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Impact of Behavioral Feeding Intervention on Child Emotional and Behavioral Functioning, Parenting Stress, and Parent-Child Attachment

Knight, Rachel M.*; Albright, Jeremy J.; Huth-Bocks, Alissa; Morris, Natalie K.*; Mills, Lauren*; Klok, Kaylin*; Kallabat, Nora*; Drayton, Amy K.*

Journal of Pediatric Gastroenterology and Nutrition: May 9, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPG.0000000000002382
Original Article: Nutritionand Growth: PDF Only

Objectives: Behavioral intervention is the only treatment for pediatric feeding problems with well-documented empirical support. However, parents may be hesitant to pursue behavioral intervention due to concerns about possible negative side effects on child behavioral health and the parent-child relationship. This study investigated associations between behavioral feeding treatment and parenting stress, internalizing and externalizing behavior problems in young children, and parent-child attachment quality.

Methods: Participants included 16 mother-child dyads seeking treatment from a behavioral feeding clinic at a large Midwestern university medical center. Children were between the ages of 30 and 45 months (adjusted) at baseline. Caregivers completed the Child Behavior Checklist for Ages 1.5–5 (CBCL/1.5–5), the Parenting Stress Index, 3rd Edition Short Form (PSI/SF), and mother-child dyads participated in the Strange Situation procedure at baseline and again after 6 months. The treatment group (n = 12) began outpatient behavioral feeding intervention following the baseline evaluation, while the control group (n = 12) remained on the clinic waitlist until after the 6-month follow-up.

Results: The treatment group demonstrated decreases in internalizing and externalizing child behavior problems and parenting stress compared to the control group. No significant differences were demonstrated in parent-child attachment quality within or between groups.

Conclusions: Behavioral feeding intervention had positive effects on perceptions of child emotional and behavioral functioning and maternal parenting stress. Intervention also did not impact the quality of the mother-child attachment relationship. Further research with a larger sample size and additional observational measures of behavior is needed to support the replicability and generalizability of these results.

*Michigan Medicine, Department of Pediatrics, Division of Pediatric Psychology, Ann Arbor, MI

Methods Consultants, Ypsilanti, MI

University Hospitals Cleveland Medical Center, Department of Pediatrics, Division of Developmental and Behavioral Pediatrics and Psychology, Cleveland, OH.

Address correspondence and reprint requests to Amy K. Drayton, PhD, Department of Pediatrics Michigan Medicine, 1500 E. Medical Center Drive, SPC 5718 MPB 2232, Ann Arbor, MI 48109 (e-mail:

Received 18 July, 2018

Accepted 29 March, 2019

Conflicts of Interest and Source of Funding: This study was supported by the

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,