Do Children with Drug-Resistant Epilepsy Exhibit the Same Eating Habits and Feeding Difficulties as Their Healthy Peers? A Multifaceted Assessment of Eating Habits, Feeding Behaviors, and Nutritional Status in Pediatric Patients with Drug-Resistant E

Background/Objectives: Age-related eating difficulties, combined with restrictive ketogenic diet therapies (KDTs), may contribute to a narrow range of consumed foods and reduced dietary variety in children’s diet. Methods: The study aim is to compare nutritional status, food neophobia (FN), food texture preferences, and eight eating behaviors—including food fussiness (FF)—as well as meal variety and repetitiveness, between children with drug-resistant epilepsy undergoing KDT (KD group; n = 15) and healthy children (n = 100), by the Child Food Texture Preference Questionnaire, the Children’s Eating Behavior Questionnaire and the Modified Children’s Food Neophobia Scale. Results: No significant differences were found in nutritional status (percentile: weight: 53 (31.50–78.00) vs. 51.50 (35.50–71.25), p > 0.9999; height: 43 (26.5–59.5) vs. 51 (31.75–70.25), p > 0.9999; BMI: 50 (21.5–92.5) vs. 51.5 (33–69.5), p > 0.9999) and in most eating behavior domains, although both groups showed a high prevalence of feeding difficulties. The KD group showed significantly greater meal repetition (3 (2–3) vs. 2 (1–2), p = 0.0468) and lower dietary variety (3 (2–3) vs. 4 (4–4), p = 0.0004), emotional undereating (4 (4–8.5) vs. 10 (9–13), p = 0.0059) and overeating (4 (4–7) vs. 8 (6–10), p = 0.0196) scores. Within the study population, eating behaviors clustered into distinct patterns predisposing toward either an “adaptive” or a “maladaptive” approach to food. Conclusions: There is a need for an individualized approach to addressing eating difficulties in children following KDT. It seems reasonable to introduce targeted screening assessments for FN and FF to facilitate early identification of patients at risk of unfavorable eating styles.