Infant feeding practices and later parent-reported feeding difficulties: a systematic review

Nutr Rev. 2021 Oct 11;79(11):1236-1258. doi: 10.1093/nutrit/nuaa135.


Context: Early feeding practices may influence the acceptance of new foods and contribute to the development of feeding difficulties later in childhood.

Objective: The aim of this systematic review was to evaluate the association of breastfeeding duration, timing of complementary feeding introduction, and feeding techniques with feeding difficulties or their subtypes, namely picky or fussy eating, food refusal, and food neophobia, in children older than 1 year of age.

Data sources: Guidance from the Cochrane Collaboration and the Centre for Reviews and Dissemination was followed. MEDLINE, Embase, and PsycINFO databases were searched up to December 2019. Additionally, references from included articles were screened.

Study selection: Interventional and observational studies were eligible. Of the 3653 records obtained after the search strategy was applied, 21 observational studies (cohort, case-control, cross-sectional), many with important methodological limitations, and 1 randomized controlled trial were included.

Data extraction: Three authors extracted data independently.

Results: Results were synthesized narratively. Twelve observational studies assessed the association of breastfeeding duration with parent-reported feeding difficulties. Longer duration of breastfeeding tended to be associated with fewer childhood feeding problems in the majority of studies, but the differences were often small and not significant. Eight observational studies that examined the timing of complementary feeding introduction in relation to parent-reported feeding difficulties showed inconsistent results. Baby-led weaning, as compared with spoon-feeding, was significantly associated with less fussiness at age 12 to 36 months in 1 of 5 studies.

Conclusions: This review showed no strong evidence to support the hypothesis that early feeding practices contribute significantly to specific parent-reported feeding difficulties in children older than 1 year of age. Additional methodologically rigorous studies are needed to confirm these findings.

Systematic review registration: PROSPERO registration number CRD42018115792.

Keywords: breastfeeding: feeding difficulties; complementary feeding; picky eating; systematic review.

Publication types

  • Systematic Review

MeSH terms

  • Breast Feeding*
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Feeding Behavior*
  • Female
  • Humans
  • Infant
  • Infant Nutritional Physiological Phenomena
  • Parents