Multiaxial evaluation of mother-child interaction in toddlers with feeding problems

Recent research emphasizes the critical role of parent-child interaction quality in the development and maintenance of feeding problems (FP). This study examined the relationship between mother-toddler interaction quality and FP in in toddlers aged 12-36 months, incorporating recent theoretical advances and intervention approaches. A cross-sectional comparative study was conducted with 58 mother-toddler dyads (33 with FP, 25 nonFP) recruited from pediatric and child psychiatry clinics. Mothers completed standardized assessments including Infancy Adaptive Eating Behavior Scale, Brief Infant-Toddler Social-Emotional Assessment, and Brief Symptom Inventory. Mother-toddler interactions during play and structured tasks were video-recorded and scored using the Mother-Toddler Interaction Multiaxial Assessment (MTI-MAXA). Toddlers with FP exhibited significantly more problematic eating behaviors and lower interaction quality compared to nonFP group. Mothers in the FP group had significantly lower total scores, particularly in Reciprocity and Flexibility-Adaptation. Toddlers in the FP group showed lower scores across most subscales, with overall dyadic interaction quality significantly poorer. Higher child involvement scores were associated with reduced odds of having FP, and greater maternal interaction quality predicted lower FP severity. No significant differences were found in maternal or child psychopathological risk between groups. The MTI-MAXA demonstrated excellent interrater reliability, with high internal consistency for both maternal (α =.933) and child (α =.946) interaction scores. These findings demonstrate that early relational difficulties contribute to FP independently of psychopathology. The study provides evidence for the effectiveness of observational assessment tools in identifying at-risk dyads and supports the implementation of family-centered, relationally-focused interventions. Early identification and targeted intervention focusing on interaction quality may prevent the escalation of subclinical difficulties into diagnosable feeding disorders.