Pediatric Feeding Disorders Research Articles

Family functioning and eating psychopathology in developmental restrictive eating disorders after Covid-19 lockdown

PurposeWhile the impact of Covid-19 lockdowns on family dynamics and eating behaviors has been widely studied, there is limited and conflicting evidence regarding families of children and adolescents with restrictive eating disorders (EDs). This study examines differences in eating psychopathology and perceptions of family functioning in pediatric patients with anorexia nervosa (AN; restrictive and atypical) and avoidant/restrictive food intake disorder (ARFID) before and after the pandemic.MethodsA total of 640 children and adolescents with restrictive EDs and their parents, assessed from January 2018 to December 2022, were grouped into pre-Covid-19, Covid-19, and post-Covid-19 periods. Measures included the Family Assessment Device, the Eating Disorders Inventory-III, and the Eating Disorders Questionnaire in Childhood. Data were analyzed using ANOVA (p < .05).ResultsChildren and adolescents with AN showed greater difficulties compared to children and adolescents with ARFID both in family functioning and eating psychopathology. In particular, children with AN in the COVID-19 group exhibited higher scores in Affective and Mood Disorders, Obsessive–Compulsive Disorder, Pica, and Selective Eating compared to the pre-Covid-19 group. Adolescents with AN reported worse eating psychopathology in Post-COVID-19 group compared to others.ConclusionsPatients with restrictive EDs show more dysfunctional family functioning and greater eating psychopathology after the pandemic compared to preceding periods but results varied by age and diagnosis. These findings highlight the need for diagnosis-specific, tailored interventions to address the evolving clinical and family dynamics in pediatric ED populations.Level of evidence: Level V Evidence obtained from a cross-sectional descriptive study.

Self-Injurious Behavior During Treatment of Pediatric Feeding Disorder: An Evaluation of Treatment Outcomes

Self-Injurious Behavior During Treatment of Pediatric Feeding Disorder: An Evaluation of Treatment Outcomes

Cross-Cultural Adaptation and Preliminary Validation of the Italian Version of the Feeding-Swallowing Impact Survey for both Members of Parental Dyads.

The Feeding/Swallowing Impact Survey (FS-IS) is the first validated instrument to measure the impact of Pediatric Feeding Disorder (PFD) on their caregivers. This study aimed to translate and adapt the FS-IS into Italian (FS-IS-IT) and analyze its reliability and validity, for both fathers and mothers. The FS-IS-IT was developed using Beaton et al.'s 5-stage process. This cross-sectional study involved 32 dyads of parents of children with PFD and 15 dyads of caregivers of children with developmental disorders without PFD. Twenty caregivers completed the FS-IS-IT questionnaire twice to ensure test-retest reliability. All caregivers completed the Zarit Burden Inventory(ZBI) and the IDDSI Diet Functional Scale for construct validity analysis. ROC analysis was used to evaluating the diagnostic properties of FS-IS-IT in screening between dyads of children with PFD and dyads without these symptoms. The FS-IS-IT was reliable for both fathers and mothers, with satisfactory internal consistency (mothers' McDonald'sω=0.93; fathers' McDonald'sω=0.94) and test-retest reliability (intraclass correlation coefficient > 0.97). Moderate-to-strong statistically significant correlations (mothers:r(32)=0.73;p =.018; fathers:r(32)=-0.42;p=.018).r(32)=-0.41;p=.018). The FSIS-IT was featured by optimal diagnostics (mothers: AUC=0.97; fathers: AUC=0.94), a cut-off of 1.58 for mothers and 1.65 for fathers has shown good specificity and sensitivity. The FS-IS-IT is a reliable and valid tool for the assessment of the impact of PFD and shows optimal diagnostic properties.

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.

Parental Overvaluation of Child Weight/Shape Is Associated With Disordered Eating in Children Beyond Associations With Parental Internalized Weight Bias.

Parental Overvaluation of Child Weight/Shape Is Associated With Disordered Eating in Children Beyond Associations With Parental Internalized Weight Bias.

Acceptance and Commitment Therapy for a Parent of a Child With Pediatric Feeding Disorder: A Case Study

Objective: Pediatric feeding disorder (PFD) is a common condition for young children and can cause stress among parents. However, there are no parent psychosocial interventions that have been tested for efficacy in this population. Acceptance and commitment therapy (ACT) holds great promise for addressing parent stress among parents of children with PFD. In the present case report, we describe the application of ACT with a parent of a child with PFD, with a focus on parent and child outcomes and parent-reported implementation barriers and facilitators. Method: The mother of a young child with PFD completed six sessions of ACT focused on the stress she was experiencing related to her child’s feeding issues. Treatment was offered in the context of her child’s PFD treatment setting, and sessions were held over telehealth. Results: This mother’s stress improved from high to average over the course of treatment, using the Parental Stress Scale. The majority of her improvements in stress were following the first two sessions. She also reported qualitative benefits related to her parenting, her child’s feeding, and her general well-being. She reported several facilitators of treatment, including the flexibility offered throughout treatment the use of telehealth, and acknowledgment of her experiences. She reported barriers including mental health stigma, time constraints, and childcare. Conclusions: Brief treatment of parental stress, offered in a pediatric treatment setting is feasible to implement and may have clinical utility in supporting families of children with PFD or other medical conditions.

An Important Springboard Toward Establishing Diagnostic Connection Between Avoidant Restrictive Food Intake Disorder and Pediatric Feeding Disorder.

Diagnostic ambiguity has surrounded the two primary diagnoses for dysfunctional feeding and eating in pediatric populations-that is, pediatric feeding disorder (PFD) and avoidant restrictive food intake disorder (ARFID). Recent expert consensus emphasized the need for diagnostic refinement to enhance understanding and improve clinical and research activities for both conditions. With the proposed revision of ARFID, Zickgraf and colleagues provide a research grounded springboard for beginning the revision process. The proposal centers upon a new Criterion A that emphasizes ARFID as a disorder driven by a negative, temporally proximate association with eating/food involving three distinct, yet potentially co-occurring responses of disgust/distaste, anhedonia/uncomfortable fullness, and acute fear/panic. In this commentary, we consider the potential benefits of the proposed framework from the PFD perspective and identify three additional areas-DSM text revisions, benefits of a shared feeding and eating disorder diagnosis, and a call for education and advocacy to complement future revisions-for further consideration during work to improve PFD and ARFID diagnostic systems.

Neonatal Inflammation and Feeding Disorders at 1 Year in Infants With Congenital Gastrointestinal Malformations.

To investigate the associations between inflammatory markers and the risk of paediatric feeding disorders (PFD) at 1 year of age in infants with congenital gastrointestinal malformations (CGMs). Neonates with CGMs admitted to our NICU and prospectively followed up in our outpatient clinic were included. The presence of PFD was assessed at the 1-year visit using the Montreal Children's Hospital Feeding Scale (MCH-FS). Data on potential risk factors for PFD were retrospectively collected. Fifty-nine neonates were included. They had a median MCH-FS at 1 year of 25 [IQR = 19-37]. PFD (MCH-FS > 45) was diagnosed in 15% of cases, of which 56% were severe. The number of days with a C-reactive protein (CRP) level > 40 mg/L was significantly higher in the PFD patients. After adjusting for confounding factors, a duration of CRP > 40 mg/L remained significantly associated with PFD at 1 year (OR = 1.23, [1.02-1.47]). Similarly, the number of neonatal surgical procedures (OR = 11.4, [2.15-60.6]) was independently associated with PFD at 1 year. PFD at 1 year was observed in 15% of newborns with CGMs in our cohort. Our results suggest that sustained severe inflammation caused by surgery and its complications during the neonatal period may have long-term effects on feeding behaviour.

Validation of an Arabic Questionnaire to Assess Pediatric Behavioral Feeding Disorders

Plain Language SummaryPediatric feeding disorder (PFD) is characterized by age-inappropriate oral intake in at least one of the following domains (medical, nutritional, feeding skills, or psychosocial) lasting daily for at least 2 weeks. It affects 25–45% of typically developing children and up to 80% of those with developmental delays. Parent-directed questionnaires are particularly useful in assessing parents’ perception of behavior during mealtimes and providing information about parenting styles, child behavior, or feelings related to mealtimes, including the frequency and severity of these behaviors. Several questionnaires have been developed for English-speaking populations to assess child mealtime behaviors, but no valid Arabic questionnaire is available. The present study aimed to develop and validate an Arabic questionnaire to identify behavioral feeding problems during mealtime in Arabic-speaking children, filling a gap in existing assessment tools. This case-control study evaluated behavioral feeding difficulties in 100 Egyptian Arabic-speaking children aged 1–5 years. Mansoura Pediatric Eating Assessment Scale (MPEAS) was developed to assess behavioral feeding problems. The scale includes 40 items in four subdomains (feeding skills, mealtime circumstances, child behavior, and parent behavior). Scoring was based on a 4-point Likert scale, with lower scores indicating greater impairment. The validity and reliability of MPEAS were tested through various procedures. The results demonstrated MPEAS’s excellent validity and reliability. Mansoura Pediatric Eating Assessment Scale (MPEAS) is an easily applicable tool for assessing behavioral feeding problems in Arabic-speaking children. Its use can lead to the recognition of specific problems, which in turn can guide the selection of suitable treatment plans.

Clinical Outcomes Among Adolescents Diagnosed With Anorexia Nervosa During the COVID-19 Pandemic.

The COVID-19 pandemic was associated with a significant rise in the incidence of anorexia nervosa (AN) and atypical anorexia nervosa (AAN), longer wait times and reduced opportunities for in-person medical services. How these changes affected clinical outcomes among adolescents newly diagnosed with AN/AAN remains largely unknown. We performed a retrospective analysis of standardized intake and follow-up data from a pediatric eating disorder program to compare clinical outcomes among adolescents newly diagnosed with AN/AAN during pre-pandemic (July/2017-December/2018) and pandemic (July/2020-December/2021) periods. Clinical data were collected at the time of diagnosis and at 1-, 3-, 6-, and 12-month intervals. The primary outcomes were unscheduled AN/AAN-related emergency department visits and need for medical hospitalization. Overall, 253 patients were included (pre-pandemic = 77; pandemic = 176). By 12-months following diagnosis, 18.8% (95% CI 13.3%-25.3%) of patients diagnosed during the pandemic had unscheduled AN/AAN-related emergency department visits, compared to 7.8% (95% CI 2.9%-16.2%, p = 0.03) of those diagnosed pre-pandemic. Medical hospitalization was required more frequently in the pandemic group (35.8%; 95% CI 28.7%-43.4%) compared to pre-pandemic (15.6%; 95% CI 8.3%-25.6%, p = 0.001). Mean weight gain at 12-months did not differ between groups (8.1 kg pre-pandemic vs. 8.8 kg pandemic; p = 0.35) however the mean time to target weight was longer in the pandemic group (2.7 vs. 4.4 months; p = 0.002). Patients newly diagnosed with AN/AAN during the pandemic had significantly more AN/AAN-related emergency department visits and hospitalizations and took longer to achieve target weight than those diagnosed pre-pandemic. These findings suggest a more complicated treatment course among adolescents diagnosed with AN/AAN during the pandemic.

Identifying and evaluating factors related to feeding disorders in children using the path analysis method.

Pediatric feeding disorders (PFDs) refer to the impaired consumption of food that is inappropriate for a child's age group. Understanding the causes and influencing factors of PFDs is crucial for managing these disorders. This study aimed to analyze the factors associated with PFDs using the path analysis method. A cross-sectional study was conducted on 500 children aged 6 months to 18 years who visited gastroenterology and child nutrition clinics. Data were collected through interviews with mothers and physicians, and analyzed using the path analysis method. The model included latent variables such as feeding disorders and birth status, as well as observed variables such as socio-economic status, food group, feeding practices, destructive behaviors, sleep, and body mass index (BMI) z-score. We conducted three path analyses. The socio-economic status (SES) directly and indirectly plays a role in feeding disorders in children; the total effect on feeding disorders was positive (β = 0.075). The direct effect of SES on the intake of food groups was positive (β = 0.190), on BMI z-score was positive (β = 0.100), and it was generally associated with a negative effect on feeding disorders (β = -0.05). The total effect of destructive behaviors on body mass was negative (β = 0.262) and on feeding disorders was positive (β = -0.041). Children who had regular sleep had significantly fewer feeding disorders (total effect: -0.369). Socio-economic status, destructive behaviors, sleep, and BMI were found to be factors influencing eating disorders in children.

Response Blocking to Identify Inappropriate Self-Feeding as a Motivation or a Skill Deficit.

Persistent inappropriate self-feeding (e.g., finger-feeding food typically consumed using a utensil after 14-24 months of age) is common for children with neurodevelopmental disorders and other delays and can result in energy and nutrient deficiencies. Although interventions for problematic feeding behavior are common, there is limited information for children without a pediatric feeding disorder who self-feed but exclusively do so inappropriately. We used a proactive approach, with a foundation in the skill-acquisition literature, to address the inappropriate self-feeding of seven children with neurodevelopmental disorders or other delays but without a feeding-related diagnosis. We first evaluated response blocking as an assessment to identify motivation and skill deficits. The assessment identified a skill deficit, a motivation deficit, and a combined deficit for four, two, and one participant, respectively. These results informed treatment for six of the seven participants. Treatment for a motivation deficit included response blocking with and without programmed differential reinforcement. Treatment for a skill deficit included backward chaining with response blocking and programmed differential reinforcement. Treatments were generally successful for all six participants. We discuss the usefulness and implications of response blocking as a brief assessment for inappropriate self-feeding.

A US-Based Consensus on Diagnostic Overlap andDistinction for Pediatric Feeding Disorder andAvoidant/Restrictive Food Intake Disorder.

As diagnoses covering dysfunctional feeding and eating in pediatrics, avoidant/restrictive food intake disorder (ARFID) and pediatric feeding disorder (PFD) contain inherent areas of overlap in their diagnostic criteria. Areas of overlap include criteria regarding nutritional consequences associated with feeding/eating dysfunction and shared emphasis on possible psychosocial impairment associated with restricted food intake. Complicating the differential diagnosis process is a lack of guidance regarding when the two conditions occur independently, co-qualify, and/or transition into the other. Feeding Matters' Research Initiatives Task Force planned and hosted a PFD-ARFID consensus meeting, with the aim of reaching a consensus regarding diagnostic clarity on PFD and ARFID. Criteria for participation focused on US residents who either: (a) served as an author on the ARFID workgroup or PFD consensus papers, or (b) provided community representation via board or committee roles. The consensus process followed three stages: prework, the meeting, and post-work/writing. Twelve participants were present for the meeting, with 14 involved in pre- and post-work/writing. The final panel included four psychologists representing the ARFID community and seven multidisciplinary members representing PFD's four domains (medical, nutrition, skill, and psychosocial) plus a Zero-to-Three community representative and two representatives from Feeding Matters. Results yielded 10 consensus statements and visuals to support the consensus statements. The consensus process and results underscore an ongoing need to improve diagnostic systems and reinforce calls for strengthening healthcare expertise for both PFD and ARFID. Community-based participatory research is recommended to advance both diagnoses and reduce ambiguity in practice settings.

Empirical Approaches to the Classification of Avoidant/Restrictive Food Intake Disorder.

Avoidant/restrictive food intake disorder (ARFID) is a relatively new formal diagnosis for which empirical classification research (defined here as studies using latent class/latent profile analysis-type methods) is still emerging. Such research focused on ARFID is an important gap to fill given questions about (1) the boundaries between ARFID and phenotypically similar presentations (e.g., eating disorders [EDs] such as anorexia nervosa [AN], and pediatric feeding disorder [PFD]), and (2) within-ARFID heterogeneity. These questions have practical implications, including diagnostic reliability and treatment selection. This forum synthesizes the limited empirical classification literature seeking to quantitatively distinguish ARFID from non-ARFID EDs or from PFD, and/or characterize within-ARFID heterogeneity. To our knowledge, only five studies in clinical samples have used empirical classification methods to delineate ARFID from non-ARFID EDs and/or characterize within-ARFID heterogeneity; no studies have used such methods to delineate ARFID from PFD. Existing studies are mixed in determining how well ARFID can be distinguished from other EDs (particularly AN), but converge in identifying several potential ARFID subclasses (i.e., sensory sensitivity, low appetite, feared eating-related consequences, and subclass representing a combination of these) with some overlapping features. The existing ARFID empirical classification literature should guide future ARFID classification research priorities (e.g., incorporating mechanistic variables as classification indicators, incorporating longitudinal variables as classification validators) to inform differences between ARFID and other disorders and between ARFID presentations. Dimensional approaches to conceptualizing, studying, and modeling psychopathology (namely, the Hierarchical Taxonomy of Psychopathology [HiTOP] and the Research Domain Criteria [RDoC]) may offer useful insights.

Diet, growth, nutritional status and predictors of severity of feeding difficulties in autistic children with co-occurring pediatric feeding disorder

Diet, growth, nutritional status and predictors of severity of feeding difficulties in autistic children with co-occurring pediatric feeding disorder

A guide to the community management of paediatric eating disorders.

Eating disorders (EDs) are a group of serious, potentially life-threatening illnesses that typically have their onset during adolescence and can be associated with severe medical and psychosocial complications. The impact of EDs on caregivers and other family members can also be significant. Health care providers (HCPs) play an important role in the screening and management of adolescents and young adults with EDs. This position statement assists community-based HCPs with recognizing, diagnosing, and treating EDs in the paediatric population. Screening modalities, indications for hospitalization, medical complications, and monitoring of young people with EDs are summarized. Current evidence supports the use of family-based treatment (FBT) as the first-line psychological therapeutic modality for adolescents with restrictive EDs. While the provision of FBT may be beyond the scope of practice for some community physicians, this statement reviews its core tenets. When an ED is diagnosed, early application of these principles in the community setting by HCPs may slow disease progression and provide guidance to families.

Anorexia nervosa with comorbid autism spectrum disorder: Optimizing care for youth, caregivers, and health care providers.

Youth with anorexia nervosa (AN) have been reported to have high levels of comorbid autism spectrum disorder (ASD) and ASD-like traits suggesting a potential shared underlying neurodevelopmental or genetic link between the disorders. Youth with comorbid AN and ASD symptomatology generally require more intensive treatment and have worse psychological outcomes following treatment. To date, no Canadian national guidelines exist for the treatment of this comorbidity. An informal survey of tertiary paediatric eating disorder programs across Canada revealed that centres do not routinely screen for ASD at intake and few offer any treatment modifications for youth with AN and suspected/diagnosed comorbid ASD. This represents a significant care gap for this clinical sub-population and an important area for future study and healthcare provider training.

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

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

Supplemental Material for Acceptance and Commitment Therapy for a Parent of a Child With Pediatric Feeding Disorder: A Case Study

Supplemental Material for Acceptance and Commitment Therapy for a Parent of a Child With Pediatric Feeding Disorder: A Case Study

Trajectory of Infant Problematic Feeding Symptoms: Study Protocol.

Infants with developmental risk factors are more likely to have feeding problems and develop chronic feeding disorders. Early detection and understanding of the progression of problematic feeding and its relationship with a child's biological functioning and the family feeding environment will enhance effective symptom management and development of interventions to prevent pediatric feeding disorders. The New Through Two (NewThru2) feeding study protocol is described. Study aims are to (a) characterize symptoms of problematic feeding and trajectories of symptoms from pre-discharge from neonatal intensive care through age 24 months; (b) determine the relationship of child biological function at discharge with symptom characteristics and trajectories; (c) describe the child's feeding environment and its relationship to symptoms from discharge through 24 months; and (d) determine the relationship between problematic feeding symptoms and growth and developmental outcomes. NewThru2 is a prospective, longitudinal, mixed method study following over 200 infants who received care in a neonatal intensive care unit and were identified as at risk for compromised development. The study follows enrolled infants through 24 months of age. Symptoms of problematic feeding are measured pre-discharge by clinical observation and medical record review and post-discharge by parent report. Biological function is measured by medical history and cardiorespiratory and autonomic nervous system function during feeding prior to discharge. Child feeding environment is measured by strategies parents use to manage feeding, the effect of feeding on the parent and family, and the use of feeding services. A subset of parents is interviewed to achieve a contextual understanding of the family feeding environment. Child outcome measures include parent-reported feeding skills and clinician-reported growth and neurodevelopment. The results of this study will improve understanding of pediatric feeding disorders during a time of development sensitive to adequate nutrition and with infants at risk for developmental delays or impairments.