Executive function and mealtime behavior among preschool-aged children born very preterm

• Preschool-aged children (n = 41) born very preterm (< 30 weeks' gestation) were studied.
• Children's executive function was assessed objectively and by parent report.
• Frequency and severity of child mealtime behavior problems were reported by parents.
• Children with better executive function had fewer mealtime behavior problems.

ObjectiveTo determine whether executive function in preschool-aged children born very preterm was associated with problematic mealtime behavior.Study designExecutive function of 41 preschool-aged children (mean age = 47 months) born at < 30 weeks' gestation was assessed using a standardized protocol (gift bag) and by parent-report (Behavior Rating Inventory of Executive Function–Preschool). The gift bag assessment was video-recorded and good executive function defined as the child not touching the gift bag and remaining seated for > 2 min. Parent-reported frequency and severity of child mealtime behavior problems was assessed with a 20-item index (Meals in Our Household, α = 0.94). Multivariable regression was used to model associations between executive function and mealtime behavior problems.ResultsBRIEF-P global executive composite t-scores [mean (standard deviation [SD]) = 53.5 (15.7)] and mealtime behavior problems scores [mean (SD) = 18.5 (13.6)] were correlated (r = 0.57, P < 0.0001). Adjusted for child sex, age, birth weight, weeks' gestation, parent education, and neonatal intensive care unit length of stay, a 10-unit difference in BRIEF-P t-score was associated with a 7.2-unit difference in mealtime behavior problems score (P < 0.0001). Ten children (24%) demonstrated good executive function during the gift bag assessment. Parents reported these children displayed better executive function on the BRIEF-P and had fewer mealtime behavior problems (mean 11.2 vs. 20.8, P = 0.02). Adjusted for covariates, good performance on the gift bag task was associated with 14.1 unit lower mealtime behavior problems score (P = 0.03).ConclusionAmong preschool-aged children born very preterm, difficulties with executive function may manifest as mealtime behavior problems. Larger studies are needed to help parents anticipate and manage these behaviors.