Factors associated with the different types of feeding difficulties in children aged 0 to 10 years: a retrospective study in a Brazilian reference center

Keywords: child, child nutrition, risk factors


Aims: To identify factors associated with the prevalence of different types of feeding difficulties in children aged 0 to 10 years.
Methods: This is a retrospective observational study with data from children aged 0-10 years diagnosed with some feeding difficulty, attended at a reference center located in the city of São Paulo, Brazil. The presence of feeding difficulty was analyzed according to the multidisciplinary diagnosis, appearing of the complaint, information about pregnancy and breastfeeding, parenting style, presence of organic causes and associated complications. Data were tabulated using Microsoft Excel software and statistical analyzes were performed using IBM SPSS Statistics 21 using absolute and relative frequencies, mean, standard deviation, chi-square test and Kruskall-Wallis test associated with Dunn post-hoc test.
Results: 166 patients were analysed, with male, preschool age and full-term predominance. The most prevalent diagnosis was picky eating, with no associated organic diseases or reactions. Diagnoses of feeding difficulty were statistically significant associated with age, gestational age at birth, age and feeding phase of onset of the complaint.
Conclusions: The factors that were associated with the different types of feeding difficulty were age, gestational age at birth, age and feeding phase of emergence of the complaint. The present study allows us to initiate a more specific direction of orientation actions and prevention of feeding difficulties, thus highlighting the importance of conducting studies of this nature.


Download data is not yet available.


Kerzner B, Milano K, MacLean WC, Berall G, Stuart S, Chatoor I. A Practical Approach to Classifying and Managing Feeding Difficulties. Pediatrics [Internet]. 2015 [cited 2020 Mar 1];135(2): 344-53. https://dx.doi.org/10.1542/peds.2014-1630

Kerzner B. Clinical Investigation of Feeding Difficulties in Young Children: A Practical Approach. Clin Peditr (Phila) [Internet]. 2009[cited 2020 Mar 1]; 48: 960- 5. https://dx.doi.org/10.1177/0009922809336074

Kachani AT, Abreu CLM, Lisboa SBH, Fisberg M. Seletividade alimentar da criança. Pediatria [Internet]. 2005;27(1): 48-60.

Müller PW, Salazar V, Donelli TMS. Dificuldades Alimentares na Primeira Infância: Uma Revisão Sistemática. Estud Pesqui Psicol [Internet]. 2017;17(2): 635-52.

Sampaio ABM, Nogueira TL, Grigolon RB, Roma AM, Pereira LE, Dunker KLL. Seletividade Alimentar: uma abordagem nutricional. J Bras Psiquiatr [Internet]. 2013;62(2):164-70. http://dx.doi.org/10.1590/S0047-20852013000200011

Maximino P, Machado RHV, Junqueira P, Ciari M, Tosatti AM, Ramos CC, Fisberg M. Como acompanhar a criança com dificuldade alimentar em escopo multidisciplinar? Protocolo de atendimento multiprofissional na infância e adolescência – estudo piloto. J Hum Growth Dev [Internet]. 2016 [cited 2020 Mar 1];26(3): 331-40. http://dx.doi.org/10.7322/jhgd.122816

Fisberg M, Tosatti AM, Abreu CL. A criança que não come – abordagem pediátrico-comportamental. Blucher Medical Proceedings. 2° Congresso Internacional Sabará de Especialidades Pediátricas. 2014 [cited 2020 Mar 1];1(4). https://dx.doi.org/10.5151/medpro-2cisep-019

Xue Y, Lee E, Ning K, Zheng Y, Ma D, Gao H, Yang B, Bai Y, Wang P, Zhang Y. Prevalence of picky eating behavior in Chinese school-age children and associations with anthropometric parameters and intelligence quotient. A cross-sectional study. Appetite [Internet]. 2015 [cited 2020 Mar 1]; 91: 248-55. https://dx.doi.org/ 10.1016/j.appet.2015.04.065

Jansen PW, Roza SJ, Jaddoe VWV, Mackenbach JD, Raat H, Hofman A, Verhulst FC, Tiemeier H. Children’s eating behavior, feeding practices of parents and eight problems in early childhood: results from the population-based Generation R Study. Int J Behav Nutr Phys [Internet]. 2012 [cited 2020 Mar 1]; 9(130). https://dx.doi.org/10.1186/1479-5868-9-130

Ostberg M, Hagelin E. Feeding and sleeping pro lems in infancy – a follow up at early school age. Child Care Health Dev [Internet]. 2011 [cited 2020 Mar 2]; 37(1): 11-25. https://dx.doi.org/10.1111/j.1365-2214.2010.01141.x

Taylor CM, Wernimont SM, Northstone K, Emmett PM. Picky/fussy eating in children: Review of definitions, assessment, prevalence and dietary intakes. Appetite [Internet]. 2015 [cited 2020 Mar 2]; 95: 349-59. https://dx.doi.org/10.1016/j.appet.2015.07.026

Hughes SO, Power TG, Fisher JO, Mueller S, Nicklas TA. Revisiting a neglected construct: parenting styles in a child-feeding context. Appetite [Internet]. 2005 [cited 2020 Mar 2]; 44(1):83-92. https://dx.doi.org/10.1016/j.appet.2004.08.007

Horst K, Deming DM, Lesniauskas R, Carr BT, Reidy KC. Picky eating: Associations with child eating characteristics and food intake. Appetite [Internet]. 2016 [cited 2020 Mar 2]; 103:286-93. https://dx.doi.org/10.1016/j.appet.2016.04.027

Johnson S, Matthews R, Draper ES, Field DJ, Manktelow BN, Marlow N, Smith LK, Boyle EM. Eating difficulties in children born late and moderately preterm at 2y of age: a prospective population- based cohort study. Am J Clin Nutr [Internet]. 2016 [cited 2020 Mar 2]; 103:406-14. https://dx.doi.org/10.3945/ajcn.115.121061

Maranhão HS, Aguiar RC, Lira DTJ, Sales MUF, Nóbrega NAN. Dificuldades alimentares em pré-escolares, práticas alimentares, pregressas e estado nutricional. Rev Paul Pediatr [Internet]. 2018 [cited 2020 Mar 2]; 36(1):45-54. http://dx.doi.org/10.1590/1984-0462/;2018;36;1;00004

Benjasuwantep B, Chaithirayanon S, Eiamudomkan M. Feeding problems in health young children: prevalence, related factors and feeding practices. Pediatric Reports [Internet]. 2005 [cited 2020 Mar 2]; 5(10): 38-42. https://dx.doi.org/10.4081%2Fpr.2013.e10

Viljakainen HT, Figueiredo RAO, Rounge TB, Weiderpass E. Picky eating - A risk factor for underweight in Finnish preadolescents. Appetite [Internet]. 2019 [cited 2020 Mar 2]; 133: 107-14. https://dx.doi.org/10.1016/j.appet.2018.10.025

Migraine A, Nicklaus S, Parnet P, Lange C, Monnery- Patris S, Des Robert C, Darmaun A, Flamant C, Amarger V, Rozé JC. Effect of preterm birth and birth weight on eating behavior at 2 y of age. Am J Clin Nutr [Internet]. 2013 [cited 2020 Mar 2]; 97:1270-7. https://dx.doi.org/10.3945/ajcn.112.051151

Cao YT, Svensson V, Marcus C, Zhang J, Zhang JD, Sobko T. Eating behavior patterns in Chinese children aged 12-18 months ans associations with relative weight - factorial validation of the Children’s Eating Behavior Questionnaire. Int J Behav Nutr Phys Act [Internet]. 2012[cited 2020 Mar 5]; 9(5). https://doi.org/10.1186/1479-5868-9-5

Burklow KA, McGrath AM, Valerius KS, Rudolph C. Relationship Between Feeding Difficulties, Medical Complexity, and Gestacional Age. Nutrition in Clinical Practice [Internet]. 2002 [cited 2020 Mar 5];16(6): 373- 8. https://doi.org/10.1177/0115426502017006373

Pagliaro CL, Bühler KEB, Ibidi SM, Limongi SCO. Dificuldades de transição alimentar em crianças prematuras: revisão crítica de literatura. J Pediatr [Internet]. 2016 [cited 2020 Mar 5];92(1): 7-14. http://dx.doi.org/10.1016/j.jped.2015.05.004

Volger S, Xiaoyang S, Tong LM, Zhao D, Fan T, Zhang F, Ge J, Ho WM, Hays NP, Yao M. Nutrient intake and dietary patterns in children 2.5-5 years of age with picky eating behaviours and low weight-for-height. Asia Pac J Clin Nutr [Internet]. 2017 [cited 2020 Mar 5];26(1): 104-9. https://dx.doi.org/10.6133/apjcn.102015.02

Carruth BR, Ziegler PJ, Gordon A, Barr SI. Prevalence of picky eaters among infants and toddlers and their caregivers’ decisions about offering a new food. J Am Diet Assoc [Internet]. 2004;104(1): 57-64.

Svensson V, Lundborg L, Cao Y, Nowicka P, Marcus C, Sobko T. Obesity related eating behaviour patterns in Swedish preschool children and association with age, gender, relative weight and parental weight - factorial validation of the Children’s Eating Behavior Questionnaire. Int J Behav Nutr Phys Act [Internet]. 2011 [cited 2020 Mar 5];8(134). https://doi.org/10.1186/1479-5868-8-134

Specht IO, Rohde JF, Olsen NJ, Heitmann BL. Duration of exclusive breastfeeding may be related to eating behavior and dietary intake in obesity prone normal weight young children. PLoS ONE [Internet]. 2018 [cited 2020 Mar 5];13(7). https://doi.org/10.1371/journal.pone.0200388

Galloway AT, Lee Y, Birch LL. Predictors and consequences of food neophobia and pickiness in young girls. J Am Diet Assoc [Internet]. 2003;103(6):692-8.

Hendricks K, Briefel R, Novak T, Ziegler P. Maternal and child characteristics associated with infant and toddler feeding practices. J Am Diet Assoc [Internet]. 2006 [cited 2020 Mar 5];106(1): 135-48.

Maslin K, Dean T, Arshad SH, Venter C. Fussy eating and feeding difficulties in infants and toddlers consuming cows’ milk exclusion diet. Pediatr Allergy Immunol [Internet] 2015 [cited 2020 Mar 5];26(6): 503-8. https://dx.doi.org/10.1111/pai.12427

Johnson S, Harris G. A preliminary study of the predictors of feeding problems in late infancy. J Reprod Infant Psychol [Internet] 2004 [cited 2020 Mar 5]; 22: 183-8. https://doi.org/10.1080/02646830410001723760

How to Cite
Okuizumi, A. M., Morimoto, J. M., Nogueira, L. R., Maximino, P., & Fisberg, M. (2020). Factors associated with the different types of feeding difficulties in children aged 0 to 10 years: a retrospective study in a Brazilian reference center. Scientia Medica, 30(1), e35530. https://doi.org/10.15448/1980-6108.2020.1.35530
Original Articles