Association Between Anthropometric Failure and Behavioral Feeding Problems in Children

Context-Dependent Associations

In children with esophageal atresia-tracheoesophageal fistula (EA-TEF), 25% of patients whose parents were anxious about feeding developed moderate to severely disturbed eating habits, with behavioral difficulties regarding food directly linked to growth problems 1
In children with skeletal dysplasias, such as rhizomelic chondrodysplasia punctata, feeding difficulties correlate with failure to thrive, with 50% requiring enteral nutrition due to feeding problems 2, 3
In children with Shwachman-Bodian-Diamond syndrome, 48-73% presented with feeding difficulties as neonates requiring enteral nutrition, with failure to thrive documented in 62-79% 4
In conditions with primary organic causes, such as pancreatic insufficiency, malabsorption, or metabolic complications, anthropometric failure may occur independent of behavioral feeding issues 4, 5

The American Academy of Pediatrics and other guideline societies may recommend screening for neurodevelopmental disorders, such as ADHD, when evaluating underlying conditions contributing to both behavioral feeding problems and anthropometric failure, although this specific recommendation is not cited here, the association between ADHD and feeding problems is well established 4

Observational assessment provides superior data to self-report measures for capturing feeding behaviors, though it is more resource-intensive, as noted by the International Journal of Behavioral Nutrition and Physical Activity 6, 7, 8
The American Academy of Pediatrics recommends considering screening for neurodevelopmental disorders, such as ADHD, where feeding problems are 3-4 times more prevalent, when evaluating for underlying conditions 9, 10

The World Health Organization growth standards can be used to calculate the Composite Index of Anthropometric Failure (CIAF), capturing height-for-age, weight-for-height, weight-for-age, and combined failures, with significant correlations between feeding problems and anthropometric failure 6, 8

The Academy of Nutrition and Dietetics suggests that videotaped mealtime observations should complement standardized feeding assessment scales, such as the Behavioral Pediatrics Feeding Assessment Scale, to provide more accurate assessment than questionnaires subject to social desirability bias 6, 8