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Bidirectional associations between fussy eating and functional constipation in preschool children
Anne Tharner1, Pauline W Jansen2, Jessica C Kiefte-de Jong3
1Department of Epidemiology, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Insights
A child's fussy eating behavior and functional constipation are linked in a two-way relationship. This cycle can lead to ongoing gastrointestinal issues in children.
Area of Science:
- Pediatric Gastroenterology
- Developmental Psychology
Background:
- Fussy eating and functional constipation are common in childhood.
- The relationship between these two conditions is not fully understood.
Purpose of the Study:
- To investigate the bidirectional associations between fussy eating behavior and functional constipation in children.
Main Methods:
- Prospective cohort study of 4823 children from pregnancy.
- Fussy eating assessed at age 4 using the Child Eating Behavior Questionnaire.
- Functional constipation assessed at ages 2, 3, 4, and 6 using ROME criteria.
Main Results:
- Higher food fussiness at age 4 predicted increased risk of functional constipation at ages 4 and 6.
- Previous constipation predicted a higher risk of fussy eating at age 4.
- Path analysis confirmed a bidirectional relationship, forming a potential vicious cycle.
Conclusions:
- A cycle may exist where functional constipation leads to unhealthy eating, increasing gastrointestinal disease risk.
- Early identification and intervention may be crucial for breaking this cycle.
Objective:
To examine bidirectional associations between a child's fussy eating behavior and functional constipation.
Study Design:
Participants were 4823 children enrolled in a prospective cohort study from pregnancy onward. We assessed fussy eating at age 4 years with the Child Eating Behavior Questionnaire, and assessed functional constipation using ROME II and III criteria with parental questionnaires at age 2, 3, 4, and 6 years.
Results:
Higher food fussiness at age 4 years was associated with a greater risk of functional constipation at both 4 years (OR, 1.30; 95% CI, 1.20-1.42; P < .001 per 1 SD increase) and 6 years (OR, 1.12; 95% CI, 1.03-1.23; P < .05 per 1 SD increase). The converse was also observed; previous constipation predicted a greater risk of being a fussy eater at age 4 years (constipation at 2 years: OR, 2.05; 95% CI 1.43-2.94; P < .001; constipation at 3 years: OR, 1.72; 95% CI, 1.26-2.35, P < .001). Path analyses confirmed that the association between fussy eating and functional constipation was indeed bidirectional, showing that functional constipation at age 3 years predicted fussy eater classification at age 4 years (β = 0.06; P < .001), which in turn predicted functional constipation at age 6 years (β = 0.08: P < .001) independent of each other.
Conclusion:
A vicious cycle might develop in which children with functional constipation develop unhealthy eating behavior, which in turn increases the risk of functional gastrointestinal disease.
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