Time to reconsider feeding difficulties in healthy children: a narrative synthesis of definitions and associated factors

Objective Despite the lack of a “gold-standard” definition and identification of influential factors for identifying feeding difficulties in children, many international studies have been published in recent years on the subject. Thus, the aim was to examine studies on children with feeding difficulties and their associated factors that impact on their difficulties. Methods Feeding difficulties were identified as limit the variety of food intake, and/or avoiding food due to sensory stimulus, i.e., food appearance, aroma, and flavor. A literature search in three databases was performed up to April 2021. English language articles were included if they investigated preschool and school age children using an observational or experimental design evaluating feeding difficulties and their factors. Results Findings indicate that almost 60% of the studies evaluated picky/fussy eaters, followed by 20% evaluating food neophobia. Parental influence, mainly mothers, were seemed to be the most reported influence. Studies have shown a lower consumption of fruit and vegetables and higher intake of discretionary foods among picky and food neophobic children. Most of the studies showed that children were on normal weight to overweight status. Few studies identified socio-demographics (i.e., age, sex, race/ethnicity, and birth age), emotional distress and other lifestyle behaviors (screen-time use during meals). Studies were mixed in terms of positive effects on breastfeeding and introduction to foods. Conclusion Improved feeding difficulties in this population group are dependent from these factors, whereas they should be used to inform policies, strategies, and use in clinical practices.