Eating Behaviors, Caregiver Feeding Interactions, and Dietary Patterns of Children Born Preterm: A Systematic Review and Meta-Analysis

A Systematic Review and Meta-Analysis Infants born preterm(<37 weeks of gestation) often experience feeding problems during hospitalization. Whether difficulties persist or have longterm 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. We used random-effectsmeta-analysis of proportions to examine the prevalence of oromotor eating skill and eating behavior challenges 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%) of children born preterm experienced oromotor eating difficulties and 16% (95% CI: 4%, 27%) and 20% (95% CI: 11%, 28%), respectively, exhibited challenging eating behaviors. During late infancy and early childhood, oromotor eating difficulties (OR: 2.86; 95% CI: 1.71, 4.77; I-2 = 67.8%) and challenging eating behaviors (OR: 1.52; 95% CI: 1.11, 2.10; I-2 = 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 pretermchildren experience frequent oromotor eating difficulties and challenging eating behaviors throughout the early years. Given pretermbirth increases risk of later obesity and diet- related chronic disease, research examining the effects of caregiver-child interactions on subsequent diet is warranted.

Automated summary

This article presents a systematic review and meta-analysis on feeding difficulties and eating behaviors among preterm children. The findings suggest that preterm children are more likely to experience oromotor eating difficulties and challenging eating behaviors compared to term-born peers. Additionally, the article highlights the importance of studying the effects of caregiver-child interactions on subsequent diet in order to prevent obesity and diet-related chronic diseases.