Parent report of mealtime behaviors in young children with type 1 diabetes mellitus: implications for better assessment of dietary adherence problems in the clinic.

Parents of children with a chronic illness that has a nutrition treatment component often report mealtime behavior problems. Although research suggests that parents of young children with type 1 diabetes mellitus (T1DM) perceive more mealtime behavior problems than parents of controls, no study has examined the pattern of mealtime behaviors reported by parents of children with T1DM. We examined parents' perceptions of mealtime behaviors of children with T1DM using the Behavioral Pediatric Feeding Assessment Scale (BPFAS). We hypothesized that parents of young children with T1DM would describe similar mealtime problems as has been found in families of children with clinical feeding problems. Data from 85 families of children with T1DM (mean = 5 +/- 1.5 years) were used. Factor analysis for children with T1DM identified a 6-factor solution. Four factors (child refusal, picky eater, stalling, food texture) were similar to factors identified in children with clinical feeding problems. Two unique factors, reflecting strict dietary requirements and intense disruptive behavior, were identified for children with T1DM. Consistent with our hypothesis, we conclude that patterns of mealtime behaviors appear similar for children with T1DM and children with clinical feeding problems. However, for young children with T1DM, unique problems exist, related to a strict feeding schedule consistent with the diabetes diet. Within routine diabetes care, the BPFAS is a valid and clinically useful tool to assess dietary adherence and mealtime behaviors in children. Monitoring via the BPFAS can identify families in need of behavioral interventions to improve mealtime functioning.