Behavioral Feeding Problems and Parenting Stress in Toddlers With Food Protein–Induced Allergic Proctocolitis

The study aimed to evaluate behavioral feeding problems and parenting stress in toddlers diagnosed with food protein–induced allergic proctocolitis (FPIAP), compared with healthy controls.The case-control study involved 182 children aged 1 to 3 years diagnosed with FPIAP (n = 89) and healthy controls (n = 93). Diagnosis of FPIAP was made based on clinical symptoms of hematochezia and other symptoms after consuming suspected food with elimination of symptoms on avoidance. Children with chronic diseases or genetic, metabolic, or neurologic disorders were excluded.Demographic data were collected along with the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) to evaluate mealtime behaviors. The Parenting Stress Index–Short Form was used to assess parents’ difficulty in their role and sense of competence. Data on feeding transitions, mealtime routines, and parental concerns were also gathered.Most toddlers had single food allergies (75%) with cow’s milk being the most common trigger (95.5%). Toddlers with FPIAP were introduced to complementary foods later and experienced more feeding difficulties during transition to complementary foods. Although total BPFAS scores were similar between groups, the FPIAP group showed significantly higher scores in parent-related frequency, total problem, child-related problem, parent-related problem, and poor strategies scores. The FPIAP group also has greater levels of parental distress, dysfunctional parent-child interactions, and overall stress compared with healthy controls. Interestingly, following allergy-related social media was linked to lower odds of severe feeding problems by BPFAS scoring.FPIAP in early life is associated with lasting impacts on feeding behavior and parental stress. Despite clinical resolution of FPIAP, challenges persist into toddlerhood. Supportive strategies and early intervention are essential for affected families.Although often considered a natural history of resolution, this study highlights continued impacts FPIAP can have on families and children. Continued support for families diagnosed with FPIAP may contribute to healthier eating behaviors and less stress when progressing from infancy to toddlerhood.