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.