Date of Award

1-2026

Document Type

Thesis

Degree Name

Master of Science (MS)

College/School

College for Community Health

Department/Program

Nutrition and Food Studies

Thesis Sponsor/Dissertation Chair/Project Chair

Jessica Bihuniak

Committee Member

Doreen Liou

Committee Member

Emma Auten

Abstract

Pediatric feeding difficulties is an umbrella term that is used to describe children with a variety of problematic feeding behaviors and/or mealtime impairments that can impact age-appropriate food consumption, growth and the caregiver-child relationship. There is a lack of research from nutrition professionals regarding the nutrient intake, diet quality and growth outcomes among patients with pediatric feeding difficulties. Furthermore, changes in nutrient intakes during intensive outpatient treatment have not been formally assessed. PURPOSE: The purpose of Manuscript 1 was to describe the demographic profile, medical history, and baseline mealtime behaviors, usual diet, and diet quality of patients with feeding difficulties in New Jersey. The purpose of Manuscript 2 was to assess changes in dietary intake, food diversity, and growth outcomes from week 1 and week 12 of outpatient therapy for feeding difficulties. METHODS AND MATERIALS: A retrospective chart review on 21 patients from the Pediatric Feeding Intensive Program at Children's Specialized Hospital was conducted. All dietary data were analyzed using the Nutrition Data System for Research (NDSR). Manuscript 1 includes data from caregiver completed intake forms, demographics, medical history, mealtime behaviors, and 3-day food records. Three day food records provided an estimate of each patient’s usual diet prior to treatment. Baseline calories, macronutrients, micronutrients and Heath Eating Index (HEI) scores ( measure of diet quality) were calculated. Differences in dietary intake were compared between patients born premature (< 37 weeks) and mature. Manuscript 2 includes the dietary assessment of therapy meals (weighted gram sheets) used to treat feeding difficulties at the beginning (week 1) and at the end of therapy (week 12) o. Calories, macronutrients, volume of food, supplement use, nutrients of concern, diet variety and growth outcomes were compared between week 1 and week 12. RESULTS: The majority of the population (76.2%) were male. An Autism Spectrum Disorder (ASD) diagnosis was found in 71.4% of patients. Most prominent mealtime behaviors included sensitivity to textures, inappropriate mealtime behaviors, difficulty chewing, and a caregiver reported unhealthy diet. Based on the usual diet, premature born babies showed significantly higher intake of vitamin D, calcium, and iron. Supplement usage was more prominent in premature born patients. From week 1 to week 12 of treatment, significant differences were found in the following variables: calories, macronutrients, volume of food, and nutrients of concern. Diet variety showed significance in all food groups (vegetable, fruit, protein, grain, and total number of foods). All anthropometric measures displayed significant increases from week 1 to week 12. CONCLUSION: Patients receiving treatment for feeding difficulties in NJ present with a wide variety of nutrition and growth outcomes prior to starting therapy. The heterogeneity in outcomes may delay the early identification of feeding difficulties in some patients, as not all patients present underweight prior to treatment. Intensive outpatient treatment improves caloric and nutrient intakes and increases the variety of foods consumed. Long-term effects of treatment are unknown and post-treatment dietary assessment is warranted.

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