternative explanation-social disappointment-shifts the cause of this discontent away from the unequal reward, to the human experimenter who could-but elects not to-treat the subject well. This study investigates whether social disappointment could explain frustration behaviour in long-tailed macaques, Macaca fascicularis. We tested 12 monkeys in a novel 'inequity aversion' paradigm. Subjects had to pull a lever and were rewarded with low-value food; in half of the trials, a partner worked alongside the subjects receiving high-value food. Rewards were distributed either by a human or a machine. In line with the social disappointment hypothesis, monkeys rewarded by the human refused food more often than monkeys rewarded by the machine. Our study extends previous findings in chimpanzees and suggests that social disappointment plus social facilitation or food competition effects drive food refusal patterns.

Characteristics of endotoxemia in different ways of treatment of experimental burn in rats

The article evaluates the dynamics of toxemia and detoxification capabilities of various wound dressings in thermal burn injury in rats in the experiment. A wound dressing based on collagen and chitosan Collachit® and a membrane wound dressing containing a hyperosmolar solution in the cavity were compared. Studies of the dynamics of toxemia in burn disease after experimental thermal injury were carried out on Wistar rats (n=20). Analysis of the results of the study was carried out on the basis of clinical, morphological and biochemical parameters of the peripheral blood of rats with experimental burn injury. The study of the morphology of blood cells is carried out according to generally accepted methods. Biochemical manifestations of endotoxemia are established by the dynamics of ALT, AST, urea, creatinine. In the 1st group of rats (n=10), the Collachit® wound dressing was applied. In the 2nd group (n=10), a semi -permeable membrane filled with a hyperosmolar solution, constituting a necrolytic enzyme, was fixed on the surface of the burn. As a result, it was found that burn toxemia in rats proceeded in 2 phases and was accompanied by depression, food refusal, leukocytosis, increased LII, liver transferases, creatinine and urea. Hematological deviations were characterized by non-uniform dynamics, corresponding to the phase of burn toxemia with maximum increases on days 1-2 and 5-7, a fall on days 3-4, and days 8-10. Hematological manifestations of toxemia depended on the method of treatment and were less pronounced with the use of membrane wound dressings than with collachitis. External signs of toxemia do not in all cases correspond to the hematological and biochemical profile of toxemia, which indicates the possibility of a latent course of burn disease with some methods of treatment. The applied wound dressings had a pronounced antiseptic efficacy, characterized by the absence of purulent-inflammatory complications over the entire period of the experiment.

Strategies to Promote Positive Mealtime Behavior in Early Childhood

Picky eating and problem behavior during meals are commonly reported issues among young children, particularly toddlers (Manikam & Perman, 2000). It is estimated that up to 50% of children under the age of 5 experience difficulties during mealtimes (Benjasuwantep et al., 2013). These difficulties may include tantrums when nonpreferred foods are presented, turning their head away from bites, pushing food away, crying, spitting out bites of nonpreferred food, and holding bites in the mouth. Over time, these behaviors can lead to significant limitations in the variety and amount of foods that children consume, thus compromising their growth and development. While there are a variety of reasons a child may engage in these problem behaviors, the food refusal or selectivity often persists after other contributing factors have been resolved (Dobbelsteyn et al., 2005). A behavior analytic approach can be used to address mealtime problem behavior. These interventions are focused on changing aspects of the child’s environment and caregiver response in order to change the child’s behavior during meals. This approach has been well-evaluated in the literature, and many regard it to be the most effective intervention for treating children’s problem behavior during meals (Kerwin, 1999). The scope of this paper was to provide evidence-based behavior analytic recommendations to caregivers, teachers, and other early childhood therapeutic providers. Recommendations provided in this article are applicable to a variety of feeding difficulties that may present in early childhood. While recommendations discussed in this paper have been supported in the literature, research lacks a comprehensive instructional guide of best practices that can be used by providers with limited expertise or experience in feeding concerns.

Nutritional status and eating behavior of children with autism spectrum disorders in Vietnam: A case-control study.

Background: Atypical eating behaviors and feeding issues are common in children with autism spectrum disorder (ASD). Aim: This study aims to evaluate the nutritional status and eating behavior of the ASD and typically developing groups. Methods: A case-control study was conducted from January to April 2019 in Nghe An, Vietnam. A total of 93 children in each group participated in the study with their main caregivers. We applied the Children's Eating Behavior Inventory (CEBI) to evaluate the eating behaviors of children. Results: Overweight and obesity in ASD children accounted for 41.9%. The CEBI score and %CEBI of the ASD group was higher than that of the control group (104.0 ± 14.2 and 91.3 ± 8.3; 24.1 ± 21.4 and 5.0 ± 11.8, respectively). Most of the adverse mealtime behaviors of ASD children focused on excessive duration (52.7%), distraction (40.9%), and food refusal (39.8%). In total 88.2% of caregivers had to comfort their ASD children at every meal, followed by threatening, scolding, or punishing children if they refused to eat (57.0%). Conclusion: Being overweight/obese and having eating behavior difficulties were prevalent among ASD children in Vietnam. Safer alternatives, such as lifestyle measures and seeking help from a nutritional therapist, can help ASD children reduce weight and modify their erroneous feeding habits.

Approach to acute psychosis in older adults.

Approach to acute psychosis in older adults.

Food Difficulties in Infancy and ASD: A Literature Review.

The aim of this literature review is to investigate the potential association between specific food difficulties and autism spectrum disorder (ASD) during the first two years of life. The search was conducted in PubMed, Google Scholar, Embase and PsycInfo databases. Twenty-one studies were synthesized (3763 infants and children). Difficulties during breastfeeding, breast milk refusal and avoidance of taking solids have been linked to ASD. Infants with ASD have been referred to as picky eaters. Problematic mealtime behaviour during infancy has also been associated with ASD. The present review highlights the association between food difficulties, including problematic mealtime behaviours, food selectivity, breastfeeding difficulties and food refusal during infancy and ASD early during life, including the first months.

Congenital syphilis in a preterm newborn with gastrointestinal disorders and postnatal growth restriction

BackgroundCongenital syphilis (CS) depends on the placental transmission of Treponema pallidum (TP) spirochetes from an infected mother to fetus during pregnancy. It shows a wide clinical variability with cutaneous and visceral manifestations, including stillbirths, neonatal death, and asymptomatic cases. Preterm infants with CS may have more severe features of disease than the term ones, due to the combined pathogenic effect of both CS and prematurity.Case presentationWe report on a female preterm (32+6 weeks of gestation) newborn showing most of the typical CS manifestations, in addition to gastrointestinal disorders including feeding difficulties, colon stenosis and malabsorption leading to postnatal growth restriction. The mother resulted positive at the syphilis screening test of the first trimester of pregnancy, but she did not undergo any treatment. At birth, our newborn was VDRL positive (antibody titer four times higher compared to the mother), and she was treated with intravenous benzathine benzylpenicillin G for 10 days (50,000 IU/Kg three times per day). Poor tolerance to enteral nutrition (abdominal distension, increased biliary type gastric secretions) was observed. A barium enema X-Ray identified a colon stenosis within the descending tract. However, the poor general conditions due to a concurrent fungal sepsis did not allow to perform any surgical procedure, and a conservative approach with total parenteral nutrition was started. The following evolution was marked by difficulties in enteral feeding including refusal of food and vomiting, to which also contributed the neurological abnormalities related to a perinatal asphyxia, and the affective deprivation for the physical absence of the mother during hospitalization. At 5 months of age, after the introduction of an amino acid-based formula (Neocate LCP Nutricia ®), an improvement of enteral feeding was observed, with no further and significantly decreased episodes of abdominal distension and vomiting respectively, and regular stool emission. A psychological support offered to the family allowed a more stable bond between the mother and her baby, thus providing a significant additional benefit to food tolerance and growth. She was discharged at 5 months of age, and included in a multidisciplinary follow-up. She at present shows global growth delay, and normal development apart from mildly increased tone of lower limbs.ConclusionsOur report highlights less common clinical CS manifestations like gastrointestinal disorders including feeding difficulties, colon stenosis and malabsorption leading to postnatal growth delay. Moreover, it underlines how prematurity may worsen the clinical evolution of such congenital infection, due to the additional pathogenic effect of possible associated diseases and/or conditions like sepsis, hypoxic/ischemic injury, or use of drugs. CS may be observed also in high-income countries, with high rates of antenatal screening and availability of prenatal treatment. A multidisciplinary network must be guaranteed to the affected subjects, to ensure adequate care and improve the quality of life for patients and their families.

Study of Acute Toxicity of an Herbal Extract of <i>Astragalus vulpinus</i>

This paper studies the acute toxicity of an herbal extract of Astragalus vulpinus Willd. growing in the Astrakhan Oblast. Experiments were carried out on white nonlinear rats. The animals were divided into several groups (n = 6): the control group receiving intragastric distilled water and the experimental groups receiving intragastric extract of the Astragalus vulpinus extract once at doses of 100, 500, 1000, 2000, and 4000 mg/kg. On the first day after extract administration, the animals were under continuous observation. During the entire observation period for 14 days, the animals were monitored in terms of their general condition, body weight, food refusal, and coat appearance, as well as their response to sound, light, and tactile stimuli. The response to sound was evaluated by a sudden sharp knock on the cage and identification of the animal’s flinching. The response to light was assessed by shining light into the eye with a penlight to control eye lid closure. Tactile stimuli were evaluated by compressing the basal part of the tail. After removing the animals from the experiment, macroscopic examination of internal organs (brain, liver, spleen, heart, stomach) and hematological analysis of blood smears were performed. During the research, the LD50 of the Astragalus vulpinus herbal extract under study was established. When the extract was administered at a dose of 4000 mg/kg, animal mortality was recorded (3 individuals died by the third day). In the remaining animals, a decrease in weight and leukocyte count was observed along with changes in the gastric mucosa. In terms of acute toxicity, the extract under study was found to belong to low-toxic substances with an LD50 of 4000 mg/kg. However, its administration at a dose of 4000 mg/kg led to changes in leukocyte count and gastric mucosa. Therefore, the chronic toxicity of Astragalus vulpinus herbal extracts requires additional research.

The impact of COVID-19 pandemic on food habits and neophobia in children in the framework of the family context and parents' behaviors: A study in an Italian central region.

This paper aims to evaluate whether changes in lifestyle and eating habits resulting from the Covid-19 emergency have influenced the post-pandemic level of food neophobia and in children living in an Italian central region. A sample of 99 children took part in a retrospective assessment carried out with a self-administrated questionnaire. Pre and post-pandemic evaluation of eating habits, physical activity, and lifestyle indicators was carried out. Food neophobia was evaluated following the Child Food Neophobia Scale (CFNS). Descriptive statistics were produced. A contingency analysis was performed to check associations between variables. For a large part of the sample (97%) the selective food refusal did not change during the pandemic period. About 70% of participants did not change their eating habits, with some subgroups reporting an increase in the consumption of fruits (22.2%), vegetables (19.2%), and legumes (21.2%). Relevantly the impact of the pandemic on the sedentary attitude passed from 25.3 to 70.7%. Neophobia was not associated with ponderal status (p-value 0.5). However, in normal-weight children, a high prevalence of intermediate-level neophobia (78.4%) was found. 39.4% of the studied children were involved in meal preparation during social isolation, with an increase in the proportion of children that shared all meals with their family (32.3% vs. 78.8%). Non-coercive parent behaviors in reaction to food refusal were associated with low levels of neophobia (p-value < 0.05). In this sample, for the effect of parents' attitudes, the pandemic positively affected children's food habits and, consequently, the level of neophobia after the social restrictions. The main implication of the study is the importance of capitalizing on the period of restrictions in order to involve children in meal sharing and food preparation.

Food preferences and eating behavior among children with autism spectrum disorder: A causal-comparative study in Lahore

This study aims to compare the eating behaviors, food preferences, and body mass index of children with and without Autism residing in Lahore, Pakistan. The study participants were aged 5-12 years, and were divided into two groups: 60 children with Autism spectrum disorder (ASD), and 120 typically developing (TD) school children. The sample was drawn from three Autism schools and three private schools through the purposive sampling technique. Data regarding the participants’ basic personal history, food preferences, and eating behavior were obtained from their parents using a self- administered structured questionnaire. BMI for age percentiles of the children was obtained from standard charts, based on their height and weight measurements. Among participants with Autism, 46.7% were obese, compared to 23.3% of the participants without Autism. Children with Autism exhibited a significantly greater degree of limited variety (U= 2797.000, p= 0.009) and food refusal (U= 1586.000, p= 0.000) as compared to children without Autism. Greater preference for food in the vegetable group was related to a higher BMI for the age percentile, for children with Autism (r = 0.327, p = 0.011). A p-value &lt; 0.05 was considered to be statistically significant. Children with Autism exhibited selective eating and food refusal to a greater degree than children without Autism.

Strategies and behaviors used by mothers in interactions with their young children during a mealtime in peri-urban areas of Huánuco, Peru.

This study aimed to gain an in-depth understanding about different strategies used by mothers to feed their 6-23-month-old children, as well as to learn about mothers' behaviors in response to situations of food refusal by her child, in order to generate evidence that contributes to the information gap on responsive feeding in Peru. The study was conducted in the city of Huánuco, a peri-urban area of Peru, with mothers of children in the complementary feeding stage participating. An in-depth 5-hour home observation was conducted in eight mother-child dyads. Both the mothers' and children's mealtime and food-related behaviors were coded and an inductive thematic analysis was applied. The primary objective of many of the strategies used by the mothers was to get their child to eat a little more. Six strategies were identified: pressure, encouragement, facilitating intake, acceptance, negotiation and reasoning. Certain differences were found in the strategies employed by the mother according to the age of her child, with mothers of younger children using more encouragement and mothers of older children using more pressure for their child to eat. The mothers' behavior in response to the child's refusal of food was both responsive and non-responsive (controlling), depending on the reason for the refusal. The findings are of great value for understanding about the feeding interactions of mother-child dyads in Peru and they start to address the information gap and can support the development of nutritional intervention strategies for use with children.

Exclusive breastfeeding practice and associated factors among mothers of infants age 6 to 12 months in Somali region of Ethiopia

In Ethiopia, only 58% of the mothers practice exclusively breast feeding, which is far from recommended; therefore, identifying factors associated with exclusive breast feeding helps to fill this gap. Community-based mixed cross-sectional study was conducted on 532 mothers. Binary logistic regression was performed and Variables with p value ≤ 0.05 in multivariable analysis declared as statistically significant variables. For the qualitative part focused group discussion was performed, and a thematic framework analysis was done. Finally the results were presented with narration. Prevalence of exclusive breastfeeding was 52%. Husband education (AOR = 2.9; 95% CI 1.6, 5), colostrum feeding (AOR = 2.3; 95% CI 1.3, 3.9), antenatal care (AOR = 2.1; 95% CI 1.1, 4.3.), place of delivery (AOR = 2.1, 95% CI 1.2, 3.6), residence (AOR = 0.3; 95% CI 0.2, 0.6), counseling during postnatal care (AOR = 2; 95% CI 1.2, 3.3) were associated with exclusive breastfeeding. As most discussant explained reason for not exclusive breastfeeding were due to different perceptions such as breast milk not sufficient, giving water decrease infantile colic and fear of food refusal. Prevalence of breastfeeding is low. Husband education, residence, colostrum feeding, antenatal care, institutional delivery, counseling during antenatal and postnatal care were significantly associated variables.

Acupuncture for the treatment of childhood anorexia: A systematic review and meta-analysis

ObjectivesChildhood anorexia, among the commonest symptoms of children, involved long-term loss of appetite/decreased food intake and refusal to try or eat certain foods. Acupuncture is increasingly popular in childhood anorexia due to the side effects and dissatisfaction of conventional treatment, but, the efficacy and safety of acupuncture for childhood anorexia have not been reviewed systematically. MethodsFrom 12 electronic databases, randomized controlled trials (RCTs) assessing acupuncture for childhood anorexia were identified in June 2021, with posttreatment improvement in clinical symptoms of anorexia as the primary outcome. A meta-analysis was conducted if two or more studies used the same interventions or same outcome measures. The risk of bias and quality of evidence were evaluated. ResultsA total of 32 RCTs with 3518 participants were included. When acupuncture was used as monotherapy or adjunctive therapy, the total effectiveness rate based on anorexia symptoms, hemoglobin levels, abdominal subcutaneous fat, and body weight significantly improved. However, results in nutritional indices were inconsistent. The recurrence rate of anorexia was significantly lower in the acupuncture group. No serious adverse events in relation to acupuncture were reported. in general, the risk of bias of the included studies was unclear and the quality of evidence for the main findings was low to moderate. ConclusionsAcupuncture may improve symptoms of childhood anorexia without serious adverse events. However, because of the low methodological quality and quality of evidence in existing reports, further high-quality clinical trials are needed to conclusively establish the efficacy and safety of this treatment.