The Influence of Family in Children's Feeding Difficulties: An Integrative Review

Pâmela Gracielle da Fonseca¹António Raposo^2*Nada Alqarawi³Ibrahim Alasqah³Mariana Figueiredo Pinto¹Tábata Monaliza Marcelino Martins¹Viviane Dias Gonçalves⁴Simone Cardoso Lisboa Pereira¹Najla A. Albaridi⁵Mona N. BinMowyna⁶Ariana Saraiva⁷Nathalia Sernizon Guimarães^1*

• ¹Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
• ²CBIOS, Universidade Lusófona Research Center for Biosciences & Health Technologies, Lisbon, Portugal
• ³Qassim University, Buraidah, Al-Qassim, Saudi Arabia
• ⁴Ibirité City Hall, Ibirité, Brazil
• ⁵Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
• ⁶Shaqra University, Shaqraa, Riyadh, Saudi Arabia
• ⁷Lusofona University, Lisbon, Portugal

Background: Feeding difficulties, such as limited appetite, selective eating, and food phobia, affect caregivers' ability to provide adequate nutrition to children. These issues impact 25-40% of nonneurodivergent children and up 80% of neurodivergent children. Aim: This review examines how family involvement influences the improvement, worsening, or maintenance of feeding difficulties in neurodivergent and non-neurodivergent preschool and school-age children. Methods: An integrative review was conducted using Embase, PubMed, Scopus, Cochrane Library, Lilacs and grey literature (Google Scholar and Connect Papers). The review focused on randomized clinical trials (RCTs) involving parents or caregivers of children aged 2-10 years, assessing lifestyle or psychological interventions. Results: From 1,257 studies, 8853 primary articles were screened. Of the 100 most recent articles on grey literature, 2 met the eligibility criteria after full-text assessment and were therefore included in the review. Thirty-six studies were reviewed in full, leading to 11 RCTs with 630 children aged 1 to 14. Interventions included behavioral education, sensory education, and cooking classes. Findings indicated increased vegetable acceptance in two studies, improved feeding difficulties scores in five, and reduced avoidant/restrictive food intake disorder (ARFID) symptoms in two studies. One study showed no significant differences between control and intervention groups. Conclusion: Familyinvolved interventions generally produced positive outcomes in managing feeding difficulties. However, methodological variability and the predominance of studies from high-income countries limit the generalizability of these results. Future research should focus on standardizing diagnostic criteria and developing culturally sensitive interventions.