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Adverse growth in kids tied to feeding habits, parental feeding concerns

Audrey Abella
04 Jul 2019

A child’s feeding habits and parental feeding concerns were associated with poor growth status in children, according to a study.

A total of 303 healthy children aged 1–3 years (mean chronological age 21.3 months, 52.8 percent male) attending well-baby clinics in Singapore and Malaysia were evaluated. Feeding concerns and presence of organic* and behavioural** red flags for feeding difficulties were provided by the parents. [Pediatr Neonatol 2019;doi:10.1016/j.pedneo.2019.04.004]

Thirteen percent of children had growth faltering (<3rd centile for weight-for-age as per World Health Organization Growth Standards). More than one in three parents (36.3 percent) expressed concern about their child’s feeding behaviour. Organic and behavioural red flags were respectively identified in 18.5 percent and 46.5 percent of their children, while 9.9 percent displayed both red flags.

Growth faltering was significantly higher among children whose parents expressed feeding concerns (odds ratio [OR], 3.05, 95 percent confidence interval [CI], 1.51–6.14; p<0.001), was strongly associated with the presence of at least one organic red flag (OR, 2.68, 95 percent CI, 1.24–5.54; p=0.011), and was four times higher among children who had food refusal (OR, 4.05, 95 percent CI, 1.83–8.96; p<0.001).

Organic red flags may suggest underlying disorders (eg, oesophagitis, food allergy), while the accounts of food refusal were based on poor body weight, as parents were twice as likely to be concerned about their child’s feeding if they had poor weight than those whose children were growing well, said the researchers.

Given the growth faltering risk associated with organic red flags and/or food refusal, such feeding issues should be addressed early for proper clinical intervention, they noted.

 

Parental account may be insufficient

Feeding difficulties signal a more serious issue than ‘picky eating’, which is generally considered a mild and transient form of sensory disturbance requiring attention at the primary care level. [Dev Disabil Res Rev 2008;14:118-127] Feeding difficulties could lead to significant adverse health, nutritional, or emotional consequences. [Asia Pac Fam Med 2012;11:5; Clin Pediatr (Phila) 2009;48:960-965]

Parental feeding concerns should be given serious thought due to its association with poor growth, said the researchers. “[A]s part of routine care and anticipatory guidance for children, parents should be asked about their child’s feeding, with specific questions regarding the presence of organic and behavioural red flags for feeding difficulties, regardless of whether parents express feeding concerns or not.”

However, the possibility of misperception cannot be discounted, as parents may inaccurately identify true feeding difficulties, which could lead to underreporting of feeding concerns, noted the researchers. “It [could be] likely that parents may not have recognized organic/behavioural red flags for feeding difficulties and therefore did not report these as feeding concerns. [Therefore,] relying on parental report of feeding concern alone may be insufficient to detect feeding issues.”

 

Evaluating other parameters

Almost 40 percent of the parents of children with growth faltering did not express feeding concerns. “The most likely explanation is that causes of growth faltering are complex and multifactorial,” said the researchers, citing adverse feeding practices and family history of small stature among parents or elder siblings as possible causes.

Therefore, regular monitoring of growth status is recommended at each clinic visit, underscored the researchers. Serial measurement of growth parameters should be compared against standard growth charts, as this remains the gold standard of diagnosing adverse growth in young children, they said.

It is also imperative to evaluate dietary intake including energy intake to establish whether feeding difficulties adversely impacted energy intake leading to growth faltering, they added.

 

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