Behavioral feeding problems and parenting stress in toddlers with food protein-induced allergic proctocolitis

Food protein-induced allergic proctocolitis (FPIAP) typically develops in infancy, a critical period for taste preference and feeding skill development. Eliminating culprit foods, along with limited food options and the child's distressing symptoms, can significantly impact the mothers' parenting roles. However, research on behavioral feeding problems and parenting stress in toddlers with FPIAP is lacking.

To assess feeding behaviors and parenting stress levels in toddlers with FPIAP compared with healthy controls.

In this case-control study, parents of toddlers with FPIAP (n = 89) and healthy controls (n = 93) completed a socio-demographic form, the Behavioral Pediatrics Feeding Assessment Scale (BPFAS), and the Parenting Stress Index-Short Form.

Seventy-five percent of toddlers with FPIAP had single food allergies, and cow's milk (95.5%) was the most common trigger. Children with FPIAP initiated complementary feeding later than controls (P = .001) and preferred vegetables (P < .001). They experienced more challenges during the transition to complementary foods (P < .001). Whereas BPFAS total and child-related frequency and restriction scores were similar between groups (P > .05), the FPIAP group had significantly higher parent-related frequency, total problem, child-related problem, parent-related problem, and poor strategies scores (P < .05). In addition, the FPIAP group exhibited higher levels of parental distress, parent-child dysfunctional interaction, difficult child, and total stress scores (P < .001). Multivariate logistic regression analysis revealed that increased maternal total stress scores were associated with higher BPFAS total frequency scores (≥85) (odds ratio [OR]: 1.065, 95% CI: 1.031-1.101, P < .001) and total problem scores (≥10) (OR: 1.049, 95% CI: 1.021-1.077, P < .001). In addition, following social media accounts related to allergic proctocolitis was negatively associated with having higher BPFAS total frequency scores (≥85) (OR: 0.253, 95% CI: 0.073-0.878, P = .030).

Toddlers with FPIAP and their parents experience greater mealtime challenges compared with healthy controls, correlating with higher levels of parenting stress. Clinicians should recognize and address these challenges.