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A Comparative Analysis of Eating Behavior of School-Aged Children with Eosinophilic Esophagitis and Their Caregivers' Quality of Life: Perspectives of Caregivers

  • Girish HiremathEmail author
  • Elizabeth Rogers
  • Elizabeth Kennedy
  • Jonathan Hemler
  • Sari Acra
Original Article


Eosinophilic esophagitis (EoE) can affect eating behavior in infants and children and this may lead to stressful interactions with their caregivers and potentially impact their caregivers' quality of life. Clinical evaluation of eating behaviors can be time consuming and burdensome. Caregivers can provide a comprehensive assessment of their child’s eating behavior; however, this has not been well studied in children with EoE. In a case–control study, we used Child Eating Behavior Questionnaire (CEBQ) to compare caregivers' perception of eating behaviors in children (ages 11 ± 4 years; Mean ± SD) with EoE (cEoE; N = 42) to that of non-EoE controls (cControls; N = 38), and Feeding/Swallowing Impact on Children’s Caregivers Questionnaire (FS-IS) to examine the impact of EoE-related eating problems on their caregivers' quality of life. There were no differences between the cEoE and cControls perceptions of eating behaviors as assessed by CEBQ. In FS-IS, the cEoE indicated that they were worried about the way their child would breathe or if the child would choke while feeding (2.28 ± 0.16 vs. 1.25 ± 0.13; p < 0.001), and also indicated that it was hard for them to feed their child as it took a long time to prepare liquids and foods the “right” way (2.1 ± 0.20 vs. 1.17 ± 0.09; p < 0.001) when compared to cControls. Our results suggest that caregivers' perception of the eating behavior of school-aged children with and without EoE do not differ significantly, yet the perception of feeding/swallowing issues in children with EoE can negatively impact their caregivers' quality of life. Further research is needed to discern the eating behavior in children with EoE and its relationship with their caregivers' quality of life.


Eating behavior Eosinophilic esophagitis Deglutition and deglutition disorders Feeding problems Swallowing problems Caregivers' quality of life 



G.H. is supported by American College of Gastroenterology Junior Faculty Career Development Award, Vanderbilt University Turner Hazinski award, Vanderbilt University Katherine Dodd Faculty Scholar program, and the Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR; U54 AI117804) training award. CEGIR is part of the Rare Disease Clinical Research Network, an initiative of the Office of Rare Diseases Research, National Center for Advancing Translational Sciences, and is funded through collaboration between the National Institute of Allergy and Infectious Diseases, the National Institute of Diabetes and Digestive and Kidney Diseases, and the National Center for Advancing Translational Sciences. CEGIR also is supported by patient advocacy groups including the American Partnership for Eosinophilic Disorders, Campaign Urging Research for Eosinophilic Diseases, and Eosinophilic Family Coalition. J.H is supported by a Food Allergy Research and Education Clinical Network Grant and the Vanderbilt University Katherine Dodd Faculty Scholar program. We acknowledge Ms. Cindy Womack-Ramirez and Ms. Melissa Beavers for their assistance with data collection and data management.

Compliance with Ethical Standards

Conflict of interest

All authors disclose that they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Supplementary material

455_2019_9984_MOESM1_ESM.docx (24 kb)
Supplementary material 1 (DOCX 23 kb)
455_2019_9984_MOESM2_ESM.doc (84 kb)
Supplementary material 2 (DOC 84 kb)
455_2019_9984_MOESM3_ESM.doc (58 kb)
Supplementary material 3 (DOC 58 kb)


  1. 1.
    Furuta GT, Katzka DA. Eosinophilic esophagitis. N Engl J Med. 2015;373:1640–8.CrossRefGoogle Scholar
  2. 2.
    Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J. Allergy Clin. Immunol. 2011;128:3–20.CrossRefGoogle Scholar
  3. 3.
    Haas AM, Maune NC. Clinical presentation of feeding dysfunction in children with eosinophilic gastrointestinal disease. Immunol Allergy Clin North Am. 2009;29:65–75.CrossRefGoogle Scholar
  4. 4.
    Cannington EM, Dolen WK. Feeding dysfunction in children with eosinophilic gastrointestinal diseases. Pediatrics. 2011;128(S110):S110.2-S111.Google Scholar
  5. 5.
    Dodrill P, Gosa MM. Pediatric dysphagia: physiology, assessment, and management. Ann Nutr Metab. 2015;66:24–31.CrossRefGoogle Scholar
  6. 6.
    Flood EM, Beusterien KM, Amonkar MM, Jurgensen CH, Dewit OE, Kahl LP, et al. Patient and caregiver perspective on pediatric eosinophilic esophagitis and newly developed symptom questionnaires. Curr Med Res Opin. 2008;24:3369–81.CrossRefGoogle Scholar
  7. 7.
    Borowitz KC, Borowitz SM. Feeding problems in infants and children: assessment and etiology. Pediatr. Clin. North Am. 2018;65:59–72.CrossRefGoogle Scholar
  8. 8.
    Sheppard JJ, Malandraki GA. Pediatric dysphagia. Swallowing—physiology disorders diagnosis and therapy. New York: Springer; 2015. p. 161–88.CrossRefGoogle Scholar
  9. 9.
    Arvedson JC. Assessment of pediatric dysphagia and feeding disorders: clinical and instrumental approaches. Dev Disabil Res Rev. 2008;142:118–27.CrossRefGoogle Scholar
  10. 10.
    Piazza-Waggoner C, Driscoll KA, Gilman DK, Powers SW. A comparison using parent report and direct observation of mealtime behaviors in young children with cystic fibrosis: implications for practical and empirically based behavioral assessment in routine clinical care. Child Health Care. 2008;37:38–48.CrossRefGoogle Scholar
  11. 11.
    Whelan E, Cooper PJ. The association between childhood feeding problems and maternal eating disorder: a community study. Psychol Med. 2000;30:69–77.CrossRefGoogle Scholar
  12. 12.
    Dellon ES, Liacouras CA, Molina-Infante J, Furuta GT, Spergel JM, Zevit N, et al. Updated international consensus diagnostic criteria for eosinophilic esophagitis: Proceedings of the AGREE Conference. Gastroenterology. 2018;155:1022–33.CrossRefGoogle Scholar
  13. 13.
    Wardle J, Guthrie CA, Sanderson S, Rapoport L. Development of the children’s eating behaviour questionnaire. J Child Psychol Psychiatry. 2001;42:963–70. Scholar
  14. 14.
    Lefton-Greif MA, Okelo SO, Wright JM, Collaco JM, McGrath-Morrow SA, Eakin MN. Impact of children’s feeding/swallowing problems: validation of a new caregiver instrument. Dysphagia. 2014;29:671–7.CrossRefGoogle Scholar
  15. 15.
    Menard-Katcher C, Henry M, Furuta GT, Atkins D, Maune NC, Haas AM. Significance of feeding dysfunction in eosinophilic esophagitis. World J Gastroenterol. 2014;20:11019–22.CrossRefGoogle Scholar
  16. 16.
    Mehta P, Furuta GT, Brennan T, Henry ML, Maune NC, Sundaram SS, et al. Nutritional state and feeding behaviors of children with eosinophilic esophagitis and gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr. 2018;66:603–8.CrossRefGoogle Scholar
  17. 17.
    Taft TH, Ballou S, Keefer L. Preliminary evaluation of maternal caregiver stress in pediatric eosinophilic gastrointestinal disorders. J Pediatr Psychol. 2012;37:523–32.CrossRefGoogle Scholar
  18. 18.
    Stoner JB, Bailey RL, Angell ME, Robbins J, Polewski K. Perspectives of parents/guardians of children with feeding/swallowing problems. J Dev Phys Disabil. 2006;18:333–53.CrossRefGoogle Scholar
  19. 19.
    Rommel N, De Meyer A-M, Feenstra L, Veereman-Wauters G. The complexity of feeding problems in 700 infants and young children presenting to a tertiary care institution. J Pediatr Gastroenterol Nutr. 2003;37:75–84.CrossRefGoogle Scholar
  20. 20.
    Illingworth RS, Lister J. The critical or sensitive period, with special reference to certain feeding problems in infants and children. J Pediatr. 1964;65:839–48.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Pediatric Gastroenterology, Hepatology and NutritionMonroe Carell Jr. Children’s Hospital at Vanderbilt University Medical CenterNashvilleUSA
  2. 2.Division of Pediatric Allergy, Immunology and Pulmonary MedicineMonroe Carell Jr. Children’s Hospital at Vanderbilt University Medical CenterNashvilleUSA

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