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

Abstract

Infants born preterm (<37 weeks of gestation) often experience feeding problems during hospitalization. Whether difficulties persist or have long-term 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-effects meta-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; 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-child interactions on subsequent diet is warranted. This review was registered at www.crd.york.ac.uk/prospero/ as CRD42020176063.

Keywords: diet quality; eating behaviors; feeding and eating disorders of childhood; feeding skills; food parenting; meta-analysis; oromotor skills; parent–child interaction; picky eating; preterm birth.

FIGURE 1

Systematic review study selection process to examine the oromotor skills, eating behaviors, food parenting, and dietary patterns of children born preterm compared with term-born peers.

FIGURE 2

Prevalence of oromotor eating difficulties among infants and children born preterm. Random-effects meta-analysis of proportions using a maximum likelihood estimator. Results are expressed as prevalence (95% CI). The weighting for each study is the inverse of the total variance. I² = the percentage of variation across studies that is due to heterogeneity rather than chance. Values of 25%, 50%, and 75% were considered as low, moderate, and high heterogeneity, respectively.

FIGURE 3

Odds of oromotor eating difficulties: comparison of infants and children born preterm and at term. Random-effects meta-analysis using a REML model. Results are presented as ORs (95% CIs). The weighting for each study is the inverse of the total variance. I² = the percentage of variation across studies that is due to heterogeneity rather than chance. Values of 25%, 50%, and 75% were considered as low, moderate, and high heterogeneity, respectively. REML, restricted maximum likelihood.

FIGURE 4

Prevalence of eating behavior challenges among infants and children born preterm. Random-effects meta-analysis of proportions using a maximum likelihood estimator. Results are expressed as prevalence (95% CI). The weighting for each study is the inverse of the total variance. I² = the percentage of variation across studies that is due to heterogeneity rather than chance. Values of 25%, 50%, and 75% were considered as low, moderate, and high, respectively.

FIGURE 5

Odds of eating behavior challenges: comparison of infants and children born preterm and at term. Random-effects meta-analysis using a REML model. Results are presented as ORs (95% CIs). The weighting for each study is the inverse of the total variance. I² = the percentage of variation across studies that is due to heterogeneity rather than chance. Values of 25%, 50%, and 75% were considered as low, moderate, and high heterogeneity, respectively. REML, restricted maximum likelihood.

FIGURE 6

Prevalence of any eating challenge, not specified among infants and children born preterm. Any eating challenge refers to articles that did not differentiate between oromotor eating difficulties or eating behavior challenges. Random-effects meta-analysis of proportions using a maximum likelihood estimator. Results are expressed as prevalence (95% CIs). The weighting for each study is the inverse of the total variance. I² = the percentage of variation across studies that is due to heterogeneity rather than chance. Values of 25%, 50%, and 75% were considered as low, moderate, and high heterogeneity, respectively.

FIGURE 7

Odds of any eating challenge, not specified: comparison of infants and children born preterm and at term. Any eating challenge refers to studies that did not differentiate between oromotor eating difficulties or eating behavior challenges. Random-effects meta-analysis using a REML model. Results are presented as ORs (95% CIs). The weighting for each study is the inverse of the total variance. I² = the percentage of variation across studies that is due to heterogeneity rather than chance. Values of 25%, 50%, and 75% were considered as low, moderate, and high heterogeneity, respectively. REML, restricted maximum likelihood.