A Study on Behavioral Pediatric Feeding Status: Maternal Opinions Pediatric Feeding Status: Maternal Opinions

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Leyla Ozgen
Nurhan Unusan


Feedings disorder, food refusal, feeding problems


Summary. Aim: This research aimed to examine behavioral feeding status in children aged 6-8 according to maternal opinions. The research investigated if Behavioral Pediatrics Feeding Assessment Scale (BPFAS) overall score differed significantly by family structure, mother’s history of nutrition education and child’s history of health problems and medication use. Materials and methods: The population was Kocaeli province, while the sample comprised 245 children and their mothers selected with convenience sampling from primary schools in Kocaeli Turkey. Data analysis: The study data were gathered with a questionnaire form and the Behavioral Pediatrics Feeding Assessment Scale. Mann Whitney U tests were conducted to investigate if BPFAS subscale scores differed by mother’s history of nutrition education, and if BPFAS overall score differed by family structure, mother’s history of nutrition education and child’s history of health problems and medication use. Differences in BPFAS overall score by child’s Body Mass Index (BMI), age group and parents’ educational attainment were analyzed with Kruskal Wallis H tests. Results and discussion: 54.3% of the children participating in the study were female, while the percentages of the children aged 6, 7 and 8 were 21.2%, 28.6% and 50.2%, respectively. 64.5% of the children were underweight and 4.1% were overweight according to their BMI. Mean maternal and paternal ages were 35.4 ±1.1 and 39.6±1.1 years, respectively. In the study, a standard deviation greater than two was indicative of pediatric feeding behaviors. The majority of the children’s BMI was below 18.5, suggesting an inadequate and unbalanced nutritional behavior, which can be considered an indicator of incipient malnutrition. Conclusions and suggestions:  the researchers recommend popularizing nutrition education in schools as a government policy to combat childhood underweight and malnutrition.

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1- http://globalnutritionreport.org/The Global Nutrition Report. Global Nutrition Report from Promise to Impact Ending Malnutrition By 2030. (Accessed 8 June 2018).
2- Pesch HM, Daniel AR, Miller AL, add et al. Feeding styles among mothers of low-income children identified using a person-centered multi-method approach. Appetite 2020; 146(1):1-9.
3-Eslavaa VH, Fernand JK, Vollmer TR. Pediatric feeding problems: A field of application in behavior analysis. Rev Alerg Mex 2016; 7: 144-156.
4-Burklow KA, Mcgrath AM, Valerius KS, Rudolph C. Relationship between feeding difficulties, medical complexity, and gestational age. NCP 2002;17(6): 373-378. doi:10.1177/0115426502017006373
5-Estrem HH, Thoyre SM, Knafl KA, Pados BF, Riper MV. “It's a Long-Term Process”: Description of Daily Family Life When a Child Has a Feeding Disorder. Journal of Pediatric Health Care 2018; 32(4) July–August: 340-347.
6-Cetin SH, Yalınbas EE, Dibeklioglu S. Evaluation of Behavioral Modification for Children with Poor Appetite. Osmangazi Journal of Medicine 2019: 1-12. Doi: 10.20515/otd.500245
7-Onal S, Var EC, Ucar A. Adapting Behavioral Pediatric Feeding Assessment Scale (BPFAS) to Turkish. Nevsehir Journal of Science and Technology 2017; 6(1): 93-101. doi:10.17100/nevbiltek.296685
8-Chen X, Cisse-Egbuonye N, Spears EC, Mkuu R, McKyer ELJ. Children’s healthy eating habits and parents’ socio-demographic characteristics in rural Texas, USA. Health Education Journal 2018:1–14. https://doi.org/10.1177/0017896917752014.
9-King NA, Hester J, Gately PJ. The effect of a medium-term activity- and diet-induced energy deficit on subjective appetite sensations in obese children. International Journal of Obesity 2007;31(2): 334-339. doi:10.1038/sj.ijo.0803391
10-Hendricks K, Briefel R, Novak T, Ziegler P. Maternal and child characteristics associated with infant and toddler feeding practices. J Am Diet Assoc 2006;106(1): 135-148. doi:10.1016/j.jada.2005.09.035
11-Xue Y, Lee E, Ning K, add et al. Prevalence of picky eating behaviour in Chinese school-age children and associations with anthropometric parameters and intelligence quotient. A cross-sectional study. Appetite 2015; 91: 248-255. doi:10.1016/j.appet.2015.04.065
12-Saarilehto S, Lapinleimu H, Keskinen S, Helenius H, Talvia S, Simell O. Growth, energy intake, and meal pattern in five-year-old children considered as poor eaters. J Pediatr 2004; 144: 363–367. doi:10.1016/j.jpeds.2003.12.028
13-Velardo S, Drummond M. Australian children's perceptions of discretionary foods. Appetite 2018;120: 43-48. doi:10.1016/j.appet.2017.08.022
14- Creswell JW. Research Design. Qualitative, Quantitative and Mixed Method Approaches 2016. 2.Printing. Ankara: Education Book Publishing.
15- Erkus A. Scientific research process for behavioral sciences 2013, Ankara: Seckin.
16-Demiriz S, Ozgen L. Children's Vegetable and Fruit Consumption: Mother and Child Opinions. Gazi University Journal of Gazi Educational Faculty (GUJGEF) 2019; 39(2): 681-701.
17-Ozgen L, Demiriz S. Determining MothersAttitude in Developing Preschool Children Eating Behaviours. Procedia – Social and Behavioral Sciences 2015;191(2): 662-667.
18-He M, Evans A. Are parents aware that their children are overweight or obese? Can Fam Physician 2007; 53(9): 1493-99.
19-Estrem HH, Thoyre SM, Knafl KA, Pados, BF, Riper MV. (2018). “It’s A Long-Term Process”:Description Of Daily Family Life When A Child Has A Feeding Disorder. The National Association of Pediatric Nurse Practitioners 2018; 32(4):340-347. doi:10.1016/j.pedhc.2017.12.002
20-Lydecker JA, Riley KE, Grilo CM. Associations of parents self, child, and other “fat talk” with child eating behaviors and weight. Int J Eat Disord 2018:1-5. doi:10.1002/eat.22858
21-Rudolph KD. Gender differences in emotional responses to interpersonal stress during adolescence. J Adolesc Health 2002; 30(4): 3-13.
22-Noel RJ, Silverman AH. A problem that is difficult to swallow. J Pediatr 2017;181: 7-8. doi:10.1016/j. jpeds.2016.11.052
23-Patel MR, Reed GK, Piazza CC, Bachmeyer MH, Layer SA, Pabico RS. An evaluation of a high-probability instructional sequence to increase acceptance of food and decrease inappropriate behavior in children with pediatric feeding disorders. Res Dev Disabil 2006; 27: 430-432.
24-Greer AJ, Gulotta CS, Masler EA, Laud RB. Caregiver stress and outcomes of children with pediatric feding disorderstreated in an intensiveinterdisciplinary program. J Pediatr Psychol 2007;33(6): 612-20. doi:10.1093/jpepsy/jsm116.
25-Mohseni M, Aryankhesal A, Kalantari N. Prevalence of malnutrition among Iran’s under five-year-old children and the related factors: a systematic review and meta-analysis. Iran Journal Pediatrics 2018:1147-1158.
26-Gocgeldi E, Acıkel C, Türker T, Hasde M. Investigation of Frequency of Leftover Drugs at Home and Related Factors. TAF preventive medicine bulletin 2009;8(2): 113-118.
27-Aldridge VK, Dovey TM, Martin CI, Meyer C. Identifying clinically relevant feeding problems and disorders. Journal of Child Health Care 2010; 14: 261-270.
28- Estrem HH, Pados BF, Park J, Knafl KA, Thoyre SM. Feeding problems in infancy and early childhood: Evolutionary concept analysis. Journal of Advanced Nursing 2017; 73:56–70.
29- Williams K, Field D, Seiverling L. Food refusal in children: A review of the literature.
Res Dev Disabil 2010;31: 625-633.
30- Jaafar NH, Othman A, Majid NA, Harith S, Zabidi-Hussin Z. Parent-report instruments for assessing feeding difficulties in children with neurological impairments: a systematic review. Dev Med Child Neurol 2018; 61(2):1-10. doi:10.1111/dmcn.13986
31http://nutrition.gov.tr/content/files/home/turkey_healthy_nutrition_and_active life program.pdf. Ministry Of Health Department Of Publich Health. Turkey Healthy Eating and Active Life Program (2013-2017) (2013). (Accessed 8 June 2019).
32-Rylatt L, Cartwright T. Parental feeding behaviour and motivations regarding pre-school age children: A thematic synthesis of qualitative studies. Appetite 2016; 99: 285-97. doi:10.1016/j.appet.2015.12.017
33-Davison KK, Jurkowski JM, Li K, Kranz S, Lawson HA. A childhood obesity intervention developed by families for families: results from a pilot study. International Journal of Behavioral Nutrition and Physical Activity 2013:10(1). doi:10.1186/1479-5868-10-3
34-Kurt E, Orun E. Management of the feeding problems in children. Journal of Current Pediatrics 2016;14(3):0-0.
35-Unal F. Clinical Approach to Children with Low Appetite. Journal of Current Pediatrics 2011;1(9):79-84.
36-Lioret S, McNaughton SA, Spence AC, Crawford D, Campbell KJ. Tracking of dietary intakes in early childhood: The Melbourne Infant Program. European Journal of Clinical Nutrition 2013; 67(3): 275-281. doi:10.1038/ejcn.2012.218