{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T15:29:22Z","timestamp":1772033362241,"version":"3.50.1"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T00:00:00Z","timestamp":1752019200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Feeding difficulties, such as limited appetite, selective eating, and food phobia, affect caregivers' ability to provide adequate nutrition to children. These issues impact 25%\u201340% of non-neurodivergent children and up 80% of neurodivergent children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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\u201310 years, assessing lifestyle or psychological interventions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From 1,257 studies, 885 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Family-involved 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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2025.1609714","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T05:46:49Z","timestamp":1752126409000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["The influence of family in children\u2019s feeding difficulties: an integrative review"],"prefix":"10.3389","volume":"13","author":[{"given":"P\u00e2mela Gracielle","family":"da Fonseca","sequence":"first","affiliation":[]},{"given":"Ant\u00f3nio","family":"Raposo","sequence":"additional","affiliation":[]},{"given":"Nada","family":"Alqarawi","sequence":"additional","affiliation":[]},{"given":"Ibrahim","family":"Alasqah","sequence":"additional","affiliation":[]},{"given":"Mariana Figueiredo","family":"Pinto","sequence":"additional","affiliation":[]},{"given":"T\u00e1bata Monaliza Marcelino","family":"Martins","sequence":"additional","affiliation":[]},{"given":"Viviane Dias","family":"Gon\u00e7alves","sequence":"additional","affiliation":[]},{"given":"Simone Cardoso Lisboa","family":"Pereira","sequence":"additional","affiliation":[]},{"given":"Najla A.","family":"Albaridi","sequence":"additional","affiliation":[]},{"given":"Mona N.","family":"BinMowyna","sequence":"additional","affiliation":[]},{"given":"Ariana","family":"Saraiva","sequence":"additional","affiliation":[]},{"given":"Nathalia Sernizon","family":"Guimar\u00e3es","sequence":"additional","affiliation":[]}],"member":"1965","published-online":{"date-parts":[[2025,7,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"960","DOI":"10.1177\/0009922809336074","article-title":"Clinical investigation of feeding difficulties in young children: a practical approach","volume":"48","author":"Kerzner","year":"2009","journal-title":"Clin Pediatr (Phila)"},{"key":"B2","doi-asserted-by":"publisher","first-page":"S4","DOI":"10.1055\/s-0038-1670717","article-title":"Consenso da associa\u00e7\u00e3o brasileira de nutrologia sobre o uso de suplementos alimentares para crian\u00e7as com dificuldades alimentares","volume":"11","author":"Nogueira-de-Almeida","year":"2018","journal-title":"Int J Nutrol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1542\/peds.2014-1630","article-title":"A practical approach to classifying and managing feeding difficulties","volume":"135","author":"Kerzner","year":"2015","journal-title":"Pediatrics"},{"key":"B4","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1016\/B978-0-08-101931-3.00017-3","article-title":"Neophobia in children with special needs: selective eating and its treatment","author":"Williams","year":"2018","journal-title":"Food Neophobia Behavioral and Biological Influences. Woodhead Publishing"},{"key":"B5","doi-asserted-by":"publisher","first-page":"Article 104241","DOI":"10.1016\/j.foodqual.2021.104241","article-title":"A systematic review of studies using the food neophobia scale: conclusions from thirty years of studies","volume":"93","author":"Rabad\u00e1n","year":"2021","journal-title":"Food Qual Prefer"},{"key":"B6","doi-asserted-by":"publisher","first-page":"897","DOI":"10.3390\/nu10070897","article-title":"Influence of food neophobia level on fruit and vegetable intake and its association with urban area of residence and physical activity in a nationwide case-control study of Polish adolescents","volume":"10","author":"Guzek","year":"2018","journal-title":"Nutrients"},{"key":"B7","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/j.appet.2017.03.025","article-title":"Food neophobia and its association with intake of fish and other selected foods in a Norwegian sample of toddlers: a cross-sectional study","volume":"114","author":"Helland","year":"2017","journal-title":"Appetite"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.1017\/S1368980017003615","article-title":"Prevalence of food neophobia in pre-school children from southern Poland and its association with eating habits, dietary intake and anthropometric parameters: a cross-sectional study","volume":"21","author":"Kozio\u0142-Kozakowska","year":"2018","journal-title":"Public Health Nutr"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1497","DOI":"10.1177\/13623613251314223","article-title":"Food selectivity and eating difficulties in adults with autism and\/or ADHD","volume":"29","author":"Bayoumi","year":"2025","journal-title":"Autism"},{"key":"B10","doi-asserted-by":"publisher","first-page":"107931","DOI":"10.1016\/j.appet.2025.107931","article-title":"The association of picky eating among preschoolers in Kuwait with mothers\u2019 negative attitudes and weight concerns","volume":"208","author":"Alkazemi","year":"2025","journal-title":"Appetite"},{"key":"B11","volume-title":"Guidelines on Feeding Difficulties","year":"2022"},{"key":"B12","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1590\/1984-0462\/;2018;36;1;00004","article-title":"Dificuldades alimentares em pr\u00e9-escolares, pr\u00e1ticas alimentares pregressas E estado nutricional","volume":"36","author":"Maranh\u00e3o","year":"2018","journal-title":"Rev Paul Pediatr"},{"key":"B13","doi-asserted-by":"publisher","first-page":"286","DOI":"10.3389\/fped.2017.00286","article-title":"Maternal feeding practices among children with feeding difficulties-cross-sectional study in a Brazilian reference center","volume":"5","author":"Machado","year":"2018","journal-title":"Front Pediatr"},{"key":"B14","doi-asserted-by":"publisher","first-page":"589","DOI":"10.11124\/JBISRIR-2017-003521","article-title":"Caregivers\u2019 experiences of feeding children with cerebral palsy: a systematic review protocol of qualitative evidence","volume":"16","author":"Taylor","year":"2018","journal-title":"JBI Database System Rev Implement Rep"},{"key":"B15","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1186\/s12912-024-02652-y","article-title":"Caregivers\u2019 experience of having a child with down syndrome: a meta-synthesis","volume":"24","author":"Zhang","year":"2025","journal-title":"BMC Nurs"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e20240160","DOI":"10.1590\/2317-1782\/e20240160pt","article-title":"Feeding difficulties in typical children, sociodemographic factors, and family perception. Dificuldade alimentar em crian\u00e7as t\u00edpicas, fatores sociodemogr\u00e1ficos e percep\u00e7\u00e3o da fam\u00edlia","volume":"37","author":"Trofino","year":"2025","journal-title":"CoDAS"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.3390\/nu13041138","article-title":"The influence of parental dietary behaviors and practices on children\u2019s eating habits","volume":"13","author":"Mahmood","year":"2021","journal-title":"Nutrients"},{"key":"B18","doi-asserted-by":"publisher","first-page":"2705","DOI":"10.1017\/S1368980015000695","article-title":"Factors within the family environment such as parents\u2019 dietary habits and fruit and vegetable availability have the greatest influence on fruit and vegetable consumption by Polish children","volume":"18","author":"Wolnicka","year":"2015","journal-title":"Public Health Nutr"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2225","DOI":"10.3390\/nu15092225","article-title":"Division of responsibility in child feeding and eating competence among Brazilian caregivers","volume":"15","author":"Dusi","year":"2023","journal-title":"Nutrients"},{"key":"B20","doi-asserted-by":"publisher","first-page":"109","DOI":"10.5935\/cadernosdisturbios.v21n2p109-127","article-title":"Abordagem interdisciplinar para avalia\u00e7\u00e3o e interven\u00e7\u00e3o em dificuldades alimentares no autismo","volume":"21","author":"Duarte","year":"2021","journal-title":"Cad P\u00f3s-Grad Dist\u00farb Desenvolv"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e0239274","DOI":"10.1371\/journal.pone.0239274","article-title":"Family meal frequency and its association with food consumption and nutritional status in adolescents: a systematic review","volume":"15","author":"do Amaral E Melo","year":"2020","journal-title":"PLoS One"},{"key":"B22","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1111\/j.1748-720X.2007.00111.x","article-title":"Parental influence on eating behavior: conception to adolescence. The journal of law, medicine & ethics: a journal of the American society of law","volume":"35","author":"Savage","year":"2007","journal-title":"Med Ethics"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.29219\/fnr.v65.7679","article-title":"Effectiveness of a kindergarten-based intervention to increase vegetable intake and reduce food neophobia amongst 1-year-old children: a cluster randomised controlled trial","volume":"65","author":"Blomkvist","year":"2021","journal-title":"Food Nutr Res"},{"key":"B24","doi-asserted-by":"publisher","first-page":"221","DOI":"10.4162\/nrp.2016.10.2.221","article-title":"Taste education reduces food neophobia and increases willingness to try novel foods in school children","volume":"10","author":"Park","year":"2016","journal-title":"Nutr Res Pract"},{"key":"B25","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1111\/ijpo.12011","article-title":"A parent-based intervention to promote healthy eating and active behaviours in pre-school children: evaluation of the MEND 2-4 randomized controlled trial","volume":"11","author":"Skouteris","year":"2016","journal-title":"Pediatr Obes"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.3390\/nu12051415","article-title":"A serious game approach to improve food behavior in families\u2014a pilot study","volume":"12","author":"Skouw","year":"2020","journal-title":"Nutrients"},{"key":"B27","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1016\/j.cbpra.2018.11.001","article-title":"The (extremely) picky eaters clinic: a pilot trial of a seven-session group behavioral intervention for parents of children with avoidant\/restrictive food intake disorder","volume":"26","author":"Dahlsgaard","year":"2019","journal-title":"Cogn Behav Pract"},{"key":"B28","doi-asserted-by":"publisher","first-page":"746","DOI":"10.1002\/eat.23077","article-title":"Feasibility of conducting a randomized clinical trial using family-based treatment for avoidant\/restrictive food intake disorder","volume":"52","author":"Lock","year":"2019","journal-title":"Int J Eat Disord"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1623","DOI":"10.1002\/eat.23341","article-title":"SPACE-ARFID: a pilot trial of a novel parent-based treatment for avoidant\/restrictive food intake disorder","volume":"53","author":"Shimshoni","year":"2020","journal-title":"Int J Eat Disord"},{"key":"B30","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.jpeds.2019.03.046","article-title":"The autism managing eating aversions and limited variety plan vs. parent education: a randomized clinical trial","volume":"211","author":"Sharp","year":"2019","journal-title":"J Pediatr"},{"key":"B31","doi-asserted-by":"publisher","first-page":"2002","DOI":"10.1002\/jaba.711","article-title":"Treating food selectivity as resistance to change in children with autism spectrum disorder","volume":"53","author":"Crowley","year":"2020","journal-title":"J Appl Behav Anal"},{"key":"B32","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1002\/jaba.650","article-title":"Randomized controlled trial of an applied behavior analytic intervention for food selectivity in children with autism spectrum disorder","volume":"52","author":"Peterson","year":"2019","journal-title":"J Appl Behav Anal"},{"key":"B33","doi-asserted-by":"publisher","first-page":"105623","DOI":"10.1016\/j.appet.2021.105623","article-title":"Taste education\u2014a food-based intervention in a school setting, focusing on children with and without neurodevelopmental disorders and their families. A randomized controlled trial","volume":"167","author":"Thorsteinsdottir","year":"2021","journal-title":"Appetite"},{"key":"B34","doi-asserted-by":"publisher","first-page":"983","DOI":"10.1177\/01454455221098118","article-title":"Behavior analytic feeding interventions: current state of the literature","volume":"47","author":"Williams","year":"2023","journal-title":"Behav Modif"},{"key":"B35","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1093\/jpepsy\/jsv006","article-title":"Behavioral pediatrics feeding assessment scale in young children with autism Spectrum disorder: psychometrics and associations with child and parent variables","volume":"40","author":"Allen","year":"2015","journal-title":"J Pediatr Psychol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1175927","DOI":"10.3389\/fped.2023.1175927","article-title":"The prevalence and predictors of feeding difficulties in children at self-feeding transition stage","volume":"11","author":"Tang","year":"2023","journal-title":"Front Pediatr"},{"key":"B37","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1186\/s40337-019-0267-x","article-title":"An ARFID case report combining family-based treatment with the unified protocol for transdiagnostic treatment of emotional disorders in children","volume":"7","author":"Eckhardt","year":"2019","journal-title":"J Eat Disord"},{"key":"B38","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1002\/eat.22994","article-title":"Applying family-based treatment (FBT) to three clinical presentations of avoidant\/restrictive food intake disorder: similarities and differences from FBT for anorexia nervosa","volume":"52","author":"Lock","year":"2019","journal-title":"Int J Eat Disord"},{"key":"B39","doi-asserted-by":"publisher","first-page":"e0178149","DOI":"10.1371\/journal.pone.0178149","article-title":"Parenting styles, feeding styles and food-related parenting practices in relation to toddlers\u2019 eating styles: a cluster-analytic approach","volume":"12","author":"van der Horst","year":"2017","journal-title":"PLoS One"},{"key":"B40","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/j.appet.2015.02.038","article-title":"Strategies used by parents to influence their children\u2019s food preferences","volume":"90","author":"Russell","year":"2015","journal-title":"Appetite"},{"key":"B41","doi-asserted-by":"publisher","first-page":"e1041","DOI":"10.15649\/cuidarte.1041","article-title":"Comportamento dos pais e comportamento alimentar da crian\u00e7a: revis\u00e3o sistem\u00e1tica","volume":"11","author":"Freitas Santos","year":"2020","journal-title":"Rev Cuid"},{"key":"B42","doi-asserted-by":"publisher","first-page":"e20200026","DOI":"10.1590\/1980-265X-TCE-2020-0026","article-title":"Parenting practices and the child\u2019s eating behavior","volume":"30","author":"Santos","year":"2021","journal-title":"Texto Contexto Enferm"},{"key":"B43","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1177\/0884533611430231","article-title":"Interprofessional group intervention for parents of children age 3 and younger with feeding difficulties: pilot program evaluation","volume":"27","author":"Owen","year":"2012","journal-title":"Nutr Clin Pract"},{"key":"B44","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1007\/s13668-016-0153-y","article-title":"The relationship between food insecurity, dietary patterns, and obesity","volume":"5","author":"Morales","year":"2016","journal-title":"Curr Nutr Rep"},{"key":"B45","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1017\/S1368980019003380","article-title":"Food insecurity and weight status of socially vulnerable child beneficiaries of a food assistance programme in Macei\u00f3, Northeast Brazil","volume":"23","author":"Lucena","year":"2020","journal-title":"Public Health Nutr"},{"key":"B46","doi-asserted-by":"publisher","first-page":"2045","DOI":"10.1590\/1413-81232022275.09832021","article-title":"Mental distress and food insecurity in pregnancy","volume":"27","author":"Harmel","year":"2022","journal-title":"Ci\u00eanc Sa\u00fade Coletiva"},{"key":"B47","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1016\/j.jped.2020.12.003","article-title":"Prevalence of childhood obesity in Brazil: systematic review and meta-analysis","volume":"97","author":"Ferreira","year":"2021","journal-title":"J Pediatr (Rio J)"},{"key":"B48","doi-asserted-by":"publisher","first-page":"e13232","DOI":"10.1111\/mcn.13232","article-title":"Sociodemographic inequities in nurturing care for early childhood development across Brazilian municipalities","volume":"18","author":"Buccini","year":"2022","journal-title":"Matern Child Nutr"},{"key":"B49","doi-asserted-by":"publisher","first-page":"37","DOI":"10.3390\/children12010037","article-title":"Feeding problems assessment tools in children: a scoping review","volume":"12","author":"Destriatania","year":"2025","journal-title":"Children"},{"key":"B50","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1002\/jpr3.12136","article-title":"Feeding difficulties, food intake, and growth in children with esophageal atresia","volume":"5","author":"Birketvedt","year":"2024","journal-title":"JPGN Rep"},{"key":"B51","doi-asserted-by":"publisher","first-page":"1070388","DOI":"10.3389\/fnut.2022.1070388","article-title":"The impact of COVID-19 pandemic on food habits and neophobia in children in the framework of the family context and parents\u2019 behaviors: a study in an Italian central region","volume":"9","author":"Di Nucci","year":"2022","journal-title":"Front Nutr"},{"key":"B52","doi-asserted-by":"publisher","first-page":"e210012","DOI":"10.1590\/1980-549720210012","article-title":"The COVID-19 pandemic and changes in the lifestyles of Brazilian adolescents","volume":"24","author":"Malta","year":"2021","journal-title":"Rev Bras Epidemiol"},{"key":"B53","doi-asserted-by":"publisher","first-page":"1078","DOI":"10.3390\/children9071078","article-title":"Effect of COVID-19 lockdown on children\u2019s eating behaviours: a longitudinal study","volume":"9","author":"Umano","year":"2022","journal-title":"Children"},{"key":"B54","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1080\/21642850.2022.2043750","article-title":"The impact of COVID-19 on the eating habits of families engaged in a healthy eating pilot trial: a thematic analysis","volume":"10","author":"Porter","year":"2022","journal-title":"Health Psychol Behav Med"},{"key":"B55","doi-asserted-by":"publisher","first-page":"e2022023","DOI":"10.1590\/1984-0462\/2023\/41\/2022023","article-title":"Changes in lifestyle behaviors during the COVID-19 pandemic in children and adolescents with congenital heart disease","volume":"41","author":"Honicky","year":"2023","journal-title":"Rev Paul Pediatr"},{"key":"B56","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1901\/jaba.2010.43-155","article-title":"Recent studies on feeding problems in children with autism","volume":"43","author":"Volkert","year":"2010","journal-title":"J Appl Behav Anal"},{"key":"B57","doi-asserted-by":"publisher","first-page":"e202310200","DOI":"10.5546\/aap.2023-10200.eng","article-title":"Feeding difficulties in childhood: a narrative review. Dificultades alimentarias en la infancia: una revisi\u00f3n narrativa","volume":"122","author":"Saure","year":"2024","journal-title":"Arch Argent Pediatr"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1609714\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T13:37:15Z","timestamp":1752154635000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1609714\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,9]]},"references-count":57,"alternative-id":["10.3389\/fped.2025.1609714"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1609714","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,9]]},"article-number":"1609714"}}