EatingBehaviors,CaregiverFeedingInteractions, andDietaryPatternsofChildrenBornPreterm: ASystematicReviewandMeta-Analysis

Abstract

Infantsbornpreterm(<37weeksofgestation)oftenexperiencefeedingproblemsduringhospitalization.Whetherdifficultiespersistorhavelongterm sequelae on childhood eating is unclear. We aimed to describe the oromotor eating skills (e.g., chewing/swallowing), eating behaviors (e.g., food neophobia), food parenting practices (e.g., pressure to eat), and dietary patterns of preterm children during late infancy (6–12 mo) and early childhood (>12 mo–7 y) and to determine whether these differed from those of term-born peers. We identified 67 articles (57 unique studies) for inclusion.Weusedrandom-effectsmeta-analysisofproportionstoexaminetheprevalenceoforomotoreatingskillandeatingbehaviorchallenges among preterm children, standard meta-analysis for comparisons with term-born peers, and the Grading of Recommendations, Assessment, Development and Evaluation approach to assess the certainty of evidence. Forty-three percent (95% CI: 24%, 62%) of infants and 25% (95% CI: 17%,33%)ofchildrenbornpretermexperiencedoromotoreatingdifficultiesand16%(95%CI:4%,27%)and20%(95%CI:11%,28%),respectively, exhibitedchallengingeatingbehaviors.Duringlateinfancyandearlychildhood,oromotoreatingdifficulties(OR:2.86;95%CI:1.71,4.77;I2=67.8%) and challenging eating behaviors (OR: 1.52; 95% CI: 1.11, 2.10; I2 = 0.0%) were more common in those born preterm than in those born term: however, the certainty of evidence was very low. Owing to the low number and heterogeneity of studies, we narratively reviewed literature on food parenting and dietary patterns. Mothers of preterm infants appeared to have heightened anxiety while feeding and utilized coercive food parenting practices; their infants reportedly received less human milk, started solid foods earlier, and had poorer diet quality than term-born peers. In conclusion, meta-analyses show preterm children experience frequent oromotor eating difficulties and challenging eating behaviors throughout the early years. Given preterm birth increases risk of later obesity and diet-related chronic disease, research examining the effects of caregiver–childinteractionsonsubsequentdietiswarranted.Thisreviewwasregisteredatwww.crd.york.ac.uk/prospero/asCRD42020176063