Associations between regulatory problems in early childhood and parental feeding practices, child eating behaviour, and weight: A systematic review and narrative synthesis

Early difficulties in the regulation of emotion, sleep and eating are common in early childhood and may shape developmental pathways of eating behaviours and weight. Understanding these pathways is key to identifying modifiable targets for promoting healthy eating and growth. This systematic review aimed to synthesise available evidence linking regulatory problems (RPs) of emotion, sleeping, and eating in early childhood to feeding, eating, and weight outcomes and evaluate methodological quality and level of evidence using the National Institutes of Health Quality Assessment Tool and best evidence synthesis. We searched MEDLINE, EMBASE, and PsycINFO for studies published in English from inception to September 2025. Eligible studies included children aged 3-36 months with a measure of RP and either parental feeding practice, child eating behaviour, or weight. Methodological quality was assessed, and a narrative synthesis undertaken. Thirty-eight studies were eligible for inclusion. Most were of moderate quality (n = 33). According to best evidence synthesis, there was insufficient level of evidence for associations between emotion regulation and feeding, eating, and weight. There was moderate level of evidence for a cross-sectional association between sleep problems and eating behaviour, and of no association with weight. There was moderate level of evidence for an association between eating problems and feeding and weight. This review provides novel evidence that, while eating problems in early childhood are linked to feeding practices and weight, the evidence is less clear on the role of emotion and sleep regulation difficulties in shaping these trajectories. By highlighting early childhood as a critical yet underexplored period, our findings underscore the need for high-quality longitudinal research with homogeneous methodology to clarify whether early-life RPs represent modifiable intervention targets supporting healthy feeding, eating, and weight. PROSPERO REGISTRATION NUMBER: CRD42023463391.