Eating Behaviors, Caregiver Feeding Interactions, and Dietary Patterns of Children Born Preterm: A Systematic Review and Meta-Analysis

Abstract

Infants born preterm (<37 weeks) often experience feeding problems during hospitalization. Whether difficulties persist or have long-term sequelae on childhood eating is unclear. We aimed to describe the oromotor eating skills (e.g., chewing/swallowing), eating behaviours (e.g., food neophobia), food parenting practices (e.g., pressure to eat) and dietary patterns of preterm children during late infancy (6-12 months) and early childhood (>12 months-7 years) and to determine whether these differ from term-born peers. We identified 67 articles (57 unique studies) for inclusion. We used random-effects meta-analysis of proportions to examine the prevalence of oromotor eating skill and eating behaviour challenges among preterm children, standard meta-analysis for comparisons to term-born peers, and the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty of evidence. Forty-three percent (95% CI 24-62%) of infants and 25% (95% CI 17-33%) of children born preterm experienced oromotor eating difficulties and 16% (95% CI 4-27%) and 20% (95% CI 11-28%), respectively, exhibited challenging eating behaviours. During late infancy and early childhood, oromotor eating difficulties (OR=2.86, 95% CI 1.71, 4.77, I2= 67.8%) and challenging eating behaviours (OR=1.52, 95% CI 1.11, 2.10, I2= 0.0%) were more common in those born preterm vs. term: however, the certainty of evidence was very low. Due to low number and heterogeneity of studies, we narratively reviewed literature on food parenting and dietary patterns. Mothers of preterm infants appeared to have heightened anxiety while feeding and utilized coercive food parenting practices; their infants reportedly received less human milk, started solid foods earlier and had poorer diet quality compared to term-born peers. In conclusion, meta-analyses show preterm children experience frequent oromotor eating difficulties and challenging eating behaviours throughout the early years. Given preterm birth increases risk of later obesity and diet-related chronic disease, research examining caregiver-child interactions on subsequent diet is warranted. PROSPERO# CRD42020176063.

Birth-related, medical, and diagnostic characteristics in younger versus older children with avoidant/restrictive food intake disorder (ARFID)

“…Although previous feeding and eating disorder research underlined the relevance of associations between birth-related characteristics and the development of feeding and eating problems at early [ 14 , 15 , 17 , 18 ] and later ages [ 19 , 20 ], there was a lack of research on age-specific associations to ARFID so far. In line with hypothesis, a significantly higher rate of patients born preterm were found in the younger than older age group, indicating that prematurity may be a risk factor for developing ARFID at an early age.…”

“…Notably, due to ARFID’s diagnostic origin [ 1 , 10 ], it is plausible that patients with ARFID show similar etiological features as patients with feeding disorders, at least in younger patients. For example, pre- and perinatal complications, including prematurity and being small for gestational age (SGA), are known to be risk factors for developing feeding difficulties and disorders [ 14 – 18 ] as well as anorexia nervosa (AN) and bulimia nervosa [ 19 , 20 ], but virtually nothing is known about these conditions in ARFID. First data on birth-related characteristics in children aged 0–10 years with ARFID have been reported by Krom et al [ 8 ] showing a rate of 35% preterm births, 19% of patients being SGA, and having a median birth weight of 2700 g, indicating strong deviations from international data on birth-related characteristics [ 21 ].…”

Weight trajectories from birth to 5 years and child appetitive traits at 7 years of age: a prospective birth cohort study

“…The inclusion of confounders was based on literature review on factors possibly associated with both child early life growth (4,6,34,35) and appetitive traits at school-age (36,37) . Since crude models were very similar to the first adjusted models, these are presented as supplementary material only (online Supplementary Table 1).…”

“…This attempt may be beneficial if the prenatal conditions would prevail in postnatal life; however, they become detrimental in the case of postnatal life differing from the prenatal life (44) , increasing the risk of weight gain and overeating (45) . As premature children often experience challenging eating behaviours and eating difficulties in childhood (35) , child prematurity was also tested in the adjustment of models, together with child sex. However, we believe that since a little percentage of children were born premature in the current sample (6•84 %), effects between weight trajectories and child appetitive traits at 7 years did not change significantly.…”

Smell and taste of milk during tube feeding of preterm infants: neurodevelopmental follow-up of the randomized TASTE trial, study protocol

“…“Early nutritional learning” describes interactions with food, including smells, tastes, and emotions around feeding that modify appetite and satiety development and the rate of weight gain [ 10 – 13 ]. It occurs during a time of brain development that is marked by rapid neuronal proliferation, myelination, and synaptogenesis and is known to generate the long-term basis for food preferences and eating behavior with effects seen even into adulthood [ 14 – 17 ]. Research into the long-term effects of early nutritional experiences is sparse but investigating the potential impact on cognitive outcomes has been suggested [ 18 ].…”