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

Food allergy (FA) affects pediatric growth and psychosocial well-being. The relationship between FA and feeding difficulties is poorly understood. The current study sought to investigate feeding problems in children with parent-reported immunoglobulin # (IgE)–mediated FA and/or pediatric feeding disorder (PFD) compared with healthy children and to explore factors associated with feeding problems in children with FA.This is a matched, cross-sectional cohort study using deidentified data from a series of online surveys. Survey data from 352 parents of children aged 6 months to 7 years with parent-reported IgE-mediated FA and/or PFD were categorized into 1 of 3 cohorts: 50 children with only FA, 67 children with both FA and PFD, and 235 children with only PFD. Each cohort was individually matched to data from typically developing children also collected in the original studies based on age, sex, race, and socioeconomic characteristics.Secondary analysis was performed on deidentified data from surveys conducted between 2015 and 2017. The Pediatric Eating Assessment Tool (PediEAT) was used to obtain parent ratings of the child’s feeding problems.Children with FA exhibited more feeding problems compared with matched healthy children. Children with PFD had more severe feeding problems irrespective of comorbid FA. Older age, non-white race, increased medical comorbidity, and limited dietary variety were factors associated with feeding problems in children with FA.This study adds to evidence indicating increased prevalence of feeding problems in children with FA. Clinicians treating patients with FA should screen for feeding and growth concerns and consider referral to multidisciplinary feeding programs. Children with FA who consume a limited variety of foods may experience more feeding problems.Early identification and intervention for patients with feeding problems may help prevent behavioral problems from becoming more ingrained. Early identification of multiple risk factors may be helpful in engaging at-risk patients for early intervention strategies. A potential challenge noted by the authors is the limitation of the PediEAT tool for capturing subtle concerns about food-associated behaviors.