Feeding difficulties in preterm-born children aged 0–7 years: an observational cohort study

Background Preterm-born infants represent a population at high risk for persistent feeding difficulties, yet data on the prevalence of Pediatric Feeding Disorder (PFD) extending through early school age remain limited.Methods This observational cohort study enrolled 116 preterm-born children (84 aged 0-3 years; 32 aged 4-7 years) with structured post-NICU follow-up at a single tertiary centre (AOU Policlinico, Bari, Italy), compared with a control group of 33 term-born children. Feeding and relational profiles were assessed using the validated EDQ-C questionnaire (Eating Disorders Questionnaire in Childhood). Associations between perinatal variables and PFD risk were investigated by univariate and multivariate logistic regression.Results The prevalence of at least one clinically relevant feeding difficulty was 72.6% in the 0-3-year subgroup and 71.9% in the 4-7-year subgroup. Comparison with term-born controls revealed significantly higher rates of relational disturbance (32.7% vs. 3.0%; p = 0.001), food dysregulation (34.6% vs. 12.1%; p = 0.021), and selective food refusal (30.8% vs. 12.1%; p = 0.048). On multivariate analysis, prolonged nasogastric tube (NGT) use (OR 11.34; 95% CI 1.54-83.60; p = 0.017) and lower gestational age (OR 0.56; 95% CI 0.32-0.96; p = 0.035) were independently associated with PFD risk. Attachment style was not an independent predictor.Conclusion Preterm-born children show substantially higher rates of feeding difficulties compared with term-born peers, persisting through school age. Prolonged NGT exposure and lower gestational age are the primary independent risk factors identified within this structured follow-up cohort, supporting the need for multidisciplinary neurobehavioural surveillance extending beyond the neonatal period.