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Feeding problems in early childhood are common and affect parental behaviour with more use of maladaptive feeding strategies. Although multi‐family therapy is well known as an effective intervention for adolescents and adults with eating disorders/problems, the use of multi‐family therapy for toddlers with feeding problems is rather rare. In this paper we describe how we adapted the evidence‐based goals of multi‐family therapy to a specific format for parents and toddlers and how we used it in our clinical work. We explain the importance of creating a supportive culture in which parents may develop effective feeding strategies. We describe how we used non‐verbal techniques in multi‐family therapy as a tool for growth for both toddlers and parents. We end with some retrospective reflections and directions for future therapy and research. [ABSTRACT FROM AUTHOR]

Introduction: To date, there are no caregiver-reported screening measures of oral behaviors related to feeding. The goal of this study was to develop such a measure. Method: Caregivers of 803 children referred to a feeding clinic and 188 comparison children reported their children's frequency of nine oral behaviors. These data were used to develop an Oral Behavior Screener (OBS). Both the psychometrics of the OBS and the relations between the OBS and child demographics were examined. Results: As expected, the clinical sample demonstrated more deficits in oral behaviors than the comparison sample. We also found special needs status and age were linked to the OBS summary score. Discussion: The OBS is a brief screener that can be used by clinicians to examine the need for further assessment, possible targets for intervention, oral behaviors often associated with feeding problems. [ABSTRACT FROM AUTHOR]

Background: Child food neophobia, i.e., rejection or avoidance of novel foods at a young age, is a prevalent nutrition problem that affects the quality of children's diet and impedes the development of healthy food preferences. Sensory sensitivity can relate to the degree of food neophobia, but previous studies rarely focused on the olfactory component of this problem in children. Objective: We aimed to thoroughly examine the relationship between various aspects of olfactory sensitivity and food neophobia in children. Methods: 246 children aged between three and nine years took part in a food neophobia assessment as well as in a comprehensive, psychophysical olfactory testing. Results: We found that certain smell perception aspects such as lower odor liking, poorer odor identification ability as well as lower sensitivity to an unknown non-food odor all significantly predicted higher food neophobia in children. Among individual characteristics of either a child or a caregiver, only the child's age significantly and positively predicted food neophobia. The exploratory model looking into the role of family environment factors predicting self-reported food neophobia in children revealed that food neophobia was associated with lower control given to a child in this child's feeding process, as well as with a more frequent use of food as a reward in feeding. Conclusions: We suggest that suppressed olfactory perception and performance can play a unique role in child nutritional difficulties. The study inspires further considerations of olfaction-engaging interventions to counteract food-neophobia in children. [ABSTRACT FROM AUTHOR]

Background: Feeding problems in children with autism jeopardize the well‐being of both children with autism and their families. Mixed findings were reported from previous interventions, which were mostly evaluated by single subject research design (SSRD) studies. Moreover, feasibility assessment and social validity measurement were unaddressed by these SSRD studies. To fill this substantial knowledge gap, the present review systematically summarized and evaluated feeding interventions implemented in children with autism, which were assessed by studies employing group designs. Method: An extensive literature search in eight established online databases was conducted, and a total of 17 eligible studies published in 2009–2021 were included for further analysis. A descriptive account of the features of the investigations is provided, including assessment of study quality. Results: A total of 449 children with autism and 203 parents/caregivers participated in the included studies. The multiple use of five strategic intervention components were highlighted in this review, including nutrition education/consultations, environmental modifications, sensory exposure, cognitive components, and behaviour interventions. The reviewed interventions showed a preliminarily positive effect for modifying feeding problems in children with autism. Furthermore, the evaluation based on the RE‐AIM framework (reach, efficacy, adoption, implementation, and maintenance) demonstrated that an interdisciplinary multi‐component intervention strategy may achieve high effectiveness and feasibility in improving feeding problems in a wide range of children with autism. Conclusions: This review found that interventions achieved and maintained a positive effect on modification of feeding problems in groups of children with autism. Information and gaps identified and summarized in the implementation process may assist both researchers and stakeholders to further support these vulnerable children. [ABSTRACT FROM AUTHOR]

Infants with Down syndrome are more likely to experience feeding problems and mothers are likely to require more feeding support than mothers of typically developing infants. During the COVID-19 pandemic, many feeding support services changed from face-to-face to online, which impacted some maternal feeding experiences negatively, but no studies to date have explored the impact for mothers of infants with Down syndrome. Thematic analysis was conducted on semi-structured interviews from thirteen new mothers of infants (aged 8–17 months) with Down syndrome in the UK. Three superordinate themes were generated: (1) Every baby with Down syndrome has a unique journey, (2) There's no point asking, they won't know, (3) Lack of in-person support. Many mothers expressed frustrations over health professionals' lack of Down syndrome specific knowledge resulting in unmet needs, further magnified due to the nature of the virtual support being offered. Moreover, mothers struggled with reduced social support from other mothers when encountering feeding problems. These results hold real-world implications for health professionals who could provide more specialised face-to-face feeding support to mothers of infants with Down syndrome. This should be prioritised for children's overall development and mothers' wellbeing. [ABSTRACT FROM AUTHOR]

BackgroundThe effect of COVID-19 in pregnancy on maternal outcomes and its association with preeclampsia and gestational diabetes mellitus have been reported; however, a detailed understanding of the effects of maternal positivity, delivery mode, and perinatal practices on fetal and neonatal outcomes is urgently needed.ObjectiveTo evaluate the impact of COVID-19 on fetal and neonatal outcomes and the role of mode of delivery, breastfeeding, and early neonatal care practices on the risk of mother-to-child transmission.Study designIn this cohort study that took place from March 2020 to March 2021, involving 43 institutions in 18 countries, 2 unmatched, consecutive, unexposed women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. COVID-19 in pregnancy was determined by laboratory confirmation and/or radiological pulmonary findings or ≥2 predefined COVID-19 symptoms. The outcome measures were indices of neonatal and perinatal morbidity and mortality, neonatal positivity and its correlation with mode of delivery, breastfeeding, and hospital neonatal care practices.ResultsA total of 586 neonates born to women with COVID-19 diagnosis and 1535 neonates born to women without COVID-19 diagnosis were enrolled. Women with COVID-19 diagnosis had a higher rate of cesarean delivery (52.8% vs 38.5% for those without COVID-19 diagnosis, P14 days). Among neonates born to mothers with COVID-19 diagnosis, birth via cesarean delivery was a risk factor for testing positive for COVID-19 (odds ratio, 2.4; 95% confidence interval, 1.2-4.7), even when severity of maternal conditions was considered and after multivariable logistic analysis. In the subgroup of neonates born to women with COVID-19 diagnosis, the outcomes worsened when the neonate also tested positive, with higher rates of neonatal intensive care unit admission, fever, gastrointestinal and respiratory symptoms, and death, even after adjusting for prematurity. Breastfeeding by mothers with COVID-19 diagnosis and hospital neonatal care practices, including immediate skin-to-skin contact and rooming-in, were not associated with an increased risk of newborn positivity.ConclusionIn this multinational cohort study, COVID-19 in pregnancy was associated with increased maternal and neonatal complications. Cesarean delivery was significantly associated with newborn COVID-19 diagnosis. Vaginal delivery should be considered the safest mode of delivery if obstetrical and health conditions allow it. Mother-to-child skin-to-skin contact, rooming-in, and direct breastfeeding were not risk factors for newborn COVID-19 diagnosis, thus well-established best practices can be continued among women with COVID-19 diagnosis.

Abstract 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.

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. [ABSTRACT FROM AUTHOR]

Introduction: Children affected by Paediatric Feeding Disorder (PFD) cannot consume enough nourishment by mouth. PFD is highly prevalent and can affect the child's growth and development as well as family life. Aim: To illuminate Swedish parents' experiences of living with a child with PFD. Method: Semi‐structured interviews via telephone or video calls were conducted with 14 purposefully recruited mothers and six fathers. The interviews were analysed using content analysis. Ethics approval was obtained, and the parents all gave informed consent. Results: Four overarching themes emerged: Living with stress; Advocating for the child; Adapting family life; and Gaining hope. Parents described fearing for their child's life and health, feeling pressure over meals and being emotionally affected. They told of experiencing a lack of understanding from healthcare professionals, friends and family. Parents expressed a struggle for help, the need for early interventions and more effective treatment, and developed strategies for coping with the demands of feeding and caring for their child, accepting their living reality. Finding support from a network helped, but the adaptation of daily life affected their family relations. They felt gratitude towards helpful professionals and relief and joy when their child was doing better. Conclusions: A more cohesive chain of care is important for children with PFD, and guidelines and educational support for healthcare providers are needed. Parental experiences provide a base for knowledge for further development of early detection and intervention for children with PFD. [ABSTRACT FROM AUTHOR]

The aberrant right subclavian artery (i.e., arteria lusoria) arising from the left part of the aortic arch is a rare congenital anomaly. In some patients, esophageal compression may cause symptoms of dysphagia, also called dysphagia lusoria. It can cause serious feeding disorders and poor weight gain in young children. We present the case of an early onset of dysphagia lusoria in a 1-month-old girl whose clinical diagnosis was confirmed by esophagography and magnetic resonance imaging. This kind of vascular anomaly can present a diagnostic challenge and should be considered in diagnosing dysphagia in childhood. [ABSTRACT FROM AUTHOR]

Objective Children with Down syndrome may experience more challenges in their early feeding and may be introduced to complementary foods comparatively later than typically developing (TD) children. This scoping review aimed to identify and synthesize the existing literature that describes feeding problems and early eating experiences relating to the period of complementary feeding for children with Down syndrome. Methods Scopus, PubMed, Medline, Web of Science, and PsycInfo were searched. Journal articles published between January 1991 and June 2022 that reported on the complementary feeding period with children with Down syndrome were included. Results Eighteen journal articles met the inclusion criteria. Children with Down syndrome were introduced to complementary foods later than TD children and progressed to more challenging food textures at a slower rate. Gross and fine motor skill delays and sensory difficulties contributed to secondary feeding problems such as difficulties chewing, biting, and reduced awareness of food on lips and tongue. Parents of children with Down syndrome reported exercising more caution and employing more controlling feeding practices compared to TD and had higher levels of concern regarding their child's weight. Conclusions Guidelines and early feeding support specific to children with Down syndrome should be available before the first complementary foods are introduced and throughout this period. Feeding support should aim to address parental concerns and provide assistance when feeding problems occur, to minimize delays and encourage the optimum development of eating abilities. Future research should address the development of feeding problems during this period and explore possible interventions. [ABSTRACT FROM AUTHOR]

Background: There is a lack of evidence-based app guidance for parents of children with crying, sleeping, and feeding problems who are often highly burdened and not likely to seek professional help. A new psychoeducational app for parents providing scientifically sound information via text and videos, a diary function, selfcare strategies, a chat forum and a regional directory of specialized counseling centers may serve as a low-threshold intervention for this target group. Objective: We investigated how parents perceived the app in terms of the following: (1) overall impression and usability, (2) feedback on specific app functions regarding usefulness and (3) possible future improvements. Methods: Our clinical sample of N = 137 parents of children aged from 0 to 24 months was recruited from a cry baby outpatient clinic in Southern Germany between 2019 and 2022. A convergent parallel mixed methods design was used to collect and analyse cross-sectional data on app evaluation. After app use within the framework of a clinical trial, parents filled in an app evaluation questionnaire. Results: Most participants used the app at least once a week (86, 62.8 %) over an average period of 19.06 days (SD = 15.00). Participants rated overall impression and usability as good, and the informational texts, expert videos and regional register of counseling centers as appealing and useful. The diary function and chat forum were found to be helpful in theory, but improvements in implementation were requested, such as a timer function for the diary entry. Regarding future functionality, parents posed several suggestions such as the option to contact counseling centers directly via app, and the inclusion of the profile of their partners. Conclusions: Positive ratings of overall impression, usability, and specific app functions are important prerequisites for the app to be effective. App-based guidance for this target group should include easy-to-use information. The app is intended to serve as a secondary preventive low-threshold offer and to complement professional counseling.

Functional disorders of the esophagus are known as esophageal dysmotility disorders. Esophageal manometry can be used to study swallowing disorders, feeding problems, nonobstructive dysphagia, and lower esophageal dysfunction. This paper discusses the recent advances in and reviews the use of high-resolution esophageal manometry in children. The Chicago 4.0 classification should be used judiciously in children. Manometric studies can guide the proper management of dysmotility in children.

Background: Noonan syndrome spectrum disorders (NSSDs) constitute a group within the Rasopathies, and are one of the largest groups of syndromes with impact on multi-organ involvement known. The extreme variability of the clinical phenotype is, among others, due to the numerous different genes that are involved, and the differences in clinical presentation over the life span. We have studied the needs of patients and their relatives aiming to develop, evaluate and choose focus in research, medical care and policy to better meet their perspectives. Methods: Using the participatory and interactive Dialogue method, 80 patients and relatives mentioned 53 different problems or needs (topics) that were categorized into eight themes. These themes and the topics within each theme, were subsequently prioritized by putting them in order of importance methodologically. Results: The four highest prioritized themes were: (1) Physical problems (non-musculoskeletal related); (2) Social, emotional and behavioral problems; (3) Cognitive functioning and information processing; and (4) Problems related to the musculoskeletal system. Nineteen out of the 53 topics were physical problems. According to the total group of respondents, the top 3 prioritized topics within theme 1 were coagulation problems, heart problems, and feeding problems. Also data stratified by age groups, phenotype (NS and other NSSDs) and gender showed some remarkable results. For instance, feeding problems were prioritized as the most important topic of the highest prioritized theme, according to patients aged 0–12 years. Also feeding problems show a significant difference in its prioritization according to female patients (2) compared to male patients (7). On the other hand, heart problems were not mentioned in the top three prioritized topics in the youngest age groups, although heart problems are generally considered most important for patients with NSSD. Conclusions: With our results we underline the importance of methodologically inventorying the needs of NSSD patients, not only at the group level, but to also focus on specific needs according to e.g. age, phenotype and gender. For instance, it is remarkable that both the current Clinical Guidelines and the Noonan Syndrome diagnostic criteria give little to no attention to feeding problems, though our results indicate that, to the youngest patients, these problems have top priority. A similar situation appears to apply to the clinical management of e.g. coagulation, neuropsychological and musculoskeletal problems (like physiotherapy or occupational therapy) and to a need for (educational) tools to support patients at school or at work. Our study may help to shape targeted (clinical) management, research and policy inside and outside medical (research) institutes and shed light on the complex phenotypes of NSSDs, the families' and patients' perspectives on the everyday consequences of the many different problems, as well as their needs. [ABSTRACT FROM AUTHOR]

The purpose of this paper was to review the current state of the behavior analytic feeding intervention literature. We highlight studies that we found to be important contributions to the recent literature in the following areas: food selectivity, chewing, packing, and food refusal/tube weaning and provide suggestions for future research and clinical work in these areas. We also discuss several current topics relevant to the field in hopes to further advance research and clinical practice. These topics include considering the benefits of innovative models of service delivery such as telehealth and caregiver-implemented interventions, the importance of evaluating long-term outcomes of behavioral feeding interventions, and lastly, ethical issues to consider in the designing and implementation of behavioral feeding interventions and training of practitioners in our field. [ABSTRACT FROM AUTHOR]

We conducted a prospective cohort study with children aged 6 to 18 months to identify predictors of feeding problems in an urban sample. Parent-reported child feeding problems (Montreal Children's Hospital Feeding Scale) and picky eating, parental anxiety (Generalized Anxiety Disorder 7), and family meal structure (Meals in Our Household) were assessed via a Web-based survey at 3 time points. Data analysis included descriptive statistics, correlations, and mixed-effects regression modeling. Eighty parents completed the survey. Child picky eating (r =.51) and resistance to try new foods (r =.30), parental anxiety (r =.34), rushed mealtimes (r =.28), and child age (r =.32) were significantly associated with child feeding problems. Feeding Scale scores were, on average, 6 points higher among picky eaters than those who were not over time (p <.001). Parent reports of picky eating early in life may warrant additional clinical investigation and referral to feeding specialists. [ABSTRACT FROM AUTHOR]

Background: The rate of infants born with neonatal abstinence syndrome (NAS) increased by more than 500% between 2004 and 2016. Although feeding problems among infants diagnosed with NAS have been documented, the risk of feeding problems among infants diagnosed with NAS has not been estimated. Purpose: This study evaluates the extent to which feeding problems among infants diagnosed with NAS differ from thise in infants without an NAS diagnosis. Methods/Search Strategy: A matched retrospective cohort study (2008-2017) of infants diagnosed with NAS in the United States was conducted using hospital admission data from the Cerner Health Facts Database. Multivariable logistic regressions controlling for confounders were used to assess whether an NAS diagnosis is associated with hospital admission due to feeding problems. Findings/Results: Infants with NAS were nearly 3 times as likely (OR = 2.81; 95% CI, 2.68-2.95) to have feeding problems compared with infants without NAS after adjusting for infant and hospital characteristics. Lower birth weight, higher infant age, Hispanic ethnicity, and hospital location in the Midwest region were also associated with higher odds of feeding problems. Infants diagnosed with NAS who had feeding problems had slightly lower odds of being offered lactation services than infants without NAS who had feeding problems. Implications for Practice: These findings suggest the need for targeted feeding interventions. Implications for Research: Future research on infants with NAS may build on these findings by assessing the role of maternal factors such as nutrition and substance use to understand how parental characteristics also influence the risk for hospitalization. [ABSTRACT FROM AUTHOR]

Introduction: The Pediatric Eating Assessment Tool (PediEAT) is a parent-report tool to assess feeding problems in children aged 6 months to 7 years. This study aimed to translate and adapt the PediEAT to Persian and determine its psychometric properties. Methods: The PediEAT was translated and culturally adapted the following guidelines for health-related instruments. Face and content validity was assessed using an expert panel. This study also aimed to evaluate psychometric properties using a sample of 160 children without feeding problems and 43 children with diagnosed feeding problems. Known-groups validation was used to compare PediEAT scores between children with and without feeding problems. In criterion validity, pediatricians' opinions were used as a criterion. To calculate internal consistency, Cronbach's alpha was used. After 2 weeks, temporal stability was assessed with 40 parents who repeated the PediEAT. Results: Face and content validity showed that all tool items had CVI and kappa coefficients higher than 0.8. Known-group validity showed that the total and subscale scores significantly differed between children with and without feeding problems (p < 0.001). Criterion validity showed that criterion measurements correlated with questionnaire measurements. All four subscales and the total scale showed acceptable internal consistency reliability (Cronbach's alpha > 0.74). Test-retest reliability was acceptable (ICC = 0.987, p < 0.001). Conclusions: The PediEAT-Persian version is a valid and reliable tool for assessing symptoms of problematic feeding in Persian children aged 6 months to 7 years. [ABSTRACT FROM AUTHOR]

Background: Feeding problems are among the most common issues in infancy and childhood. It’s essential to investigate and identify these problems in early childhood because early detection can lead to early treatment of these problems. The present study intends to provide a comprehensive review of screening tools and assessment for feeding problems in infants and children. Materials and Methods: The information was obtained through PubMed, Scopus, Medline, Web of Science, Google scholar, and Iranian databases from 1993 to 2020. Based on the keywords used, 50 related articles were obtained. Then, 18 articles were selected based on the purpose of this study. Results: In total, 18 tools were obtained. The 3 tools were related to screening for feeding problems, and the rest were related to assessing feeding problems in infants and children. Also, among these tools, 5 tools could be used from birth, and the rest could be used from older ages, about 6 months onwards. Of these tools, 3 tools are completed by an assessor or therapist, and the rest by a parent or caregiver. 5 tools, in addition to examining children's nutritional issues, also assess parents' feelings and reactions to their child's feeding problems. Also, the validity and reliability of these 18 tools were examined. Conclusion: There are a variety of standard tools for screening and assessing infant and child feeding problems in English. The results of this review study, while introducing these tools to therapists, can lead to their rapid access to these tools.

Functional disorders of the esophagus are known as esophageal dysmotility disorders. Esophageal manometry can be used to study swallowing disorders, feeding problems, nonobstructive dysphagia, and lower esophageal dysfunction. This paper discusses the recent advances in and reviews the use of highresolution esophageal manometry in children. The Chicago 4.0 classification should be used judiciously in children. Manometric studies can guide the proper management of dysmotility in children. [ABSTRACT FROM AUTHOR]

Enteral feeding is a common problem in children with gastric emptying disorders. Traditional feeding methods in these patients often show a high rate of complications and maintenance issues. Laparoscopic Roux-en-Y feeding jejunostomy (LRFJ) has been described in a few patients as a minimal invasive option for enteral access in these children. The aim of this study is to evaluate the outcomes of the LRFJ procedure in our tertiary referral center. We conducted a retrospective case-series including all patients, aged 0–18 years old, that underwent a LFRJ procedure between August 2011 and December 2020 for the indication of oral feeding intolerance due to delayed gastric emptying. Outcomes evaluated were complications (short and long term) and parenteral satisfaction. In total, 12 children were identified that underwent LRFJ for the indication of oral feeding intolerance due to delayed gastric emptying. A total of 16 complications were noted in 8/12 patients (67%). Severity classified by Clavien-Dindo were grade I (n = 13), grade II (n = 1), and grade IIIB (n = 2). In 11/12 patients, parents were satisfied with the results. Conclusions: Although minor complications after LRFJ are common in our patients, this technique is a safe solution in patients with gastric emptying disorders leading to a definitive method of enteral feeding and high parenteral satisfaction. What is Known: • Traditional tube feeding in children (duodenal, PEG-J-tubes) with severe delayed gastric emptying can be challenging with a high rate of complications and maintenance issues. • Open loop jejunostomy and Roux-en-Y jejunostomy are alternative, permanent methods of feeding but either invasive or are accompanied by severe complications. Little is known in the literature about laparoscopic Roux-en-Y feeding jejunostomy. What is New: • Laparoscopic Roux-en-Y feeding jejunostomy is a permanent, safe and minimal invasive alternative option for enteral feeding in children with severe delayed gastric emptying.. [ABSTRACT FROM AUTHOR]

Background: Feeding problems are common in early childhood, and some evidence suggests that feeding problems may be associated with psychopathology. Few prospective studies have explored whether toddler feeding problems predict later psychopathology. Methods: Mothers of 1,136 children from the Upstate KIDS cohort study provided data when children were 2.5 and 8 years of age. Food refusal (picky eating) and mechanical/distress feeding problems and developmental delays were assessed at 2.5 years. Child eating behaviors (enjoyment of food, food fussiness, and emotional under and overeating) and child psychopathology (attention‐deficit/hyperactivity (ADHD), oppositional‐defiant (OD), conduct disorder (CD), and anxiety/depression) symptoms were assessed at 8 years. Results: Mechanical/distress feeding problems at age 2.5, but not food refusal problems, were associated with ADHD, problematic behavior (OD/CD), and anxiety/depression symptoms at 8 years in models adjusting for eating behaviors at 8 years and child and family covariates. Associations with mechanical/distress feeding problems were larger for ADHD and problematic behavior than anxiety/depression symptoms, though all were modest. Model estimates were similar for boys and girls. Conclusions: Much of the research on feeding problems focuses on picky eating. This study suggests that early mechanical and mealtime distress problems may serve as better predictors of later psychopathology than food refusal. Parents and pediatricians could monitor children with mechanical/distress feeding problems for signs of developing psychopathology. [ABSTRACT FROM AUTHOR]

Feeding/behavior problems are highly prevalent in autistic children. This study aimed to explore the interplay between autistic features, sensory processing patterns, emotional/behavioral difficulties, and feeding problems in children with a clinical diagnosis of autism spectrum disorder. Ninety-nine children aged 1.5–5 years were assessed using the Children's Eating Behavior Inventory (CEBI), the Child Behavior Checklist, the Revised Sensory Profile—Second Edition (SP-2), and the Food Frequency Questionnaire. The sample was divided into two subgroups based on the presence of feeding behavior problems as rated by parents on the CEBI. Children with feeding problems showed more severe internalizing symptoms and were more reactive to sensory stimuli than children without feeding problems. We also found a significant relationship between higher levels of autistic features and greater feeding behavior problems. A mediation analysis model indicated that this relationship was mediated by sensory processing, as reflected by SP-2 quadrants scores. Although preliminary, these findings suggest that children with higher levels of autistic features could be at greater risk of developing feeding behavior problems only if they also have a higher sensory sensitivity to environmental stimuli. This study adds to a growing body of research documenting feeding problems in autistic children. Our results indicate that children aged 1.5–5 years with feeding problems may present with elevated internalizing difficulties and alterations in sensory processing when compared to same-age children without feeding problems. Our study also proposes that sensory processing may be an important, mediating factor in the relationship between autism features and feeding problems. The present work suggests, therefore, that implementers should thoroughly consider the sensory profile of autistic children prior to intervening on feeding behaviors. In particular, based on these preliminary findings, feeding interventions could benefit from environments designed to support children who can find them noisy and overwhelming. [ABSTRACT FROM AUTHOR]

Congenital diaphragmatic hernia (CDH) affects 1 in 3000–5000 newborns. In survivors, long-term complications include gastroesophageal reflux (GER), feeding difficulties, and failure to thrive. Data from the parents' perspective remain scarce. This study aims to report the prevalence and impact of feeding difficulties on CDH families after discharge. National web-based survey amongst families with CDH infants in 2021. Caregivers of 112 CDH survivors participated. The baseline characteristics were representative with 54 % male, 83 % left-sided CDH, prenatal diagnosis in 83 %, and 34 % requiring extracorporeal membrane oxygenation. Most infants (81 %) were discharged within three months, with 62 % feeding by mouth, and 30 % requiring a feeding tube. Persisting feeding difficulties were experienced by 73 %, GER being the most common (66 %), followed by insufficient weight gain (64 %). After discharge, 41 % received medical support for failure to thrive. The primary-care pediatrician was consulted most frequently for information (61 %) and treatment of feeding difficulties (74 %). Therapeutic success was reported in 64 %. A cessation of symptoms was achieved in 89 % within three years. The majority of CDH infants had persistent feeding difficulties. This survey highlights the impact surrounding feeding problems on CDH families. Further studies and support systems are needed to raise the quality of life in CDH infants and their families. • In CDH survivors, symptoms involving the gastrointestinal tract are common long-term comorbidities. • Data on the prevalence of parental-perceived health issues remain scarce. • Our study provides data from a large cohort, which may help improve counselling and patients support-strategies. [ABSTRACT FROM AUTHOR]

In patients with congenital diaphragmatic hernia 1 , nutrition can represent a challenge both in the short and long term. Its failure to resolve can have a significant impact on multiple aspects of the lives of patients with congenital diaphragmatic hernia (CDH), ranging from lung function to neurodevelopment. In this review, we will describe the causes of nutritional problems in patients with CDH, their consequences, and possible strategies to address them. [ABSTRACT FROM AUTHOR]

Children with cleft lip and palate often suffer from nutritional deficiencies and subsequent growth problems, both of which are largely attributed to feeding difficulties due to the structural defect as well as the numerous surgical procedures that they undergo. The aim of this review article is to assess the nutritional needs of such children and to emphasize the role of nutrition in their long-term growth and development along with parental education on nutrition and various alternative feeding practices as an important aspect in the management of cleft lip and palate which may otherwise be overlooked. For this review, various articles on cleft lip and palate from plastic surgery to dental surgery journals were studied and more articles were based on subsequent bibliographic reviews of the above. It was concluded that to achieve optimal health in these children, the dietary changes required per day were minuscule. Rather, it is the delivery method of breast milk or formula which often needs to be changed to reduce effort and resultant caloric loss by the newborn, indirectly boosting the caloric intake and resultant weight gain and growth.

Background: Food allergy (FA) affects around 5.6 million children in the United States, conferring risk for negative impacts on growth and psychosocial functioning. While evidence suggests a higher prevalence of feeding difficulties in children with FA, the link between FA and feeding dysfunction remains unclear., Objective: To investigate feeding problems in children with parent-reported IgE-mediated FA and/or pediatric feeding disorder (PFD) compared with healthy children in a community-based sample and explore factors associated with feeding problems in children with FA., Methods: A matched cross-sectional cohort study used survey data from 352 parents of children aged 6 months to 7 years who reported a diagnosed IgE-mediated FA and/or PFD (50 with FA only, 67 with FA and PFD, and 235 with PFD only). Healthy children were matched based on age, sex, race, and socioeconomic factors. Feeding problems were assessed using the Pediatric Eating Assessment Tool. Matched-pairs generalized linear regressions compared each cohort and explored factors associated with feeding problems in children with FA., Results: Children with FA exhibited significantly higher feeding problems compared with healthy children. Children with a diagnosed PFD had more severe feeding problems, irrespective of comorbid FA. Factors linked with feeding problems in children with FA included older age, non-White race, increased medical comorbidity, and limited dietary variety., Conclusions: This study adds to evidence indicating a higher prevalence of feeding problems in children with FA. Clinicians treating FA patients should routinely screen for feeding and growth concerns and consider referral to multidisciplinary feeding programs as needed., (Copyright © 2024 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

"Picky eating" is a common behaviour seen in childhood in both clinical and nonclinical populations. Sensory processing difficulties have been repeatedly associated with food refusal and picky eating behaviours. The aim of this study was to explore the lived experiences of parents/caregivers who have a child displaying both sensory processing differences and picky eating behaviours utilising Interpretative Phenomenological Analysis (IPA). Participants were recruited from social media support groups for parents of picky eating children. Pre‐selection criteria utilised an adapted short sensory profile questionnaire to ensure the children displayed probable/definite taste‐smell, audio‐visual and tactile sensory sensitivities. Twelve participants fulfilling the required criteria were interviewed face to face utilising a semi‐structured interview schedule. Interviews were transcribed and analysed following IPA guidelines and three common themes are presented here: Battling for control of the sensory environment, Living with stigma and, disapproval, and Staying positive and moving forward. The findings show the very considerable day‐to‐day challenges of parenting a child with sensory issues with food, including a lack of support and criticism from others. It was apparent that the parents in our study gradually adopted a positive and accepting attitude to their child's eating. This acceptance allowed them to have positive interactions around food with their child such as cooking and playing with food, suggesting that experiential activities serve an important purpose in this population. Further research should examine whether parental interventions based on acceptance of child eating behaviour, and commitment to gradual positive food interactions would be the best strategy to support parents and children. Key Points: Picky eating in children with sensory processing difference led to specific behaviours around food, for example, the identification of very small sensory differences in foods, and between different brands of the same foods. This caused disruption at family mealtimes, extra food preparation work, and judgement from others.Parents all expressed a need for better awareness and support from health professionals and the wider public. Those who used online support groups found great comfort and advice from parents experiencing similar problemsParents seemed to go on a journey of acceptance of their child's behaviour, and tried to adopt positive food parenting strategies. In particular, they used experiential learning strategies such as playing with, cooking with, and shopping for food which allowed them to interact with their child and food in a positive way. [ABSTRACT FROM AUTHOR]

This study mainly aimed to study some nutritional and health problems associated with feeding infants in Alexandria, and the sample consisted of 300 infants aged 12،18 months. The general characteristics of the children were identified, the anthropometric were evaluated for the children in the study sample. The nutrition included the type of breastfeeding and solid and semi-solid complementary foods and drinks, nutritional supplements during the breastfeeding period, recording the level of hemoglobin in the blood of the children of the study sample and obtained from health centers and hospitals affiliated with the Ministry of Health and Population,, studying the manifestations and demands of growth related to taking vitamin D and also identifying the incidence of food allergy And the health problems that children suffer from, a t-test was conducted to identify the differences between the gender of the child (male or female) and each of the variables (current weight, height, hemoglobin, growth features, health problems). The results indicated that the sample included 53.7% of females compared to 46.3% of males. For infants ages ranging between 12 months (37%) and 18 months (63%), and when studying anthropometric measures, it was found that there were cases of stunting when studying height for age. Also, when studying weight for age, it was found that there were infants who suffer from underweight according to the standard growth levels of the World Health Organization. When studying infant nutrition, it was found that 77.3% of the infants had moderate nutrition, only 2% were well nourished, and the rest (20.7%) were poorly nourished. The results show that nearly a third of the sample (30%) suffer from severe anemia, compared to 24% who suffer from mild anemia, and the remaining 46% have moderate anemia. The results also indicated that there is no deficiency in the level of thyroid hormone (thyroxine). In the sample, when studying the health problems, it was found that more than half of the sample (58.6%) had health problems to a large or moderate degree, when infants are exposed to as well as food allergies, the results indicated that more than half of the sample (59%) suffer from allergies. All of them are allergic to dairy. [ABSTRACT FROM AUTHOR]

Abstract “Picky eating” is a common behaviour seen in childhood in both clinical and nonclinical populations. Sensory processing difficulties have been repeatedly associated with food refusal and picky eating behaviours. The aim of this study was to explore the lived experiences of parents/caregivers who have a child displaying both sensory processing differences and picky eating behaviours utilising Interpretative Phenomenological Analysis (IPA). Participants were recruited from social media support groups for parents of picky eating children. Pre‐selection criteria utilised an adapted short sensory profile questionnaire to ensure the children displayed probable/definite taste‐smell, audio‐visual and tactile sensory sensitivities. Twelve participants fulfilling the required criteria were interviewed face to face utilising a semi‐structured interview schedule. Interviews were transcribed and analysed following IPA guidelines and three common themes are presented here: Battling for control of the sensory environment, Living with stigma and, disapproval, and Staying positive and moving forward. The findings show the very considerable day‐to‐day challenges of parenting a child with sensory issues with food, including a lack of support and criticism from others. It was apparent that the parents in our study gradually adopted a positive and accepting attitude to their child's eating. This acceptance allowed them to have positive interactions around food with their child such as cooking and playing with food, suggesting that experiential activities serve an important purpose in this population. Further research should examine whether parental interventions based on acceptance of child eating behaviour, and commitment to gradual positive food interactions would be the best strategy to support parents and children.

Abstract Background Although tube feeding routinely saves the lives of children who do not eat by mouth, chronic tube feeding can be a burden to patients, caregivers, and families. Very few randomized trials exist regarding the best methods for weaning children from their feeding tubes. Methods The current paper describes a randomized controlled trial of an empirically supported outpatient treatment protocol for moving children from tube to oral eating called iKanEat. Specifically, we describe the methods of randomized double-blind, placebo-controlled trial which includes a 4-week course of megestrol, the only medication used in the iKanEat protocol, to determine whether the addition of megestrol results in improved child outcomes. The primary and secondary aims are to assess the safety and efficacy of megestrol as part of the iKanEat protocol. The third aim is to provide critical information about the impact of the transition from tube to oral feeding on parent stress and parent and child quality of life. Discussion This trial will provide data regarding whether megestrol is a safe and effective component of the iKanEat tube weaning protocol, as well as important data on how the tube weaning process impacts parent stress and parent and child quality of life. Trial registration ClinicalTrials.gov NCT#03815019 . Registered on January 17, 2019

While considerable research exists on parent feeding practices for infants and toddlers, past research has not focused on children with feeding problems. The goal of this study was to identify parent feeding practices in a sample of infants (n = 178) and toddlers (n = 221) referred to a hospital-based feeding clinic and then examine how these parent feeding practices were correlated with specific feeding problems. Parents completed surveys to report child demographics, feeding problems, and use of 54 feeding practices. Forty-eight (88.8%) of 54 practices were utilized more often for toddlers than for infants. Exploratory factor analysis with the 54 practices and the full sample (n = 399) produced the 16-item Baby Parent Mealtime Action Scale (BPMAS) with three dimensions: Multiple Food Offers, Use of Cereal/Pureed Foods, Use of Toys/TV. Controlling for demographics, hierarchical regression examined how each BPMAS dimension was associated with five feeding problems (underweight, tube feeding, texture problems, limited diet, mealtime disruption). Multiple Food Offers (e.g., daily offering of vegetables, offering foods from the family meal) was the dimension most correlated with fewer feeding problems such as tube feeding (β = −0.220, p < 0.001), texture rejection (β = −0.361, p < 0.001), and limited diet variety (β = −0.175, p < 0.001), but also with more mealtime disruption (β = 0.231, p < 0.001). Use of Toys/TV was correlated with more mealtime disruption (β = 0.260, p < 0.001). In addition to demonstrating a correlation between parent feeding practices and feeding problems, this study also found adding cereal/pureed foods to be common and while the dimension, Use of Cereal/Pureed Foods, was not significantly correlated with any specific feeding problem, this dimension provides an expanded understanding of cereal usage. [ABSTRACT FROM AUTHOR]

Background: Research investigating feeding problems in children with Down syndrome is scarce. This study investigated feeding problems, eating behaviours and parental feeding practices in children with Down syndrome (n = 40), and typically developing (TD) children of the same age and sex (n = 40). Method: Parents of children aged 6‐months to 5‐years in the UK completed questionnaires assessing their child's feeding problems and eating behaviours and parental feeding practices. Results: For children with Down syndrome, feeding problems were: significantly greater than for TD children; negatively associated with breast milk duration and appetite during exclusive milk feeding; and positively associated with drinking more slowly. For both groups, feeding problems were significantly correlated with more food avoidant eating behaviours. Conclusions: This study provides new information about the relationships between feeding problems and eating behaviours in early development. Longitudinal research is needed to further investigate these relationships, so that effective support can be developed for families. [ABSTRACT FROM AUTHOR]

Background and Purpose: Families of children with feeding disorder face significant challenges in supporting their child's feeding, growth, and development. The Feeding Impact Scales were developed to assess how child feeding impacts parent and family. Methods: Items were adapted from an existing scale. Parents of children with feeding difficulty completed the online survey. Item response theory (IRT) analyses were used to evaluate and reduce items. Internal consistency reliability, convergent validity, and readability were tested. Results: IRT analyses (n = 317) identified 12 items for the Parent Impact and 13 items for the Family Impact. Internal reliability for the scales were acceptable. Convergent validity was supported. Conclusions: The Feeding Impact Scales have evidence of reliability and validity. They can be utilized in practice and research. [ABSTRACT FROM AUTHOR]

Background and aim Proper nutrition in the neonate is essential for normal growth, resistance to infection, long-term health, and optimal neurologic and cognitive development. It is essential to start enteral nutrition early to infants by giving small amounts of milk to ensure that metabolic homeostasis is kept stable and to limit postnatal growth retardation. This study aimed to determine feeding problems in the newborns in the neonatal intensive care unit after starting enteral feeding in Minya General Hospital from May 2018 to August 2018. Patients and methods This study included 100 patients who had feeding problems, data of the patients were collected and analyzed according to standard guidelines, and values were expressed in terms of percentage. Results Abdominal distention was the most common feeding problem as it was in 42% of the studied cases. The most common morbidity associated with feeding problems was respiratory distress as it was in 68% of admitted cases, the common cause of distress was transient tachypnea of newborn followed by respiratory distress syndrome. The study showed a significant difference between full term and preterm regarding the method of feeding, type of milk formula, trophic feeding, and duration of parenteral nutrition. Conclusion The most morbidity associated with feeding problems was respiratory distress. Feeding problems increased in preterm. There was increasing incidence of feeding problems with infant formula than human milk. Also, necrotizing enterocolitis was in 11% of the studied cases and occurs mostly in preterm and the most common feeding problem was abdominal distention.

Background: This study examined the effectiveness of behavioral intervention on feeding problem in persons with autism in Ibadan, Nigeria. Methodology: Pretest-posttest, control group quasi-experimental research with a 2x2 factorial matrix. Data was collected with the Feeding Behavioral Analysis Test. Ten (10) persons with non-verbal autism and evidence of poor feeding habits (selectivity by food type) attending a residential school in Ibadan participated in the study. The one-way between-subjects Analysis of Co-variance (ANCOVA) was used to determine the effectiveness of the behavioral intervention. Results: Positive reinforcement was effective in reducing feeding problem in children with autism (F(1,7) = 3.023, ¿<0.05), compared to the control group (t (8)= -5.24,¿<.05). Further analysis revealed significant main effect of the age of the participants (F(1,7)) = 5.343,¿<0.05). Conclusions: there is a need for teachers, counsellors, caregivers, parents, minders and clinical psychologists to adopt positive reinforcement in the management of feeding problems among persons with autism. [ABSTRACT FROM AUTHOR]

Preterm infants are known to have long-term healthcare needs. With advances in neonatal medical care, younger and more preterm infants are surviving, placing a subset of the general population at risk of long-term healthcare needs. Oral feeding problems in this population often play a substantial yet under-appreciated role. Oral feeding competency in preterm infants is deemed an essential requirement for hospital discharge. Despite achieving discharge readiness, feeding problems persist into childhood and can have a residual impact into adulthood. The early diagnosis and management of feeding problems are essential requisites to mitigate any potential long-term challenges in preterm-born adults. This review provides an overview of the physiology of swallowing and oral feeding skills, disruptions to oral feeding in preterm infants, the outcomes of preterm infants with feeding problems, and an algorithmic approach to the evaluation and management of neonatal feeding problems. [ABSTRACT FROM AUTHOR]

Feeding problems are prevalent in children with ASD. We investigated whether the Montreal Children's Hospital Feeding Scale (MCH-FS, Ramsay et al. in Pediatrics and Child Health 16:147–151, 2011) can be used for young children with ASD. Participants (1–6 years) were selected from a clinical ASD sample (n = 80) and a general population sample (n = 1389). Internal consistency was good in both samples. In general, parents of children with ASD reported more feeding problems than those from the population sample. The response patterns on the individual items was highly similar. There was a slight increase in symptoms with age in the population sample, but not in the ASD sample. These results suggest that the MCH-FS can be used in populations that include children with ASD. [ABSTRACT FROM AUTHOR]

We experienced two consecutive cases of Wallenberg syndrome that developed after COVID-19 infection. Case 1 had symptoms such as a sore throat, but also complained of strong stress related to work and home at the same time. Therefore, it was initially thought due to a mental cause, but the psychiatrist denied depression and pointed out that it was a physical problem. After conducting neurological examinations and a videofluoroscopic (VF) swallowing examination, it was found to be dysphagia. Based on these findings, Wallenberg syndrome was diagnosed by MRI. Due to these events, it took a very long time to diagnose. Because of this experience, Case 2 was diagnosed with Wallenberg syndrome in a short time. Therefore, if symptoms like those in this case report such as feeding problems are observed after COVID-19 infection, it is considered meaningful to suspect Wallenberg syndrome from the beginning., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Medical Ethics Board of Hirose Hospital issued approval 202303. Written consent was obtained from the subjects, and individuals cannot be identified. Therefore, there is no problem in reporting this case. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Furuya et al.)

Background & Aims: Feeding problems in pre-school children are common and negative maternal feeding practices may even worsen the child's problematic eating behavior. Therefore, investigating the effects of maternal eating behaviors and attitudes towards the feeding process on pre-school children's feeding problems may be helpful for preventing feeding problems. This study sought to investigate the effects of maternal eating behaviors and attitudes towards the feeding process on feeding problems of pre-school children., Methods: Mothers of 373 children aged 3-6 were included in this cross-sectional study and data was collected by an online questionnaire including the scales of three-factor eating questionnaire (TFEQ), mother's attitudes towards the feeding process (MATFPS) and behavioral pediatric feeding assessment (BPFAS), as well as demographics and anthropometric measures (height and weight). Spearman's rho test was used to calculate correlation coefficients between the TFEQ, MATFP and BPFA scales. In order to identify independent predictors of child feeding behaviors, a multiple linear regression model was used., Results: Results showed that uncontrolled eating subscale was positively (r = 0.160, p < 0.001) and cognitive restriction subscale negatively (r = -0.126, p < 0.05) correlated with MATFP. MATFP was also positively correlated with BPFA (r = 0.368, p < 0.001). Regression analysis indicated that BPFA was significantly predicted by MATFP which was the most important contributor of child feeding problems (β = 0.24, t = 4.88, p < 0.001)., Conclusions: This study indicated that maternal eating behaviors were related to maternal attitudes towards the feeding process and, mothers' attitudes were associated with feeding problems of their pre-school children., Competing Interests: Conflict of interest disclosure The authors have declared no conflicts of interest., (Copyright © 2024 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Objectives: To compare sensory processing and mealtime problem behaviors among children with autism spectrum disorder (ASD) and typically developing controls, and to examine the relationship between atypical sensory processing and eating problems in children with ASD. Methods: 50 children (4–10 years) with a diagnosis of ASD as per DSM-5 were recruited from the pediatric psychology clinic of a tertiary care center in India. The Brief Assessment of Mealtime Behavior in Children (BAMBIC) and the Short Sensory Profile (SSP) were administered to measure feeding and sensory processing problems, respectively. Parents were interviewed about their child's dietary intake using a 3-day dietary recall. Results: The ASD group showed greater mealtime behavior problems than the control group and had significantly higher total scores on the BAMBIC (P<0.001), and on two of the three subscales including food refusal (P<0.001) and disruptive behavior (P<0.001). The ASD group, relative to the neurotypical children, showed atypical response on majority of the subscales of the short sensory profile including tactile sensitivity (P<0.001), taste sensitivity (P<0.001), movement sensitivity (P<0.001), under responsiveness (P<0.001), auditory filtering (P<0.001), low weak/energy (P=0.02), and visual/auditory sensitivity (P<0.001). Conclusions: The study underscores the need for detailed evaluation of sensory processing and feeding problems of children with ASD so that the interventions can be tailored to address their unique sensory characteristics. [ABSTRACT FROM AUTHOR]