We investigated the application of the new diagnostic term, ‘pediatric eating disorder’, to unify the medical, nutritional, dietary, and psychological competencies associated with PFD. Our results demonstrated that sociodemographic and perinatal factors associated with PFD were similar among all selected eating disorder types, supporting their derivation from a single source and the relevance of this new terminology to diagnose these eating disorders. disorders in children.
The present study included children with different types of eating disorders according to the recent consensus definition of PFD. The children were diagnosed and followed in a tertiary medical center for 2 years. We compared this cohort to a control group of age- and sex-matched apparently healthy children from the general population. We demonstrated that low SES, lack of breastfeeding and LBW were significant predictors of PFD. We also found higher rates of premature and twin pregnancies, IUGR cases, divorced and single parents, background conditions, hospitalizations, and prescription medications in the PFD group compared to the control group and that, importantly, these factors were not associated with the type of PFD. .
PFD is a relatively common clinical diagnosis with increasing prevalence, according to a recent study by Kovacic et al.18. Very few studies have examined predictors of PFD, and none of them related to the specific types of eating disorders listed in the recent consensus diagnostic definitions of PFD. This new definition provides consistent terminology, encompassing all areas and disciplines of eating disorders, and recognizing specific subtypes with therapeutic and prognostic implications9.
Our results revealed several significant predictors of PFD. Low SES as a predictor of PFD is consistent with the study by Carpnell et al. who demonstrated that low SES is associated with eating disorders at age 2 in preterm babies19. The development of healthy eating behaviors depends, among other factors, on responsive parenting behaviors, which reflect reciprocity between child and caregiver, and include recognizing internal cues of hunger and fullness with a developmentally appropriate supportive response20. Lower SES caregivers must rely on multiple caregivers of their children while they work. In addition, many low-paying jobs do not encourage breastfeeding and can therefore interfere with the child’s acquisition of good eating habits. In addition, they have fewer economic and social resources 20which may limit their ability to provide diverse and nutritious foods to their children.
We found a higher prevalence of IPN, preterm birth and twin pregnancies in the study group compared to the control group. Few studies have demonstrated that preterm infants are at high risk for oral feeding difficulties during the neonatal period21.22 and throughout childhood23.24. This could be associated with prolonged nasogastric feeding and respiratory support, delayed oral feeding25and early hypotonia 19. Samara et al. reported that feeding problems were more common at age 6 years in children born extremely preterm (23. Johnson et al. showed that late to moderate preterm infants29,30,31,32,34 were more at risk of developing picky eating habits and oral motor problems at corrected age 2 years compared to their full-term peers24. Unlike these studies, we observed no association between a specific type of PFD and preterm birth. Other studies have shown more parental stress and worries in mothers of preemies27 and multiple26 which led to their difficulty in interpreting infant behaviors and adjusting meal volumes and timings. The authors concluded that advice on feeding these infants after discharge from the maternities is necessary.27.
Migraine et al.12 demonstrated that premature and low-body-weight infants have more feeding difficulties than full-term infants at 2 years of age. However, as in our study, after adjusting for maternal and neonatal characteristics, a BW z score
We found that fewer children in the PFD group were breastfed compared to our control group. Breastfed infants would be exposed to various flavors during lactation from the maternal diet29, unlike formula-fed infants who are not exposed to the variety of flavors. Other studies suggest that breastfed infants are initially more accepting of greater variety and new foods during the weaning period, and that repeated exposure to a new food leads to greater acceptance in breastfed infants compared to formula-fed infants.27,28,29. This effect is still evident at 3 and 6 years30. Additionally, children who were breastfed appear to eat more fruits and vegetables, be less fussy, and show lower levels of neophobia (fear of new foods) later in childhood compared to formula-fed children.31.34.
To the best of our knowledge, this is the first study to provide clinical evidence on predictors of PFD according to the recent consensus definition. The diagnosis of PFD was made by a multidisciplinary team in a clinical setting. It is also the first description of the PFD subtypes included in the new ICD diagnostic term. The results of our study that sociodemographic and perinatal factors associated with PFDs are similar among PFD types may support the idea that these types derive from a single source and reinforce the relevance of using this new terminology for the PFD diagnosis. Their manifestations in the form of medical, nutritional, dietary and psychological dysfunctions underline the need to offer these children and their families multidisciplinary care in order to address all the areas that may be concerned. Early diagnosis of children at risk of PFD and appropriate multidisciplinary management can improve the prognosis of these children and enable them to develop age-appropriate eating habits.
This observational study is limited by its retrospective nature and by the absence of more precise data on the growth parameters and the mental state of the children and the parents. A certain degree of incompatibility between the clinical diagnosis and the new formal definition of PFD can be anticipated. However, since the diagnosis of PFD was made by a multidisciplinary team consisting of a pediatric gastroenterologist, a dietician, a speech therapist and a psychologist, combined with the anonymity of the parental questionnaire, we believe that the inaccuracies in the PFD and its subtypes have been minimal. Additionally, the absence of an eating disorder in the control group was determined by their parents and may have included children whose eating habits were in fact not appropriate. Finally, the cohort of patients accessed care in a subspecialty clinic and may not represent the general pediatric population. However, our hospital is a tertiary care hospital which we believe represents the general pediatric population.
In conclusion, we presented the sociodemographic and perinatal factors associated with PFD and demonstrated that these factors are unaffected by PFD subtype, supporting the use of the diagnostic classification unifying term and the need for management. multidisciplinary. Further studies should investigate the effect of different approaches to treating PFD subtypes.