Eating in Preschool Children With Cystic Fibrosis and Healthy Peers: Behavioral Analysis

Abstract

Study objective. To investigate calorie intake, behavioral eating styles, and parent perception of eating behavior of preschool children with cystic fibrosis (CF) compared with healthy peers. Design. A two group comparison study. Setting. A clinical sample of 32 preschool children with CF (aged 2 to 5 years) and a community sample of 29 healthy peers matched for age and socioeconomic status. Measurements and main results. The two groups did not differ on the total number of calories consumed per day or the percentage of calories derived form fat. The CF sample achieved a significantly higher percent of the recommended daily allowance (RDA) of energy (95% RDA) than the control group (84% RDA), P < .05, but did not achieve the CF dietary recommendations of 120% RDA. On measures of behavioral eating style, the CF sample had significantly longer meals (24.63 min) than the control group (18.57 min), P < .01, but did not differ on pace of eating or calories consumed per bite. On a measure of parent report of mealtime behavior, parents of the CF sample identified mealtime behaviors of "dawdles" and "refuses food" as more problematic (M = .93) than parents of control children (M = .22), P < .05. Conclusions. While preschool children with CF consume as much or more than healthy peers, they are not achieving the CF dietary recommendations. Furthermore, there appear to be behavioral differences in eating and parent perception of CF children's eating that may contribute to the failure to achieve dietary recommendations.

Child Behavior and Parent Management Strategies at Mealtimes in Families With a School-Age Child With Cystic Fibrosis.

“…It is also noteworthy that despite the increased calorie intake in school-age versus preschool-age children with CF, the school-age children in this sample achieved a lower percent ideal body weight (87.3%) (Stark et al, 1997) than the preschool sample (98.5%) (Stark et al, 1995). In addition, whereas the preschool-age children with CF did not differ from their same-age peers on absolute height and weight (Stark et al, 1995), the school-age sample of children with CF were found to be significantly shorter than same-age peers and to weigh significantly less (Stark et al, 1997).…”

“…It is also noteworthy that despite the increased calorie intake in school-age versus preschool-age children with CF, the school-age children in this sample achieved a lower percent ideal body weight (87.3%) (Stark et al, 1997) than the preschool sample (98.5%) (Stark et al, 1995). In addition, whereas the preschool-age children with CF did not differ from their same-age peers on absolute height and weight (Stark et al, 1995), the school-age sample of children with CF were found to be significantly shorter than same-age peers and to weigh significantly less (Stark et al, 1997). The trend for children with CF to decline in weight percentile as they age is seen in the national data collected by the CF Foundation (Cystic Fibrosis Foundation, 2003) and longitudinal studies of children with CF, and suggests that despite increased caloric intake, school-age children still are at significant risk, and possibly greater risk, because of their growth status (Zemel, Jawad, Fitzsimmons, & Stallings, 2000).…”

“…Behavioral intervention targeting improved child management strategies (i.e., contingent attention, ignoring, contingent rewards, and shaping) have shown promise in increasing caloric intake and promoting weight gain in children with CF (Jelalian, Stark, Reynolds, & Seifer, 1998). The results of this investigation demonstrate the need for continued efforts to identify strategies to improve mealtime interactions as a means of promoting adherence to diet and promoting weight gain in children with CF across the developmental spectrum (Powers et al, 2002; Stark et al, 1995, 1997). As nutritional status is linked to pulmonary functioning (Kostan et al, 2003; Peterson et al, 2003), behavioral interventions may play a significant role in increasing life expectancy for children with CF.…”

“…The present study provides data on the mealtime behaviors of school-age children with CF and their parents in comparison to same-age peers without a chronic illness. When examined along with our previous work on preschool children with CF (Stark et al, 1995(Stark et al, , 2000, these data provide important information on mealtime behaviors in children with CF from preschool through schoolage developmental periods. As hypothesized, parents of schoolage children with CF exhibited a greater frequency of both effective (direct commands and reinforcement) and ineffective (coaxing and physical prompts) child management strategies during the dinner meal.…”

“…Despite the importance of diet, adherence to dietary recommendations has been found to be low (Carter, Kronenberger, & Conradsen, 1993; Gudas, Koocher, & Wypij, 1991). On average, studies have reported that only 15%–23% of children with CF meet the dietary recommendation of 120% of the RDA for energy (Anthony, Paxton, Bines, & Phelan, 1999; Powers et al, 2002; Stark et al, 1995; Tomezsko, Stallings, & Scanlin, 1992). Recently, research has been conducted to identify barriers to meeting the CF dietary recommendations within the preschool and toddler populations with CF.…”