Association Between Autism Severity and Feeding Behaviors in Children: A Cross-Sectional Study

Importance Feeding difficulties are common in autistic children, but their relationship with autism severity remains unclear. Objective To examine differences in feeding behaviors according to autism severity and investigate associations between selected autism symptom domains and feeding behaviors in autistic children. Design Cross-sectional study. Setting Special education and rehabilitation center. Participants Eighty-two autistic children aged 4–8 years participated. Based on Childhood Autism Rating Scale (CARS) scores, 42 children were classified into the mild-to-moderate group and 40 into the severe group. Outcomes and Measures Autism severity was assessed using CARS. Feeding behaviors were evaluated using the Behavioral Pediatric Feeding Assessment Scale (BPFAS). Results Children in the severe group showed significantly higher total and subdomain BPFAS scores than children in the mild-to-moderate group ( p < .05). Significant positive associations were observed between selected CARS domains and feeding behavior problems. The strongest associations were observed for sensory-related characteristics (taste, smell, and touch response and use), relating to people, and fear or nervousness. In contrast, emotional response showed weaker but significant associations ( p < .05). Regression analysis showed that autism severity significantly predicted feeding difficulties and explained 65.1% of the variance in BPFAS scores (adjusted R 2 = .651, p < .001). Conclusions and Relevance Feeding behavior problems were more pronounced in children in the severe group, and autism severity emerged as a clinically relevant predictor of feeding difficulties. Sensory-related and socioemotional characteristics demonstrated meaningful associations with feeding behaviors, supporting the importance of individualized and multidisciplinary assessment and intervention in autistic children.