Dificultades alimentarias en la infancia: una revisión narrativa / Feeding difficulties in childhood: A narrative review

Se estima que entre el 25 % y el 40 % de los niños sanos presentan algún síntoma de dificultad alimentaria (DA) durante su crecimiento y desarrollo, y muchas veces no son adecuadamente diagnosticadas. El propósito de este trabajo consistió en realizar una revisión narrativa que reuniera la información disponible sobre las dificultades alimentarias. Se desarrollaron algoritmos de evaluación y abordaje a partir de la evidencia en la literatura. La mayoría de los problemas de alimentación en los niños pequeños (selectividad alimentaria, falta de apetito, miedo a la alimentación) a menudo coexisten y es necesario evaluar el riesgo clínico para planificar una intervención individualizada. Contar con definiciones estandarizadas y terminología común para abordar estas dificultades de manera adecuada y multidisciplinaria es uno de los caminos para optimizar su tratamiento. Involucrar a los diferentes profesionales de la salud y a los padres es fundamental para abordar las dificultades alimentarias.

It has been estimated that between 25% and 40% of healthy children show symptoms of feeding difficulties (FDs) during their growth and development; many times, these are not adequately diagnosed. The objective of this study was to conduct a narrative review that collected the available information on fee ding difficulties. Assessment and management algorithms were developed based on the bibliographic evidence. Most feeding problems in young children (feeding selectivity, loss of appetite, fear of feeding) are often con current, and a clinical risk assessment is necessary to plan an individualized intervention. Having standardized definitions and common terms to address these difficulties in an appropriate and multidisciplinary manner is one of the ways to optimize their treatment. The involvement of different health care providers and parents is critical to address feeding difficulties.

Biomedical Waste Management in Leh District

The aim of this study was to find out how Biomedical Waste (BMW) is disposed of in the Leh district and whether the healthcare facilities are following BMWM Rules 2016. A total of 19 health care facilities from Leh district were selected for this study. The data were collected through a semi-structured questionnaire from June 2021-August 2021. After analysis, it was found that all the health care facilities are involved in the disposal of BMW inside their premises. There is no involvement of the municipality or CBMWTF in handling BMW in Leh district. All the healthcare facilities have adopted the BMWM Rules 2016 but only partially.

Picky eating behaviour and its impact on growth among Pre-school children attending outpatient department of tertiary health care centre, Hyderabad : A Cross-Sectional study

Background: Picky eating is very common problem encountered by parents which does not require much intervention until other problems like micronutrients deficiency, stunting, wasting and malnutrition. Picky eating is mostly seen in preschool children and gradually withers away as age progresses but nevertheless parents need to take guard and observe the child and report any abnormality. The study was undertaken to understand the impact of picky eating on weight and height for age. Methods: The cross-sectional observational study was conducted among children attending outpatient department of tertiary health care centre in Hyderabad. A total of 200 children were included between the age 2 and 6 years. The anthropometric measurements were taken, tabulated and placed appropriately for weight for age, height for age and weight for height. Results: Among 200 Pre-school children Picky eating behaviour was observed in 54% children. The study showed among the picky eaters group the height and weight for age was lower when compared to non- picky eaters. When both picky and non- picky eaters, anthropometry were measured for association, Significance was observed for weight for age (p=0.001), height for age (p=0.001) and weight for height (p=0.01) depicting picky eating behaviour had an impact on growth of the child. Conclusion: Picky eating behaviour was observed in majority of preschool children. The height, weight and BMI is lowered compared to non-picky eaters. Interventions like parent counseling is needed and if needed medical intervention will be required.

Picky Eating Behaviour, Feeding Practices, Dietary Habits, Weight Status and Cognitive Function Among School Children in Kuala Lumpur, Malaysia

@#Introduction: Picky eating behaviour was linked to nutritional problems due to limited dietary variety. This study aimed to determine the causes and consequences associated with picky eating behaviour among school-aged children in Kuala Lumpur, Malaysia. Methods: A total of 339 children aged seven to nine years participated in this cross-sectional study. Socio-demographic factors, eating behaviours and child/ parental feeding style were assessed through parent’s questionnaires, while eating habits of children were accessed through child’s questionnaire. Body height and weight were measured; body mass index (BMI) was calculated. Cognitive function level was determined using the Raven’s Coloured Progressive Matrices test. Results: One third (38%) of the children were picky eaters and consumed lesser vegetables (χ2 =4.49,p=0.034) and fish (χ2 =5.55,p=0.019), but more milk and dairy products (χ2 =3.91,p=0.048), snacks (χ2 =6.25,p=0.012) and fast food (χ2 =7.35,p=0.007) compared to non-picky eaters. Picky eaters were more likely to have normal weight status based on weight-for-age, height-for-age and BMI-for-age compared to non-picky eaters (p<0.05). Picky eaters came from a household with other picky eaters in the family and their parents tend to use an instrumental feeding style. Picky eaters had a poorer cognitive function compared to non-picky eaters (p=0.03). Conclusion: We did not find significant differences in growth parameters between picky and non-picky eaters but picky eaters were more likely to have a poorer cognitive function. As parental feeding styles significantly influenced children’s eating behaviour, interventions should target parents to improve their children’s dietary variety.

Picky Eating Behaviour and Nutritional Status of Preschool Children in Kuala Selangor, Malaysia

@#Introduction: Picky eating is defined by the reluctance of consuming familiar foods, trying new food and having strong food preferences. It is common among children; however limited and inconsistent studies have being done to investigate the incidence and its relationship among pre-schoolers in Malaysia. Aims: To investigate the prevalence of picky eaters among pre-schoolers and its association with nutritional status. Methods: A cross-sectional study was conducted involving 192 preschool children in Kuala Selangor district, Malaysia. A set of online questionnaires consisted of Child Eating Behaviour Questionnaire (CEBQ) was administered online. Self-reported weight and height were also collected. Results: 31.8% of the children were identified as picky eaters. Their weight, weight-for-age z-score (WAZ), height, height-for-age z-score (HAZ), Body Mass Index (BMI) and BMI-for-age z-score (BAZ) were significantly lower than non-picky eaters (p<0.05). A lower degree of food responsiveness, enjoyment of food and emotional overeating combined with higher degree of food fussiness and slowness in eating were prevalent among picky eaters (p<0.05). Picky eating behaviour was significantly associated with WAZ, HAZ, and BAZ (p<0.05). Conclusion: This study revealed that 1 in 3 children is a picky eater and they are more likely to be underweight. This highlights more comprehensive studies in the future to investigate the long-term effect of such behaviour.

Correlates of picky eating behaviour in children and its effect on growth

Background: Picky eating is common in preschool-aged children. Children's picky eating behaviour has been linked both to being overweight and underweight. Authors objectives was to study the factors associates of picky eating behaviour on growth and nutritional status of children.Methods: A Cross-sectional study done in 200 parents of children between 1-5 year age visiting outpatient department. Picky eating behaviours were assessed using questions from children eating behaviour questionnaire.Results: In the study, the estimated prevalence rate was 25%, maximum 38% at 49 to 60 months. 26% of subjects with picky eating behaviour had height for age <-3SD (severely stunted) 38% of subjects with picky eating behaviour had weight for height <-3SD (severely wasted) as compared to only 4% in non-picky eating behaviour subjects. Low birth weight and exclusive breast feeding for less than 6 month, were found to be significant risk factor for development of picky eating behaviour, while no significant association was seen with the time of introduction of semisolid complimentary feeds.Conclusions: Picky eating is major parental concern and impacts growth of children. The children with picky eating behaviours need to be monitored for growth.

Dyslipidemia in children with feeding difficulties - a cross-sectional study in a Brazilian reference center / Dislipidemia en niños con dificultades alimentares - estudio transversal en un centro de referencia brasileño

ABSTRACT This study aimed at describing the lipid profile of children with feeding difficulties (FD), as well as to verify the impact of clinical types of FD and other markers on the presence of dyslipidemias (DLP). It was a cross-sectional study with 61 children between 2 and 10 years old. The following data was collected from medical records: age, gender, duration of exclusive breastfeeding (months), dosages of total cholesterol, HDL, LDL, VLDL and triglycerides (according to recommendations for age), type of FD, BMI z-score, dietary intake of carbohydrates and lipids (% energy intake), and daily consumption of milk (ml), fiber (g) and sugar sweetened beverages (SSB, ml). T-Student-test and ANOVA test were used, with a 5% significance level. Children were mostly picky eaters (55.7%), and 47.5% had dyslipidemia, mostly low HDL-c (27.6%) and hypertriglyceridemia (21.9%). No significant relationship was found between DLP and duration of exclusive breastfeeding (p= 0.93), BMI (p> 0.40), type of FD (p> 0.26), or dietary characteristics (p> 0.12). Children with dyslipidemia tended to drink higher volumes of SSB when compared to recommended values (p= 0.044). The prevalence of DLP found was higher than the average shown in children. More studies are needed to prove if there is a true association between FD and dyslipidemia.

RESUMEN El objetivo de este estudio fue describir el perfil lipídico de niños con dificultades alimentares (DA) y verificar el impacto de los tipos clínicos de DA y otros marcadores sobre la presencia de dislipemias (DLP). Se trató de un estudio transversal con 61 niños de 2 a 10 años. Se obtuvieron los datos de edad, sexo, duración de la lactancia materna exclusiva (meses), colesterol total, HDL, LDL, VLDL y triglicéridos (según las recomendaciones para la edad), tipo de DA, índice-z del IMC, consumo dietético de carbohidratos y lípidos (% energético), consumo diario de leche (ml), fibra (g) y bebidas endulzadas (SSB, ml). Se usaron pruebas T-Student y ANOVA, con nivel de significancia del 5%. Los niños fueron selectivos (55,7%) y el 47,5% dislipidémicos, principalmente con HDL-c bajo (27,6%) y hipertrigliceridemia (21,9%). No se encontró relación significante entre DLP y la duración de la lactancia materna exclusiva (p= 0,93), el IMC (p> 0,40), el tipo de DA (p> 0,26) o las características dietéticas (p> 0,12). Los niños dislipidémicos tendieron a beber mayores volúmenes de SSB en comparación con los valores recomendados (p= 0,044). La prevalencia de DLP encontrada es más alta que el promedio que se muestra en niños. Se necesitan más estudios para demostrar asociaciones sólidas entre DA y dislipidemia.

Feeding difficulties are not associated with higher rates of iron deficiency anemia in Brazilian children and adolescents: cross-sectional study

Background: Iron deficiency anemia and feeding difficulties (FD) are common issues in childhood, reinforcing the concern about the risk of micronutrient deficiencies. FD do not necessarily reflect nutritional deficiencies, since they may or may not relate to specific nutrient sources. The objective of the study is to describe the prevalence of iron depletion and iron deficiency anemia in children with FD and to seek associations with diagnosis and its markers. Methods: This is a cross-sectional study with 68 patients (convenience sample). The following data were assessed through medical records: age (months), gender, exclusive breastfeeding duration (months), birth weight (kg), iron supplementation, hemoglobin (Hb), ferritin, and C-reactive protein (CRP) levels, repertory of foods consumed (food inventory and 3-day food record analysis), and diagnosis of FD. Data were classified according to references for age and were analyzed using correlation tests, Student's t test, ANOVA and chi-square test, or its nonparametric equivalents. A significance level of 5% was considered. Results: Iron depletion and anemia were identified in 10.1 and 6% of children, respectively. Picky eating was diagnosed in 35.3%. Food repertory consisted on average of 21 foods, with null correlation to Hb and ferritin. The average fortified milk intake was 517 ml/day, with null correlation to Hb. There was no effect of diagnosis of FD on Hb (p = 0.18) or ferritin (p = 0.52). The same was verified in the children without supplementation, to both Hb (p = 0. 54) and ferritin (p = 0.08). Conclusions: No evidence of association between diagnosis of FD or repertory of foods to anemia or iron depletion was found, which could be a reassuring factor for caregivers. Reproduction in large scale as well as inclusion of dietary intake variables is suggested for further research.

How to Improve Eating Behaviour during Early Childhood / 대한소아소화기영양학회지

Eating behaviour disorder during early childhood is a common pediatric problem. Many terminologies have been used interchangeably to describe this condition, hindering implementation of therapy and confusing a common problem. The definition suggests an eating behaviour which has consequences for family harmony and growth. The recent Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition does not cover the entire spectrum seen by pediatricians. Publications are substantive but level of evidence is most of the time low. This purpose of this review is to clarify terminology of eating behaviour problems during early childhood; including benign picky eating, limited diets, sensory food aversion, selective eating, food avoidance emotional disorder, pervasive refusal syndrome, tactile defensiveness, functional dysphagia, neophobia and toddler anorexia. This tool is proposed only to ease the clinical management for child care providers. Diagnostic criteria are set and management tools are suggested. The role of dietary counselling and, where necessary, behavioural therapy is clarified. It is hoped that the condition will make its way into mainstream pediatrics to allow these children, and their families, to receive the help they deserve.

Effects of multiple herb formula SEC-22 supplementation on dietary intake, picky eating behaviors, and growth indices in thin preschool children

BACKGROUND/OBJECTIVES: Thin children may have insufficient intake of energy and nutrients, resulting in reduced immune function and growth. This study aimed to identify the effects of multiple herb formula SEC-22 supplementation on growth, dietary changes, and picky eating behaviors in thin children. SUBJECTS/METHODS: A double-blind, randomized clinical trial was conducted on 79 children aged 2-5 years with poor appetites, BMI percentile < 25, and without any illness. Subjects were given either SEC-22 (n = 35) or placebo (n = 44) for 2 months and followed for an additional 2 months. Three-day dietary records, questionnaires on picky eating behaviors, and anthropometric measures were collected. RESULTS: Energy, carbohydrate intake, and feeding difficulty improved in both groups during the intervention period. However, changes were maintained only in the SEC-22 group after 2 months of follow-up post-supplementation. 'Frequency of trying to feed' was improved in the SEC-22 group compared to the placebo group after the first month of follow-up (P < 0.05). Intakes of potassium and thiamine were improved in the SEC-22 group compared to the placebo group after the first month of intervention (P < 0.05). 'Frequency of food reward', eating amount, and intakes of carbohydrate, potassium, and vitamin C showed significant improvement compared to the placebo group after the second month of follow-up (P < 0.05). CONCLUSIONS: These results suggest that SEC-22 supplementation can improve parental feeding difficulty resulting from insufficient eating amount or picky eating as well as increase nutrient intake in thin children. Although these improvements were observable at least 2 months after supplementation, effects beyond this time frame need to be confirmed.

Effects of sensory education based on classroom activities for lower grade school children

This study is to verify the effects of sensory education based on classroom activities for 2nd and 3rd grade children. The hypothesis is that children who participated in sensory education would demonstrate positive changes in eating behaviors through sensory experiences. The sensory education program consists of 12 lessons. Twenty-six children were being recruited from one school in Changwon, Korea. Two control groups, one of which was the same age as the educated group and the other group of sixth graders, were selected by random sampling from the same school. Children answered a self-administered questionnaire. The parents (n = 20) of the children who participated in the program, took part in evaluating the program through self-administered questionnaires after the program ended. The questionnaire contained variables of general characteristics, education satisfaction, nutrition knowledge, eating attitude and behavior concerning unfamiliar foods. The score of nutrition knowledge was improved in educated children (P < 0.05). Food neophobia score towards unfamiliar foods (P < 0.05) was increased in educated children, but there are no changes in eating behaviors in all groups towards unfamiliar foods. In conclusion, sensory education is useful for having a positive eating attitude among children. Its consistent implementation could lead to healthier and well-balanced eating behaviors for children.

Association between picky eating behaviors and growth in preschool children / 한국영양학회지

This study was conducted in order to investigate the association between picky eating behaviors of preschool children and growth outcomes. In this study, picky eating behaviors were defined as containing four constructs of 'eating a small amount (ES),' 'neophoic behavior (NB),' 'refusal of specific food groups (RF),' and 'preference for specific food-preparation methods (PP).' A 7-point scale was used for the multi-item questionnaire, which consisted of 21 items (three items for ES, two items for NB, nine items for RF, and seven items for PP), in order to evaluate picky eating behaviors of children. Subjects were recruited among visitors at a medical clinic in Seoul. A total of 150 self-administered survey responses from parents of preschool children were analyzed in order to investigate the association between picky eating behaviors of preschool children and growth outcomes. Height for age (HFA) and weight for height (WFH) z-scores were used for assessment of preschool children's growth. The prevalence of ES, NB, RF, and PP was 44%, 57%, 73%, and 53%, respectively. Children with ES had lower HFA (p < 0.05) and WFH (p < 0.0001) than those without ES, while children with NB, RF, or PP had HFA and WFH were similar to their counterparts. The mean HFA z-score of children with ES was less than 0 (p < 0.05) and the mean WFH z-scores of children with ES, NB, RF, or PP were less than 0 (p < 0.05). According to the study results, related growth outcome differed depending on constructs of picky eating behaviors. In particular, picky eating of ES showed a risk of faltering height growth in preschool children. Further comprehensive studies on the reason for ES and intervention approach is warranted.

Development and Educational Effect of Nutrition Education Workbook for Improvement of Child Picky Eaters: Focused on 2nd and 3rd Graders

This study was conducted to develop a nutrition education workbook to improve picky eating in children and to evaluate the effect of nutrition education using this developed workbook. The developed workbook focused on 2nd and 3rd grade students and consisted of five units. The contents included: multi-grain, vegetables (2 units), fish, and milk. The activities, including observation, and learning the roles and names of the foods, were developed mainly to increase motivation for eating a balanced diet. This workbook was developed from April to December 2008, and was applied at 15 elementary schools containing 1,674 students from April to September 2009 in Changwon City, Korea. We evaluated changes in knowledge before and after education on nutrition, eating behavior, dietary habits, and educational activities using self-administered questionnaires. The children demonstrated significant improvements in nutritional knowledge (P<0.001), eating behavior (P<0.001), and dietary habits (P<0.001). Most of the children answered that the education program was helpful and exciting. Based on these results, we believe that the developed workbook is suitable for children picky eaters, and hope it will be used in the field of child nutrition education.

The Characteristics of Infants' Temperament, Maternal Feeding Behavior and Feeding Practices in Picky Eaters / 대한지역사회영양학회지

The purpose of this study was to determine the characteristics of infants' temperaments, maternal feeding behaviors and feeding practices in picky eaters. Participants were 83 infants (aged 12 - 24 months) from "A" hospital (Seoul) and "B" public health center (Kyunggido). Mothers completed questionnaires that assessed their own feeding behavior, feeding practices, infants' temperament and infants' feeding behavior. Picky eaters' demographics were not significantly different from non-picky eaters after adjusting sex and age. The average of thiamin, niacin and vitamin E intakes of picky eaters were below 75% Korean RDA, whereas vitamin A intakes exceed 120% RDA in both groups. Activity level of infants' temperament and disinhibition of maternal feeding behavior in picky eaters were significantly higher than those in non-picky eater. All constructs of infants feeding behavior were significantly associated with certain constructs of infants' temperament, maternal feeding practice and maternal feeding behavior. The pickiness of infants feeding behavior was positively correlated with activity level of infants' temperament, pickiness and disinhibition of maternal feeding behavior and negatively correlated with adaptability of infants' temperament. Findings suggest that maternal feeding behavior and feeding practices as well as infants' temperament should be addressed in nutrition education for picky eaters.