Unique feeding profiles in children with pediatric feeding disorder and comorbid autism spectrum disorder: a retrospective cohort study

To compare the clinical characteristics, sociodemographic factors and feeding profiles of children aged 0-60 months diagnosed with pediatric feeding disorder (PFD) with and without comorbid autism spectrum disorder (ASD), in order to characterize features unique to each diagnosis. This retrospective comparative study included all children aged 0-60 months diagnosed with PFD between 2020 and 2023 at a tertiary pediatric center. Participants were categorized into 2 groups: those with comorbid ASD (ASD-PFD group) and those without ASD (PFD-only group), reflecting children diagnosed with ASD by age 5 years within the available follow-up. Clinical, demographic, perinatal and feeding-related data were extracted from medical records and analyzed. Among 141 participants, 47 were in the ASD-PFD group and 94 in the PFD-only group. The ASD-PFD group had a higher proportion of males (52.6% vs. 34.4%, P = 0.03) and cesarean deliveries (38% vs 23%, P = 0.03). These children were born to parents with lower educational attainment (P < 0.05) and presented (10 vs. 5 months) and were diagnosed (14 vs. 9 months) with PFD at older ages (P = 0.05). Nutritional dysfunction was more prevalent (55.6% vs 26.6%), whereas psychosocial dysfunction was less common (8.3% vs. 29.8%) in the ASD-PFD group (P = 0.007). Multivariable analysis identified male sex, cesarean delivery, and lower parental educational status as independent predictors of ASD, whereas psychosocial feeding dysfunction was inversely associated with ASD. CONCLUSIONS: Children with coexisting PFD and ASD exhibit a distinct profile characterized by later diagnosis and a predominance of nutritional over psychosocial feeding dysfunction, highlighting the importance of early recognition and tailored multidisciplinary care. WHAT IS KNOWN: • Pediatric feeding disorder (PFD) is common in children with autism spectrum disorder (ASD). • Most studies focus on older children; data on infants and toddlers are limited. WHAT IS NEW: • Infants and toddlers with ASD and PFD show distinct profiles: later presentation and diagnosis, more nutritional and less psychosocial dysfunction. • In one-third, PFD preceded ASD diagnosis, highlighting feeding issues as early markers. • Lower parental education and higher cesarean rates were more common in ASD-PFD cases.