Child Development Unit, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, National University Health System, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Paediatric Gastroenterology, Nutrition, Hepatology and Liver Transplantation, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, National University Health System, Singapore.
Department of Dietetics, National University Hospital, Singapore.
Early Hum Dev. 2024 Dec;199:106137. doi: 10.1016/j.earlhumdev.2024.106137. Epub 2024 Nov 1.
Feeding difficulties are commonly reported in autistic children. However, there is limited data on the presentation, severity, and impact of feeding difficulties in autistic children in Asia.
To describe the dietary patterns, growth and nutritional status of autistic children with pediatric feeding disorder (PFD), and identify factors associated with more severe feeding difficulties.
A retrospective review of electronic medical records.
Autistic children (aged between 0 and 18 years) with PFD, who attended a multidisciplinary feeding clinic between August 2013 and December 2022.
The children's parents provided a 3-day food diary, which was verified by the dietitian and analyzed for their nutritional content using Foodworks 10 Professional. Food selectivity was classified as mild, moderate or severe, based on the number of food groups accepted and the absolute number of foods accepted in each group. Information regarding demographics, height, weight, medical information, developmental history (autism diagnosis, cognition, adaptive skills) and relevant nutritional bloodwork were collected. Parents also completed two validated questionnaires (the Behavioral Pediatrics Feeding Assessment Scale (BPFAS), which assessed childhood mealtime behaviors; and the Caregiver Feeding Style Questionnaire (CFSQ), which determined caregiver/ parental feeding styles). Factors associated with higher BPFAS total frequency scores (TFS) (representing more severe feeding difficulties) and food selectivity were analyzed.
There were a total of 98 patients (82 males), with mean ± SD (range) age of 59.2 ± 27.5 (17-169) months. They had mild (19.4 %), moderate (22.4 %) and severe (58.2 %) food selectivity, respectively. While the majority had normal weight (84.7 %) and height (88.8 %) for age, 69.4 % had diets deficient in calories, macronutrients or micronutrients (iron, calcium). Comparison between groups according to parental feeding style found that there was a significant difference in BFPAS TFS between different parental feeding styles (p < 0.001). Post-hoc testing revealed that parents who reported an authoritarian parental feeding style on the CFSQ were significantly more likely to report higher frequencies of difficult feeding behaviors on the BPFAS (98.3 ± 15.8), while an uninvolved parental feeding style was associated with the lowest BPFAS TFS (80.9 ± 11.0), Bonferroni-adjusted p < 0.001; indulgent (p = 0.012) and authoritative (p = 0.096). Intellectual impairment and Malay ethnicity were associated with more severe food selectivity [adjusted odds ratio 123.7 (95 % CI 3.09-4945.4, p = 0.01) and 38.0 (95 % CI 1.35-1074.18, p = 0.03)], respectively.
In this retrospective cohort, autistic children with PFD were at significant nutritional risk despite demonstrating normal growth patterns, with specific patient profiles being associated with more severe feeding difficulties.
自闭症儿童常报告有进食困难。然而，亚洲自闭症儿童的喂养困难表现、严重程度和影响的数据有限。
描述患有小儿喂养障碍（PFD）的自闭症儿童的饮食模式、生长和营养状况，并确定与更严重喂养困难相关的因素。
回顾性电子病历审查。
2013 年 8 月至 2022 年 12 月在多学科喂养诊所就诊的患有 PFD 的自闭症儿童（年龄在 0 至 18 岁之间）。
儿童的父母提供了 3 天的饮食日记，营养师对其进行了验证，并使用 Foodworks 10 Professional 对其营养成分进行了分析。根据接受的食物种类数和每个组接受的绝对食物数，将食物选择性分为轻度、中度或重度。收集了有关人口统计学、身高、体重、医疗信息、发育史（自闭症诊断、认知、适应技能）和相关营养血液检查的信息。父母还完成了两份经过验证的问卷（行为儿科学喂养评估量表（BPFAS），评估儿童用餐时的行为；以及照顾者喂养风格问卷（CFSQ），确定照顾者/父母的喂养风格）。分析了与更高的 BPFAS 总频率评分（TFS）（表示更严重的喂养困难）和食物选择性相关的因素。
共有 98 名患者（82 名男性），平均年龄 ± 标准差（范围）为 59.2 ± 27.5（17-169）个月。他们的食物选择性分别为轻度（19.4%）、中度（22.4%）和重度（58.2%）。虽然大多数儿童的体重（84.7%）和身高（88.8%）与年龄相匹配，但 69.4%的儿童的饮食中存在热量、宏量营养素或微量营养素（铁、钙）不足的情况。根据父母的喂养方式对各组进行比较发现，不同父母的喂养方式之间 BFPAS TFS 存在显著差异（p < 0.001）。事后检验显示，CFSQ 报告父母采用专制型喂养方式的父母更有可能在 BPFAS 报告更高频率的喂养困难行为（98.3 ± 15.8），而不参与的喂养方式与最低 BPFAS TFS 相关（80.9 ± 11.0），Bonferroni 调整后的 p < 0.001；放纵（p = 0.012）和专制（p = 0.096）。智力障碍和马来族裔与更严重的食物选择性相关[调整后的优势比 123.7（95%CI 3.09-4945.4，p = 0.01）和 38.0（95%CI 1.35-1074.18，p = 0.03)]。
在这项回顾性队列研究中，患有 PFD 的自闭症儿童尽管表现出正常的生长模式，但仍存在显著的营养风险，特定的患者特征与更严重的喂养困难相关。
