Clinical use of a food inventory to identify mayernal underreport on children's food intake: experience of a reference center in Brazil / Uso clínico do inventário alimentar para identificação do sub relato materno sobre ingestão alimentar em crianças: experiência de centro de referência brasileiro

Background: Feeding Difficulties (FD) are a common problem in childhood, and dietary assessments are extremely important to evaluate food consumption and selectivity patterns. In clinical practice, it is often observed that caregivers have an exacerbated perception of the severity of their children's FD and this may impact on dietary reports. Objectives: To compare the variety of foods consumed by children with FD under maternal perception to the evaluation performed by nutritionist using a food inventory in association with traditional methods. Methods: It is a cross sectional study with 119 motherchildren pairs, with complaints of FD followed at an outpatient service in São Paulo, Brazil. Data collected consisted of demographics, maternal caregiving style, responsibility over feeding the child, perception of children's feeding diversity (expressed in numbers, taken from a self-explanatory food inventory), presence of organic disease, type of FD, BMI Zscore, and actual repertoire of foods consumed (expressed in numbers, assessed by the nutritionist after evaluating the food inventory). The inventory provided information about the food items the child accepts without rejection, used to accept but now rejects, and completely rejects. Spearman correlation and Lynn's coefficient of variation, ANOVA and T-student tests were used, with a 5% significance level. Results and discussion: Overall food diversity ranged from 16 (p25%) to 30 (p75%) different types of foods. Maternal perceived food diversity ranged from 4,3 to 14,5 (p25-75). Around 23,7% of children were considered highly selective (less than 15 types of foods) (p=0,000). Maternal perception underestimated that assessed by the nutritionist in 2,2 times, with low reproducibility between these two variables (r=0,14). Both maternal perception and professional assessment did not vary according to age, organic comorbidities, gender, maternal parity, feeding style or responsibility over feeding routines (p>0,49). Findings enhance the importance of parental behavioral interventions and of the use of dietary research methodologies which are complementary to already validated strategies. Conclusions: There was maternal underestimation on the quantity of foods accepted by children with FD. The data reinforce the need for family orientation about the expectations regarding the feeding practices and preferences of their children

Introdução: As dificuldades alimentares (DA) são um problema comum na infância, e a avaliação dietética é extremamente importante para avaliar o consumo de alimentos e os padrões de seletividade. Na prática clínica, muitas vezes observa- se que os cuidadores têm percepção exacerbada da gravidade da DA de seus filhos, e isso pode afetar os relatos alimentares. Objetivos: comparar a variedade de alimentos consumidos por crianças com DA sob percepção materna à avaliação realizada por nutricionista, usando um inventário de alimentos em associação com métodos tradicionais. Métodos: Estudo transversal com 119 pares de mãe-filho, com queixas de DA atendidos em ambulatório em São Paulo, Brasil. Coletou-se dados demográficos, estilo parental materno, responsabilidade sobre a alimentação da criança, percepção da diversidade de alimentação das crianças (expressa em números, extraída de inventário de alimentos auto-preenchido), presença de doença orgânica, tipo de DA, IMC escorez, e repertório real de alimentos consumidos (expresso em números, avaliado pelo nutricionista depois de avaliar o inventário de alimentos). O inventário forneceu informações sobre alimentos que a criança aceita sem rejeição, costumava aceitar, mas agora rejeita, e rejeita completamente. Utilizouse correlação de Spearman e coeficiente de variação de Lynn, ANOVA e Teste T-student, com nível de significância de 5%. Resultados e discussão: a diversidade geral de alimentos variou de 16 (p25%) a 30 (p75%) tipos de alimentos. A percepção materna variou de 4,3 a 14,5 (p25-75). Cerca de 23,7% das crianças foram consideradas altamente seletivas (menos de 15 tipos de alimentos) (p = 0,000). A percepção materna subestimou a avaliação do nutricionista em 2,2 vezes, com baixa reprodutibilidade entre as duas variáveis (r = 0,14). Tanto a percepção materna como a avaliação profissional não variaram de acordo com a idade, comorbidades orgânicas, gênero, paridade materna, estilo parental ou responsabilidade sobre as rotinas de alimentação (p> 0,49). Os achados reforçam a importância das intervenções comportamentais com os pais e do uso de metodologias de investigação dietética complementares às estratégias já validadas. Conclusões: houve subestimação materna sobre a quantidade de alimentos aceitos por crianças com DA. Os dados reforçam a necessidade de orientação familiar sobre as expectativas quanto às práticas de alimentação e preferências de seus filhos

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Feeding difficulties are not associated with higher rates of iron deficiency anemia in Brazilian children and adolescents: cross-sectional study

Background: Iron deficiency anemia and feeding difficulties (FD) are common issues in childhood, reinforcing the concern about the risk of micronutrient deficiencies. FD do not necessarily reflect nutritional deficiencies, since they may or may not relate to specific nutrient sources. The objective of the study is to describe the prevalence of iron depletion and iron deficiency anemia in children with FD and to seek associations with diagnosis and its markers. Methods: This is a cross-sectional study with 68 patients (convenience sample). The following data were assessed through medical records: age (months), gender, exclusive breastfeeding duration (months), birth weight (kg), iron supplementation, hemoglobin (Hb), ferritin, and C-reactive protein (CRP) levels, repertory of foods consumed (food inventory and 3-day food record analysis), and diagnosis of FD. Data were classified according to references for age and were analyzed using correlation tests, Student's t test, ANOVA and chi-square test, or its nonparametric equivalents. A significance level of 5% was considered. Results: Iron depletion and anemia were identified in 10.1 and 6% of children, respectively. Picky eating was diagnosed in 35.3%. Food repertory consisted on average of 21 foods, with null correlation to Hb and ferritin. The average fortified milk intake was 517 ml/day, with null correlation to Hb. There was no effect of diagnosis of FD on Hb (p = 0.18) or ferritin (p = 0.52). The same was verified in the children without supplementation, to both Hb (p = 0. 54) and ferritin (p = 0.08). Conclusions: No evidence of association between diagnosis of FD or repertory of foods to anemia or iron depletion was found, which could be a reassuring factor for caregivers. Reproduction in large scale as well as inclusion of dietary intake variables is suggested for further research.

Delayed Development of Feeding Skills in Children with Feeding Difficulties-Cross-sectional Study in a Brazilian Reference Center.

BACKGROUND: Delays in gross motor development, sensory processing issues, and organic and behavioral problems are known to interfere in the development of feeding skills (FS); and-therefore-in the success of the process of feeding a child. Children with feeding difficulties (FD) commonly present inadequacy of FS. OBJECTIVES: Assessment of five FS in Brazilian children with FD, and search of associations with types of FD. METHODS: Cross-sectional study with 70 children below 10 years old. Data were obtained from medical records: age, gender, age at texture transitions, feeding phase (breastfeeding, weaning to solids or full solids) at first complaint; characteristics of the meal (duration, environment, and shared meals with adults), self-feeding practices, use of feeding equipment and bottle, mouthing, feeding position and FD diagnosis. Skills were categorized according to standards for age. Chi-Square, Anova Test (or non-parametric equivalent) and Multinomial logistic regression tests were used, with a significance level of 5%. RESULTS: There was no difference in FS (p > 0.05) or in the number of FS inadequateness (p = 0.84) according to FD diagnosis. The majority (94%) of children presented at least one delayed development of FS; 1/3 presented delays in more than half of the FS. The most prevalent inadequacies in FS were inadequate feeding position (73.5%), prolonged bottle feeding (56.9%), and inadequate self-feeding practices (37.9%). Feeding complaints first appeared at 10.9 ± 11.4 months, and picky eating was the most prevalent type of FD (37.1%). Most children were fed in inadequate environments (55.2%), without the company of adults (78%). Transition to solid foods occurred at 16 ± 5.6 months. Multinomial logistic regression showed no difference in likelihood of presenting any type of FD compared to picky eating, according to FS. Age at texture transition both from breastfeeding to complementary feeding (p = 0.95), and from complementary feeding to solid foods (p = 0.43) did not vary according to FD diagnosis. CONCLUSION: FS development or number of FS inadequateness did not vary according to FD diagnosis. Identification of these inadequacies could help the discussion for multi-professional treatment of patients with FD.

Maternal Feeding Practices among Children with Feeding Difficulties-Cross-sectional Study in a Brazilian Reference Center.

BACKGROUND: Given the positive influence of responsive caregiving on dietary habits in childhood, to raise awareness of caregivers regarding their behavior is crucial in multidisciplinary care on infant feeding. OBJECTIVES: To identify the most common responsive and non-responsive feeding practices in mothers of children with feeding complaints, as well as to seek associations between practices and caregivers' profile. METHODS: Cross-sectional study with 77 children under 18 years old, with complaints of feeding difficulties. Data were collected during interviews with mothers: child age, gender, duration of exclusive breastfeeding, presence of organic disease, dynamics of bottle use, self-feeding practices and posture at meals, use of appropriate feeding equipment; basic information about the mothers (parity and level of education), caregiver feeding style, presence of coercive feeding, frequency and characteristics of family meals. Statistical analysis considered significance level at 5%. RESULTS: The non-responsive profile predominated among mothers (76.2%, with the Authoritarian style being the most prevalent-39.7%). The responsive profile was characterized by absence of coercive feeding, stimulation of self-feeding practices, use of appropriate feeding equipment and meal environment, with interaction at meals. Non-responsive profile consisted of both inadequate environment and posture at meals, use of distraction and coercive feeding, lack of shared meals, and disregard for children's hunger signals. Only the habit of sharing meals with children was associated with mothers' profile, and considered a protection factor against non-responsive care (OR 0.23; 95% CI 0.06-0.88). Both Authoritarian (p = 0.000) and indulgent mothers (p = 0.007) breastfed exclusively for longer time than negligent ones. There was a higher level of interaction with children in "responsive" parental style (OR 0.056; p = 0.01) compared to other feeding styles. CONCLUSION: Results highlight the need for educational interventions focused on caregivers' behaviors.