Restricted accessResearch articleFirst published online 2025-12
Feeding Issues Among Preschoolers With Developmental Concerns and Risks From a Developmental Pediatrics Perspective: A Cross-Sectional Study From an Eurasian Country
This study sought to examine the association between feeding difficulties and the developmental and behavioral profiles of preschool children (n = 102) with developmental risks referred to a developmental pediatrics clinic. The Ages and Stages Questionnaire, the Ages and Stages Questionnaire: Social-Emotional, the Child Behavior Checklist, and the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) were utilized for all participants. A multiple linear regression analysis revealed a significant association between feeding issues and behavioral problems, whereas no such relationship was found with developmental domains. Positive correlations were observed across all behavioral problems and BPFAS subscales. The literature on children’s feeding issues is varied, focusing on those with severe developmental delays or neurodevelopmental disorders. However, rising admissions for milder delays, particularly in developing countries, underscore the need for comprehensive intervention. It is crucial to address these children’s feeding problems by considering medical, developmental, and particularly behavioral factors, given nutrition’s critical role in growth and development.
GodayPSHuhSYSilvermanA, et al. Pediatric feeding disorder: consensus definition and conceptual framework. J Pediatr Gastroenterol Nutr. 2019;68(1):124-129. doi:10.1097/MPG.0000000000002188.
2.
Bryant-WaughRMarkhamLKreipeREWalshBT.Feeding and eating disorders in childhood. Int J Eat Disord. 2010;43(2):98-111. doi:10.1002/eat.20795.
3.
PhalenJA.Managing feeding problems and feeding disorders. Pediatr Rev. 2013;34(12):549-557. doi:10.1542/pir.34-12-549.
4.
VaivadaTGaffeyMFBhuttaZA.Promoting early child development with interventions in health and nutrition: a systematic review. Pediatrics. 2017;140(2):e20164308. doi:10.1542/peds.2016-4308.
5.
BlackMMTrudeACLutterCK.All children thrive: integration of nutrition and early childhood development. Annu Rev Nutr. 2020;40:375-406. doi:10.1146/annurev-nutr-120219-023757.
6.
KleinertJO.Pediatric feeding disorders and severe developmental disabilities. Semin Speech Lang. 2017;38(2):116-125. doi:10.1055/s-0037-1599141.
7.
BerlinKSLobatoDJPinkosBCerezoCSLeLeikoNS.Patterns of medical and developmental comorbidities among children presenting with feeding problems: a latent class analysis. J Dev Behav Pediatr. 2011;32(1):41-47. doi:10.1097/DBP.0b013e3182040f04.
8.
SpeyerRCordierRKimJHCocksNMichouEWilkes-GillanS.Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: a systematic review and meta-analyses. Dev Med Child Neurol. 2019;61(11):1249-1258. doi:10.1111/dmcn.14253.
9.
Cooper-BrownLCopelandSDaileyS, et al. Feeding and swallowing dysfunction in genetic syndromes. Dev Disabil Res Rev. 2008;14(2):147-157. doi:10.1002/ddrr.19.
10.
HielscherLIrvineKLudlowAKRogersSMengoniSE.A scoping review of the complementary feeding practices and early eating experiences of children with Down syndrome. J Pediatr Psychol. 2023;48(11):914-930. doi:10.1093/jpepsy/jsad060.
11.
PageSDSoudersMCKralTVEChaoAMPinto-MartinJ.Correlates of feeding difficulties among children with autism spectrum disorder: a systematic review. J Autism Dev Disord. 2021;51(13):4485-4505. doi:10.1007/s10803-021-04912-6.
12.
SchwarzSMCorredorJFisher-MedinaJCohenJRabinowitzS.Diagnosis and treatment of feeding disorders in children with developmental disabilities. Pediatrics. 2001;108(3):671-676. doi:10.1542/peds.108.3.671.
13.
GalEHardal-NasserREngel-YegerB.The relationship between the severity of eating problems and intellectual developmental deficit level. Res Dev Disabil. 2011;32(5):1464-1469. doi:10.1016/j.ridd.2010.12.003.
14.
AdamsRCEliasERCouncil on Children with Disabilities. Nonoral feeding for children and youth with developmental or acquired disabilities. Pediatrics. 2014;134(6):e1745-e1762. doi:10.1542/peds.2014-2829.
15.
Memiç İnanCÖzfer ÖzçelikA. Nutritional status and feeding problems in pediatric specific learning disability. Clin Pediatr (Phila). 2023;62(9):981-990. doi:10.1177/00099228231151891.
16.
ZuckerNCopelandWFranzL, et al. Psychological and psychosocial impairment in preschoolers with selective eating. Pediatrics. 2015;136(3):e582-e590. doi:10.1542/peds.2014-2386.
17.
LewinsohnPMHolm-DenomaJMGauJM, et al. Problematic eating and feeding behaviors of 36-month-old children. Int J Eat Disord. 2005;38(3):208-219. doi:10.1002/eat.20175.
18.
McDermottBMMamunAANajmanJMWilliamsGMO’CallaghanMJBorW.Preschool children perceived by mothers as irregular eaters: physical and psychosocial predictors from a birth cohort study. J Dev Behav Pediatr. 2008;29(3):197-205. doi:10.1097/DBP.0b013e318163c388.
19.
AmmanitiMLucarelliLCiminoSD’OlimpioFChatoorI.Feeding disorders of infancy: a longitudinal study to middle childhood. Int J Eat Disord. 2012;45(2):272-280. doi:10.1002/eat.20925.
20.
PutnickDLBellEMGhassabianA, et al. Associations of toddler mechanical/distress feeding problems with psychopathology symptoms five years later. J Child Psychol Psychiatry. 2022;63(11):1261-1269. doi:10.1111/jcpp.13595.
21.
MurphyJZlomkeKVanOrmerJSwingleH.Impact of disruptive behavior in childhood feeding difficulties. J Clin Psychol Med Settings. 2020;27(2):406-415. doi:10.1007/s10880-019-09646-y.
22.
JohnsonCRTurnerKStewartPA, et al. Relationships between feeding problems, behavioral characteristics and nutritional quality in children with ASD. J Autism Dev Disord. 2014;44(9):2175-2184. doi:10.1007/s10803-014-2095-9.
23.
HollingsheadABRedlichFC.Social Class and Mental Illness: Community Study. John Wiley; 1958.
24.
SquiresJPotterLBrickerD.The ASQ User’s Guide for the AGES & Stages Questionnaires: A Parent-Completed, Child-Monitoring System. 1st ed. Paul H. Brookes Publishing; 1995.
25.
SmallJWHix-SmallHVargas-BaronEMarksKP.Comparative use of the Ages and Stages Questionnaires in low- and middle-income countries. Dev Med Child Neurol. 2019;61(4):431-443. doi:10.1111/dmcn.13938.
26.
KapciEGKucukerSUsluRI.How applicable are Ages and Stages Questionnaires for use with Turkish children?Top Early Child Spec Educ. 2010;30(3):176-188. doi:10.1177/0271121410373149.
27.
SquiresJBrickerDTwomblyE.The ASQ: SE user’s guide. 1st ed. Paul H. Brookes Publishing Co; 2003.
28.
KucukerSKapciEGUsluRI.Evaluation of the Turkish version of the Ages and Stages Questionnaires: Social-emotional in identifying children with social-emotional problems. Infants Young Child. 2011;24(2):207-220. doi:10.1097/IYC.0b013e31820eae26.
29.
AchenbachT.Manual for the Child Behavior Checklist/2-3 and 1992 Profile: Profile for Boys and Girls. 1st ed. Department of Psychiatry, University of Vermont; 1992.
30.
AchenbachTMRescorlaLA.Manual for the ASEBA Preschool Forms and Profiles. 1st ed. University of Vermont, Research Center for Children, Youth; 2000.
31.
ErolNSimsekZOnerOMunirK.Behavioral and emotional problems among Turkish children at ages 2 to 3 years. J Am Acad Child Adolesc Psychiatry. 2005;44(1):80-87. doi:10.1097/01.chi.0000145234.18056.82.
32.
YurduşenSErolNGençözT.The effects of parental attitudes and mothers’ psychological well-being on the emotional and behavioral problems of their preschool children. Matern Child Health J. 2013;17(1):68-75. doi:10.1007/s10995-012-0946-6.
33.
CristWNapier-PhillipsA.Mealtime behaviors of young children: a comparison of normative and clinical data. J Dev Behav Pediatr. 2001;22(5):279-286. doi:10.1097/00004703-200110000-00001.
34.
SanchezKSpittleAJAllinsonLMorganA.Parent questionnaires measuring feeding disorders in preschool children: a systematic review. Dev Med Child Neurol. 2015;57(9):798-807. doi:10.1111/dmcn.12748.
35.
Asar IlkÖODagO. Estimating Box-Cox power transformation parameter via goodness-of-fit tests. Commun Stat Simul Comput. 2017;46(1):91-105. doi:10.1080/03610918.2014.957839.
36.
R Core Team. R: A Language and Environment for Statistical Computing. 1st ed. R Foundation for Statistical Computing; 2013.
37.
IBM Corp. IBM SPSS Statistics for Windows, Version 23.0. 1st ed. IBM Corp; 2015.
38.
FaulFErdfelderEBuchnerALangAG.Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149-1160. doi:10.3758/BRM.41.4.1149.
39.
HelalYKadriEAfsahOAbou-ElsaadT.Validation of an Arabic questionnaire to assess pediatric behavioral feeding disorders. Folia Phoniatr Logop. 2025;1-10. doi:10.1159/000543945.
40.
El-KassasOSaadMAfsahOBazHAbou-ElsaadT.Adaptation and validation of Arabic version of the screening tool of feeding problems applied to children (STEP-CHILD). Int J Dev Disabil. 2024;1-12. doi:10.1080/20473869.2024.2368922.
41.
MaloneCSharifFGlennon-SlatteryC.Growth and nutritional risk in children with developmental delay. Ir J Med Sci. 2016;185(4):839-846. doi:10.1007/s11845-015-1377-3.
42.
MalasKTrudeauNGirouxM-CGauthierLPoulinSMcFarlandDH.Prior history of feeding–swallowing difficulties in children with language impairment. Am J Speech Lang Pathol. 2017;26(1):138-145. doi:10.1044/2016_AJSLP-15-0171.
43.
RescorlaLRossGSMcClureS.Language delay and behavioral/emotional problems in toddlers: findings from two developmental clinics. J Speech Lang Hear Res. 2007;50(4):1063-1078. doi:10.1044/1092-4388(2007/074)
44.
ChaoHCChangHL.Picky eating behaviors linked to inappropriate caregiver–child interaction, caregiver intervention, and impaired general development in children. Pediatr Neonatol. 2017;58(1):22-28. doi:10.1016/j.pedneo.2015.11.008.
45.
RenZLanHSzetoIM, et al. Feeding difficulty among Chinese toddlers aged 1–3 years and its association with health and development. Front Pediatr. 2021;9:758176. doi:10.3389/fped.2021.758176.
46.
PutnickDLBellEMGhassabianARobinsonSLSundaramRYeungE.Feeding problems as an indicator of developmental delay in early childhood. J Pediatr. 2022;242:184-191. doi:10.1016/j.jpeds.2021.11.010.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
