Feeding problems in infancy and diet quality in later childhood: a prospective cohort study

Background Feeding problems affect many children, yet their connection with diet quality in later childhood is unknown, despite the important role of diet quality on health outcomes, such as obesity. Objective To examine feeding problem behaviors and diet quality in later childhood. Design The frequency of problematic feeding behaviors (i.e., items related to food refusal, feeding difficulties, and distress) were parent-reported at 18 and 24 months in a birth cohort (2008–2010) from New York state ( n = 4,989). In this previously validated feeding behaviors scale, parents responded to how often their child engaged in behaviors such as crying/screaming during meals and food refusal, to create an average feeding problems score. Typical daily servings of food items that a child consumed were parent-reported at 30 months, 36 months, 7 years, and 9 years and diet quality using the Youth Healthy Eating Index (YHEI) was calculated, with a higher score indicating better diet quality. Mixed effects analyses calculated mean differences in YHEI per unit increase in feeding problem scores, adjusting for sociodemographic and health-related factors, such as parental education, gestational age, and any breastfeeding duration. Results Feeding problem scores at 18 and 24 months were prospectively associated with lower YHEI scores at 30/36 months (18 months: B = -1.10, 95% CI: -1.93, -0.27; 24 months: B = -1.56, 95% CI: -2.33, -0.79). Similar associations were observed at 7/9 years (18 months: B = -1.30, 95% CI: -2.61, 0.00; 24 months: B = -1.65, 95% CI: -2.96, -0.34). Conclusions Higher feeding problems in infancy (18 and 24 months) were associated with lower quality diets in childhood, even after children started school. These findings highlight the importance of feeding behaviors to long-term diet quality even with observations as early as 18 months. Trial registration NCT03106493 in clinicaltrials.gov (Dates: 07/2008–11/2019, Study Registration Date: 2017–04-10).