Persistent early feeding difficulties and subsequent growth and developmental outcomes

Aim To investigate the prevalence of feeding difficulties in infancy, and to determine whether feeding difficulties in the first 15 months can be predictive of poor growth or developmental impairments in the pre-school years. Methods Data on infant feeding behaviour and developmental milestones were collected prospectively, using self-completion questionnaires, from the parents of the 14 138 live births in the Avon Longitudinal Study of Parents and Children. Results Weak sucking (18%), and choking with feeding (55%) were common at 4 weeks of age, and 3.3% of parents described great difficulties with feeding their children at 15 months. Children who had persistent feeding problems at 1, 6, and 15 months had a prevalence of 2.6/1000. This study group had a higher prevalence of delayed motor milestones, with delayed walking at 18 months (p < 0.0001) and inability to run at 30 months (p < 0.0001); delayed language development at 18 months (p = 0.041), and impairment of articulation of speech at 38 months (p = 0.012). They also demonstrated difficult behaviours, with more frequent episodes of temper tantrums (p = 0.004) and meal refusal (p < 0.0001) at 18 months. There were reductions in the mean scores for motor skills (p = 0.001), communication (p = 0.01) and total development (p < 0.0001) at 18 months. At 30 months, 22% of the parents reported concern regarding their child's weight (p = 0.0001), and the mean weight Z scores at 9 and 18 months for this group were lower than the remaining population, although the differences did not reach statistical significance. Conclusions Feeding difficulties were widely reported by parents of infants at 4 weeks of age, and thus did not have a predictive value in identifying children who were subsequently noted to have developmental impairments. The children with persistently difficult feeding throughout their first 15 months had significant impairments in their motor, language and behavioural development, and may benefit from early referral for assessment.