Pediatric Feeding Research Articles

On the efficacy and efficiency of treating pediatric feeding disorder.

Inappropriate mealtime behavior (IMB) is a type of feeding challenge within the broader class of food refusal. The purpose of this study was to critically analyze the efficacy of interventions for the treatment of IMB through a meta-analysis of research using single-case experimental designs. We examined the extent to which different interventions resulted in decreases in IMB while also producing increases in food acceptance. This meta-analysis was also used to examine the efficiency of different interventions in achieving clinical significance. We identified 38 studies involving 266 cases in which IMB was treated with a behavioral intervention. The results indicated interventions that combined escape extinction and non-escape extinction had greater effect sizes for both reducing IMB and increasing food acceptance than either escape extinction alone or non-escape extinction alone. However, interventions that included escape extinction were slightly less efficient at decreasing IMB than were interventions that did not include escape extinction. We discuss the implications of these findings and provide recommendations for future research.

What School-Based Speech-Language Pathologists Need to Know About Pediatric Swallowing and Feeding Development and Disorders.

School-based speech-language pathologists are at the frontline for treating children with pediatric feeding disorders (PFDs). Often, speech-language pathologists are the primary allied health professionals who are charged with maximizing safety, supporting nutrition and neurodevelopmental growth. Due to the increasing need for assessment and treatment of PFDs in schools, it is fundamental that PFDs and dysphagia are detected, differentially diagnosed, and addressed to support developing children. This tutorial addresses the anatomy, physiology, and development of functional feeding and swallowing patterns across the spectrum of childhood for both PFDs and dysphagia. A clinical expert review of the anatomy, physiology, and development of functional feeding and swallowing patterns in children across the spectrum of childhood will be completed. The aim of this tutorial is to support school-based speech-language pathologists in their understanding of the anatomy and physiology of feeding and swallowing. School-based speech-language pathologists should complete this tutorial with an increased understanding and breadth of knowledge related to typical anatomy and physiology versus atypical or disordered presentations. This tutorial would support school-based speech-language pathologists in determining whether a child presents with characteristics of oropharyngeal dysphagia and/or a PFD.

Acceptance of bite presentations and feeding behaviors of 8 to 12-month-old infants: A reflection of typical feeding development

PurposeThe lack of age-appropriate expectations for feeding acceptance patterns in early childhood is a barrier to early and accurate identification of pediatric feeding disorder (PFD). The objective of the study was to describe the process by which typically developing children 8–12 months of age accept or refuse bite presentations and their corresponding feeding behaviors, aiming to establish age-appropriate normative data for feeding acceptance. MethodUsing cross-sectional methodology, we studied the proportion of bite presentations accepted, the type of feeding behaviors-passive, disruptive, expulsion, feeding concerns- observed at presentation and acceptance or refusal, and the duration between presentation to acceptance or refusal in 63 healthy infants between 8 and 12 months of age. Descriptive statistics and a one-way ANOVA were conducted to compare the effect of age and texture. ResultsFindings reveal high levels of bite acceptance of 80 % or > for children across ages, but with lower texture-specific differences. Both passive and disruptive behaviors were present even during acceptance of bites without any expulsion. Feeding concerns showed developmental trends with rapid reduction by 12 months suggesting improvement in oral feeding skills. The duration of acceptance and refusals revealed clear patterns by age and texture with an average of 3 s for acceptance but <1 s for refusal. ConclusionsThis study describes bite acceptance patterns in a cohort of typically developing infants between 8 and 12 months of age by examining the acceptance of bites, frequency and type of feeding behaviors, and duration differences when children accept versus refuse a bite. Findings may be applied in the future to provide more sensitive detection of problematic feeding patterns to aid in the detection of pediatric feeding disorder.

Go Team Go! Interprofessional Practice for Pediatric Feeding in the Schools.

The purpose of this clinical focus article is to discuss processes and procedures for building school-based programs to address the feeding and swallowing needs of students in the public-school setting. Interprofessional practice (IPP) team member roles and responsibilities, screening, eligibility, considerations for developing Individualized Education Programs that address the needs of students with pediatric feeding disorder (PFD) and dysphagia, as well as billing documentation requirements, are discussed. Additionally, coordination across the continuum of service delivery for students with PFD and dysphagia is investigated. Guidance on documentation, processes, and procedures that comply with the Individuals with Disabilities Education Act mandates will be provided. This clinical focus article will demonstrate that students with PFD and dysphagia continue to present to public schools and require skilled services and supports in order to meet their individualized needs. School-based speech-language pathologists have a legal requirement to provide these supports when deemed educationally relevant. Schools must employ processes and procedures that result in the timely and effective evaluation and identification of students with PFD and dysphagia. An IPP approach to the management of PFD and dysphagia is critical to ensure optimal outcomes for students found eligible for services.

Awareness of Safe Feeding Practices among Expecting and New Indian Mothers: A Survey

The government of India has been conducting focused programs for ensuring child and maternal nutrition, health, and well-being. A major mission in this regard is creating public awareness of importance of adequate nutrition from early on. Medical professionals have also compiled scientific recommendations that guide parents toward the timelines and type of foods to be fed in the first 24 months. However, from various research publications, child mortality rate secondary to pneumonia and obesity continues to be a major concern in India. One possible reason could be the actual household feeding practices. This study aimed to verify the understanding of pediatric feeding guidelines among expectant and new Indian mothers. Two close-ended multiple-choice questionnaires were developed and validated for expecting and new mothers. Responses were obtained from 100 participants through social media platforms using snowball paradigm. Response analysis revealed that understanding of breastfeeding guidelines was better compared to complementary feeding. While timeline-related questions received more accurate responses, most participants responded inaccurately towards safety and strategy-related information. Perceptions on feeding methods were different across the two participant groups. Developmentally normal behaviors such as gagging were considered as problem behavior by both groups. Interestingly, safety concerns were better identified by expecting mothers than new mothers. The results implied that public awareness programs need to broaden the focus from breastfeeding to include methods, strategies, and safety of complementary feeding for adequate nutrition and health. The guidelines developed in this regard need to be effectively communicated to the public for better impact on social health.

Mother-child pairs’ eating and feeding behaviours in two different nutritional status from two distinct provinces

Nutrition plays a crucial role for the bio-psycho-social growth and development of children. Mother-child pairs’ eating-feeding problems can be hypothesized to relate to the child’s nutritional status and living area. Our focus was to assess maternal attitudes and children’s eating habits in thin and normal-weight children across two cities characterized by distinct socioeconomic and demographic profiles: Ankara and Şanlıurfa. This double case-control study included the mothers whose children are aged between 2 and 7 years old in both cities. Figure Rating Scale, Child Feeding Questionnaire and Behavioral Pediatrics Feeding Assessment Scale were filled by mothers of children. The mothers of thin children were concerned more about the weight of their children, felt more responsible for feeding their children, and use of pressured them to eat more frequently compared to normal-weight children’s mothers in both cities. In Ankara, the duration of breastfeeding is longer, using formula is rarer and starting complementary food on time is more common, mother had higher scores on perceived responsibility, perceived child weight, and concern about child weight subscales; lower score on the restriction subscale compared to Şanlıurfa. Mothers of both thin and normal weight children in Şanlıurfa rated their children as weaker compared to those in Ankara. In conclusion, child eating behaviors and parental feeding practices were associated with the weight of children depending on demographic and sociocultural differences. Implementing customized, location-specific preventive educational initiatives on child feeding will not only foster behavioral changes but also yield valuable insights for shaping future interventions.

Satisfaction of telehealth implementation in a pediatric feeding clinic

&lt;abstract&gt;&lt;sec&gt; &lt;title&gt;Objectives&lt;/title&gt; &lt;p&gt;Telehealth services became commonplace during the COVID-19 pandemic and were widely reported to improve access to medical care in a variety of settings. The primary aim of this study was to assess patient- and provider-reported satisfaction with telehealth services within a multidisciplinary outpatient program for children with feeding disorders.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Methods&lt;/title&gt; &lt;p&gt;Caregivers and healthcare providers who participated in telehealth multidisciplinary visits within an outpatient pediatric feeding disorders clinic between April and June 2020 completed an online survey that assessed their visit satisfaction. The visit completion rates of in-person 2019 and virtual 2020 visits were compared.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Results&lt;/title&gt; &lt;p&gt;Thirty-six caregivers of children between 1-month and 8-years-old completed the survey. Caregivers indicated their overall satisfaction with telehealth services, finding it more convenient than seeing specialists in person. Caregivers demonstrated interest in continuing telehealth visits. Providers indicated being satisfied with the telehealth visits, with many noting that they were as effective as in-person visits. There was an increase in the number of in-person visits between 2019 compared to virtual visits in 2020, though there were no differences for the visit completion rates.&lt;/p&gt; &lt;/sec&gt;&lt;sec&gt; &lt;title&gt;Conclusions&lt;/title&gt; &lt;p&gt;Both caregivers and providers were satisfied with the telehealth services and highlighted various benefits in response to open-ended questions. However, there were concerns with the lack of available anthropometric data and measurements. Although there were no differences in the no-show rates following the implementation of telehealth, there was a significant increase in the total number of completed visits. Telehealth visits are a crucial resource for caregivers and providers in multidisciplinary pediatric feeding clinics, yet enhancing anthropometric measurements is necessary to provide quality care.&lt;/p&gt; &lt;/sec&gt;&lt;/abstract&gt;

Process improvement of a paediatric feeding clinic

PurposeThe purpose of this study is to identify opportunities to improve processes within a paediatric feeding clinic to enhance timely patient access to healthcare through effective and efficient resource use. Design/methodology/approachThe study involved three interrelated methods. First, de-identified feeding clinic data, collected over seven years, were analysed to understand patient appointments. Second, clinician workshops and the swim lane method were used to map feeding clinic processes. Third, root cause analysis was conducted to identify bottlenecks and identify improvement opportunities. FindingsThe results revealed three, poorly connected sub-processes within the feeding clinic – namely: the patient triaging and appointment scheduling or allocation process; the clinic reporting process; and the cancellation and rescheduling process. These sub-processes were poorly connected because of inadequate resources, few standardised processes, and limited coordination between the different processes. Consequently, patient appointments were typically delayed, and patient reports were not always completed in a timely manner. Processes within the paediatric feeding clinic could therefore be improved by using digital tools, patient portals and telehealth, online interventions, an automated appointment confirmation system, and/or an automated transcription of each appointment. Originality/valueThis is the first published study to apply business process management to a paediatric feeding clinic. By using three methods to clarify opportunities to improve clinic processes, it highlights the potential value of health information technology in this context. This evidence will enable health service managers to ensure that children with feeding difficulties have timely access to appropriate care.

Feeding Characteristics in Children With Food Allergies: A Scoping Review.

Food allergy (FA) affects approximately 8% of children and may be immunoglobulin E (IgE)-mediated or non-IgE-mediated. It is recognized clinically that children with both subtypes of FA may present with features of pediatric feeding disorder (PFD); however, there is currently a limited detail of presenting characteristics. The objective of this study was to synthesize the current evidence regarding the feeding characteristics of children with FA, with a focus on the feeding skills and psychosocial domains of PFD. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Papers published between 2001 and 2022 describing feeding characteristics in the feeding skills and psychosocial domains in children with FA/history of FA were included. Papers that focused solely on characteristics from the medical or nutritional domains were excluded. Descriptive information regarding demographics, methodology, allergy profile and history, and the characteristics of PFD observed was extracted using a preconceived data extraction form. Overall, 40 papers contained descriptions of feeding characteristics of children with non-IgE-mediated FA (n = 22) and IgE-mediated FA (n = 11), while four were nonspecific. In the psychosocial domain, food refusal/aversion, anxiety with eating, and poor intake were the most frequently reported, regardless of FA subtype. Less information was reported regarding feeding skills, although slowness in eating, immature diet, and delays in oral sensory-motor skills were described. Children with FA/history of FA may present with a range of characteristics that map across the feeding skill and psychosocial domains of PFD. Systematic research is needed to fully describe the feeding characteristics of children with FA. https://doi.org/10.23641/asha.24562732.

Impact of the COVID-19 pandemic on the eating behaviors of children and adolescents with autism spectrum disorder.

Introduction. Children with autism spectrum disorder (ASD) have difficulties adapting to stressful situations, such as the COVID-19 pandemic. Objective. To assess the impact of the first year of the pandemic on feeding difficulties in children with ASD. Population and methods. The caregivers of children and adolescents with non-syndromic ASD (age: 2-18 years) from a neurodevelopment unit were invited to participate. Participants completed a questionnaire and the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) online before and during the first year of the pandemic. A priority score (product between the average frequency and the problem) for each BPFAS item was estimated. Results. Among the caregivers, 56.6% (86/152) completed the survey (mother: 74.4%); children's median age was 6.3 years (p25-p75: 4.7-8.2); 80.2% of children were males; 58.1% continued with their therapy during the pandemic; and 61.6% had behavioral problems before the pandemic. During the first year of the pandemic, children had greater behavioral problems (34.9%) and feeding difficulties (61.6%); however, 31.4% of caregivers referred improvements in feeding. There were no significant differences in the BPFAS scores before and during the pandemic. The following items obtained the highest priority scores: gets up from table during meal, does not try new food, does not eat vegetables, does not eat fruits. Conclusions. A high frequency of feeding difficulties was noted during the first year of the pandemic. No differences were observed in feeding characteristics before and during the pandemic.

Assessing the US treatment landscape for paediatric feeding disorder: A survey of multidisciplinary providers.

Paediatric feeding disorder (PFD) is a common childhood condition, estimated to impact one in 37 American children under the age of five. Such high prevalence occurs against a backdrop of limited understanding of the community treatment landscape in the United States. To better understand the community treatment landscape for PFD in the United States and identify provider and treatment delivery characteristics, we collected primary data through a web-based survey targeting providers from all four PFD domains (i.e., medical, nutritional, feeding skill, and/or psychosocial) between January 2022 and March 2022. The 71-item cross sectional survey focussed on patient, provider and treatment characteristics. We distributed the survey using an electronic survey tool through Feeding Matters listserv followed by solicitation to discipline specific listservs and professional networks. The analytic approach involved descriptive statistics compared across settings and provider types, focussing on respondents within the United States. Eighty-three percent of respondents reported practicing in the United States. Most of the US sample (74.3%) involved providers from the feeding skill domain (speech-language pathologist - SLP, occupational therapist - OT) who reported delivering care through early intervention or outpatient settings using responsive and sensory based approaches. These approaches lack rigorous empirical evaluation. Survey results suggest a need to support community providers in engagement with research activity to promote a better understanding of treatment approaches and outcomes associated with a large cohort of providers delivering care (i.e. SLPs, OTs) to patients with PFD.

Virtual nourishment: Paediatric feeding disorder management with telepractice amidst COVID-19: An allied health perspective

Purpose The rapid adoption of telepractice services by health professionals was necessary to maintain service continuity for children with paediatric feeding disorders during the COVID-19 pandemic, during periods where in-person therapy was restricted. The aim of this study was to explore clinical perspectives and reflections on the use of telepractice for managing paediatric feeding disorders during the pandemic. Method A post-positivist qualitative approach using thematic analysis was adopted. This study seeks to understand participants’ experiences and thoughts from allied health professionals from speech-language pathology, occupational therapy, and dietetics working with paediatric feeding in Western Australia. All participants delivered at least 10 telepractice sessions to children from birth to 12 years with a paediatric feeding disorder. Braun and Clarke’s six-step thematic analysis process was used to analyse the data inductively. Result Eleven allied health professionals representing eight clinical settings in Western Australia, including speech-language pathology, occupational therapy, and dietetics, working with paediatric feeding were recruited. The results revealed four themes: families becoming the catalyst of change, clinician comfort over confidence, insights into authentic mealtimes, and the paradox of choice. Conclusion This study highlighted the need to build clinicians’ confidence and competence, and the provision of service guidelines and training. Although many clinicians had positive experiences with telepractice, most returned to in-person delivery once COVID-19 restrictions were lifted, emphasising the importance of comfort in service delivery selection. We recognise that the findings of this study are constrained by the fact that it was conducted in a single geographical region and utilised a small qualitative sample. While telepractice was successful in managing paediatric feeding disorders, further development and implementation of telepractice guidelines are needed for telepractice to be a viable service delivery option for families and children with feeding disorders.

Looking Beyond the Growth Curve: A Retrospective Study on Nutrient Deficient Diets in Children with Severe Food Selectivity.

Severe food selectivity places children at risk for nutrient deficiencies and long-term medical complications, if unaddressed. However, poor nutrition in highly selective eaters is often overlooked when considering other behavioral or medical concerns. Additionally, studies regarding food selectivity are sparse and limited to children with developmental delays. This study further investigates the nutritional deficiencies and growth characteristics of children with severe food selectivity to assist pediatricians in the earlier identification of patients for nutrition screening. A retrospective chart review was completed for 13 patients admitted to a pediatric feeding program solely for table-textured food selectivity. Nutrition and anthropometric data from the medical record were analyzed. All patients were determined to be following an age-appropriate growth curve but had multiple micronutrient deficiencies. Additionally, 6 children were typically developing outside of the feeding context. Results suggest that children with food selectivity may require more intensive and earlier nutrition screening beyond their growth patterns.

The Behavioral Pediatrics Feeding Assessment Scale in Telugu (BPFAS-T)

The Behavioural Paediatrics Feeding Assessment Scale (BPFAS) was commonly used to assess the children's feeding behaviours. Assessing behaviours is extremely beneficial in understanding the child's mental state and tracking further developmental aspects. This scale was available in the majority of languages; which is not available in Telugu, the language spoken by the Indian states of Andhra Pradesh and Telangana. However, cultural and lingual aspects should be considered when assessing certain aspects of children's behaviour. In this context the current study aimed to adapt the BPFAS scale into Telugu. This study included 380 parents of children with autism spectrum disorders (ASD). The children ranged in age from 1 to 8 years. Parents were instructed to fill out the questionnaire correctly. The obtained scores were examined using reliability, independent t test, and one way ANOVA. The results revealed a Cronbach's alpha of 0.729, indicating that the BPFS-Telugu is acceptable and can be used clinically. The independent t test revealed that there is a high significant difference between total scores, a significant difference between frequency scores, and no significant difference between problem scores. One-way ANOVA was used to compare severity, and the results show that there is a significant difference between total scores, a high significant difference between problem scores, and no significant difference between frequency scores. The independent test for frequency score revealed a highly significant difference between ASD children with and without behavioural problems, as well as problem scores. Overall, 55.5 % (frequency scores) and 55.1% (problem scores) of ASD children were identified with behavioural issues during feeding time. Finally, the authors stated that BPFAS in Telugu is clinically acceptable and can be used to assess for behavioural issues during feeding time.

A Design-Driven Approach to Develop Innovative Clinical Experiences in Dysphagia

Purpose: This clinical focus article presents a modified user-centered design framework in order to facilitate the role of pediatric clinicians who treat feeding/swallowing disorders in redesigning the clinical experience in order to improve outcomes. The article establishes a physiologically based design framework and presents a user-centered design tool that clinicians may utilize to view the patient interaction from a design mindset in their practice. Method: Two case studies are presented to demonstrate the clinical application of the user-centered design tool. Case 1 applies the tool to controlled flow drinking cups and includes a pilot study that explores prototype testing of a novel cup design and the resulting patient experience. Case 2 presents a unique pediatric patient and the application of the user-centered method to analyze a modified treatment experience. Conclusions: Clinicians who treat pediatric feeding and swallowing disorders can benefit from the utilization of a user-centered design approach to observe the patient experience from a design perspective. This approach provides a structure to guide individual clinicians to key insights that may lead to improved treatments. Furthermore, user-centered methods may facilitate the analysis of complex patient scenarios by clinician-led teams, which may result in novel solutions.

Prevalence of Parent Mental Health Problems in an Interdisciplinary Feeding Clinic: Short Communication.

Parents of children with pediatric feeding disorder (PFD) often experience high stress and may be at advanced risk for mental health conditions. We conducted a retrospective chart review of 413 parents who completed intake surveys at an interdisciplinary feeding clinic to determine the prevalence and types of mental health conditions among parents; 41.8% of parents reported a mental health diagnosis among the mother and/or father. Of the parents with mental health conditions, the most prevalent conditions reported were anxiety (71.1% for mothers, 50% for fathers) and mood disorders (62.7% for mothers, 40.9% for fathers). For mothers, 21.1% indicated their mental health disorder had a postpartum onset. Parents of children with birth complications were more likely to have a mental health condition (50.9%) than parents of children without a birth complication (38.7%), and parents reporting mental health conditions had children with significantly more co-occurring medical conditions. Since parent stress and mental health can influence parent-child interactions during mealtime, this study suggests the importance of addressing both parent mental health factors and child factors when treating children for PFD. Future studies are needed to develop novel interventions that support the specific mental health needs of parents of children with PFD.

Awareness and Knowledge of Speech Language Pathologists regarding Pediatric Feeding Disorders

Feeding is like a tremendous process involving multiple systems that are interconnected with each other. The speech pathologist plays an important role in helping the child develop a positive relationship with his or her mouth and food, as well as learning how to eat enjoyably, carefully, and efficiently. Objective: To determine knowledge of Speech Language Pathologists about the Pediatric Feeding Disorders. Methods: It was a cross sectional study. Data were collected from the Speech Language Pathologists through online questionnaire generated through Google forms after taking permission letter from Research and Ethics committee. Non- probability convenience sampling technique was used. Sample was calculated 157 on the basis of total number of BS graduate Speech Language Pathologists by using 95% confidence interval through sample size calculator Rao soft. Data were analyzed in SPSS 21 using descriptive statistics including frequency tables and bar charts. Results: Total 157 responses were received.145 were females and 12 males participated in this study. Out of 157 participants, 60.51% SLPs reported that they do not feel confident on their clinical expertise regarding pediatric feeding disorders and 92.4% SLPs reported that they need more knowledge and training to deal with pediatric feeding disorders. Conclusions: Many Speech Language Pathologists in Pakistan have little knowledge about the management and treatment of PFDs. They do not feel safe to evaluate, assess and intervene with pediatric feeding disorders. Therefore, they feel less confident on their treatment strategies regarding pediatric feeding disorders.

Interarytenoid injection outcomes in pediatric feeding disorders.

Type 1 laryngeal clefts (LC1) and deep interarytenoid grooves contribute to pediatric feeding disorders. Management of these defects remains heterogeneous among surgeons and interarytenoid injection augmentation (IIA) is not always offered as a treatment option. This study evaluated IIA outcomes among a pediatric patient cohort comprised mostly of those with deep interarytenoid grooves. A single-institution retrospective chart review featured children under the age of 5 years presenting for aspiration, dysphagia, or choking. Over the period of 7 years (January 2014-October 2021), 39 met inclusion criteria and had sufficient follow-up data. Descriptive statistics and subgroup analyses were performed. Of the 39 included patients, 76.92% had clinical improvement post-injection, with the mean time to follow-up being 47 days. Within the deep interarytenoid groove group, improvement rates were 82.76%. Bronchoscopy findings revealed 29 (74.36%) patients with a DIG, 3 (7.69%) with LC1, 3 (7.69%) with no anatomic abnormality, and 4 (10.26%) with vocal cord paralysis. There were no adverse events. There were no associations with the outcomes based on subgroup analysis and logistic regression. IIA is an effective and safe treatment for pediatric feeding disorders. No covariates were associated with symptom improvement. Within the deep interarytenoid groove diagnosis subgroup, IIA effectively improved symptoms. Further investigations are needed to explore predictors of success with IIA in this population. VI.

Further examination of behavior during extinction‐based treatment of pediatric food refusal

AbstractResearchers have demonstrated the effectiveness of extinction‐based treatments to reduce challenging behavior. Although bursts and temporary increases in emotional responding may occur in some basic and applied studies, recent studies on their prevalence have shown that side effects are far from ubiquitous. Woods and Borrero (2019) determined that bursts of inappropriate mealtime behavior and increases in emotional responding occurred in 30% of data sets during extinction‐based treatment of pediatric feeding difficulties. In the current study, we conducted a retrospective consecutive‐controlled case series by evaluating treatment graphs of inappropriate mealtime behavior, negative vocalizations, active acceptance, and mouth clean for 60 children admitted to an intensive day‐treatment feeding disorders program. We discuss the implications of these findings and provide general recommendations for the use of extinction‐based treatment.

Developmental Feeding Stages and Their Impact on Child Feeding Behavior.

Previous research has shown that critical periods of feeding skills development exist and feeding problems can arise in children due to delays in attaining feeding developmental milestones. This study aims to delineate the transitional process of feeding development in healthy children and children with gastrointestinal diseases (GIDs) and to examine the relationship between feeding milestones and the appearance of later feeding problems. A cross-sectional case-control study among 711 healthy Greek children and 119 children with GID, aged 2-7 years. Parents completed the Greek version of the Behavioral Pediatrics Feeding Assessment Scale and "self-reported" questionnaires assessing child's feeding history. Differences in feeding behavior of preschoolers between the 2 groups were found concerning the time of introduction of complementary (pureed), lumpy, and table foods as well as finger feeding and regular cup-drinking. Age-specific milestones as proposed by guidelines were not reached. Late introduction of complementary and lumpy foods (>6 months and >9 months, respectively) as well as finger feeding (>9 months) were predictive of more problematic feeding behaviors later on. The trajectory of feeding development, including less studied feeding milestones, both in healthy children and children with GIDs, indicates that there are discrepancies between current feeding practices and infant feeding guidelines, and a tendency to delay the acquisition of all assessed feeding milestones.