Unique feeding profiles in children with pediatric feeding disorder and comorbid autism spectrum disorder: a retrospective cohort study.

This study looked at feeding problems in young children (0-5 years) with and without autism. Children with both autism and feeding difficulties were more likely to be boys, born by cesarean section, and have parents with less education. Their feeding problems appeared later and were more often related to nutrition rather than social/behavioral issues around eating. Importantly, feeding problems sometimes appeared before autism was diagnosed, suggesting feeding difficulties might be an early sign of autism.

This retrospective cohort study compared 141 children (0-60 months) with pediatric feeding disorder (PFD), examining differences between those with and without comorbid autism spectrum disorder (ASD). The ASD-PFD group (n=47) showed distinct characteristics: higher proportion of males (52.6% vs 34.4%), more cesarean deliveries (38% vs 23%), and parents with lower educational attainment. These children presented and were diagnosed with feeding issues later (10 vs 5 months presentation; 14 vs 9 months diagnosis). Nutritionally-based feeding dysfunction was more prevalent in ASD-PFD children (55.6% vs 26.6%), while psychosocial dysfunction was less common (8.3% vs 29.8%).

Male sex, cesarean delivery, and lower parental education independently predicted ASD comorbidity, while psychosocial feeding dysfunction was inversely associated with ASD.

Clinicians should recognize distinct feeding patterns in autistic children and consider feeding difficulties as potential early autism indicators. Early identification enables timely multidisciplinary intervention. Different intervention approaches may be needed for nutritional versus psychosocial feeding dysfunction in autism.

Single-center retrospective design limits generalizability. ASD diagnosis timing dependent on clinical recognition within follow-up period. Potential selection bias from tertiary care setting. Limited sample size (n=141) may affect statistical power for some comparisons.

To compare the clinical characteristics, sociodemographic factors and feeding profiles of children aged 0-60 months diagnosed with pediatric feeding disorder (PFD) with and without comorbid autism spectrum disorder (ASD), in order to characterize features unique to each diagnosis. This retrospective comparative study included all children aged 0-60 months diagnosed with PFD between 2020 and 2023 at a tertiary pediatric center. Participants were categorized into 2 groups: those with comorbid ASD (ASD-PFD group) and those without ASD (PFD-only group), reflecting children diagnosed with ASD by age 5 years within the available follow-up. Clinical, demographic, perinatal and feeding-related data were extracted from medical records and analyzed.

Among 141 participants, 47 were in the ASD-PFD group and 94 in the PFD-only group. The ASD-PFD group had a higher proportion of males (52.6% vs. 34.4%, P = 0.03) and cesarean deliveries (38% vs 23%, P = 0.03). These children were born to parents with lower educational attainment (P < 0.05) and presented (10 vs. 5 months) and were diagnosed (14 vs. 9 months) with PFD at older ages (P = 0.05). Nutritional dysfunction was more prevalent (55.6% vs 26.6%), whereas psychosocial dysfunction was less common (8.3% vs. 29.8%) in the ASD-PFD group (P = 0.007).

Multivariable analysis identified male sex, cesarean delivery, and lower parental educational status as independent predictors of ASD, whereas psychosocial feeding dysfunction was inversely associated with ASD. Children with coexisting PFD and ASD exhibit a distinct profile characterized by later diagnosis and a predominance of nutritional over psychosocial feeding dysfunction, highlighting the importance of early recognition and tailored multidisciplinary care. • Pediatric feeding disorder (PFD) is common in children with autism spectrum disorder (ASD). • Most studies focus on older children; data on infants and toddlers are limited. • Infants and toddlers with ASD and PFD show distinct profiles: later presentation and diagnosis, more nutritional and less psychosocial dysfunction. • In one-third, PFD preceded ASD diagnosis, highlighting feeding issues as early markers. • Lower parental education and higher cesarean rates were more common in ASD-PFD cases.