Purpose Feeding difficulties impact child wellbeing and are associated with sleep disorders. Children with autism are known to have problems with sleep; however, a gap in evidence exists regarding relationships between other symptoms such as feeding difficulties. The purpose of this study was to describe feeding difficulties in children with autism referred for polysomnography and examine the relationships between feeding difficulties, dysphagia, abnormal weight, and sleep disorder. Methods A secondary analysis of the de-identified 2017–2019 Nationwide Children’s Hospital (NCH) Sleep DataBank was completed. The data were filtered for age (> 2, < 18 years), autism, feeding/dysphagia, and weight-related diagnoses. Results Our sample included 3,053 participants (M = 7.26 years); 56% males; 66% White and 94% non-Hispanic. Feeding difficulties occurred in 11% and dysphagia in 9% of the total sample (autism and non-autism). The most common abnormal weight diagnoses were obesity (30%) and abnormal weight gain (24%). Feeding difficulties and dysphagia predicted sleep disorders in the sample; however, those with autism were 3.83 times more likely to have feeding difficulties than patients without autism and 2.19 times more likely to have dysphagia. In the autism group, obesity and abnormal weight gain partially mediated the relationship between feeding difficulties and sleep disorder, and between dysphagia and sleep disorder. Conclusions In a sample of children referred for polysomnography, both feeding difficulties and dysphagia were associated with sleep disorders and were more likely in children with autism. The relationship between feeding difficulties, dysphagia, and sleep disorder in autism was enhanced by the presence of obesity and abnormal weight gain. Prospective longitudinal studies are recommended to help reveal causal relationships between these variables. Note on language: This paper refers to those diagnosed with Autism Spectrum Disorder using a mix of identity-first language (i.e., autistic child) and person-first language (i.e., child with autism). Identity-first language emphasizes that autism is an integral part of one’s identity and is preferred by most autistic people, while person-first language aims to highlight the humanity of people with autism and is primarily used by professionals and parents (Brown, Identity-first language, <CitationRef CitationID="CR4">n.d</CitationRef>.; National Autistic Society, How to talk and write about autism, <CitationRef CitationID="CR25">n.d</CitationRef>.; Wooldridge, Writing respectfully: person-first and identity-first language, <CitationRef CitationID="CR37">n.d.</CitationRef>).

Feeding, dysphagia, weight, and sleep in pediatric patients: mediation analysis and comparison of autism and non-autism

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2025年7月25日

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Ann H. Johnson,
David Farbo,
Wilson Johnson,
Andrea M. Smith,
Lisa Bashore

摘要

Purpose

Feeding difficulties impact child wellbeing and are associated with sleep disorders. Children with autism are known to have problems with sleep; however, a gap in evidence exists regarding relationships between other symptoms such as feeding difficulties. The purpose of this study was to describe feeding difficulties in children with autism referred for polysomnography and examine the relationships between feeding difficulties, dysphagia, abnormal weight, and sleep disorder.

Methods

A secondary analysis of the de-identified 2017–2019 Nationwide Children’s Hospital (NCH) Sleep DataBank was completed. The data were filtered for age (> 2, < 18 years), autism, feeding/dysphagia, and weight-related diagnoses.

Results

Our sample included 3,053 participants (M = 7.26 years); 56% males; 66% White and 94% non-Hispanic. Feeding difficulties occurred in 11% and dysphagia in 9% of the total sample (autism and non-autism). The most common abnormal weight diagnoses were obesity (30%) and abnormal weight gain (24%). Feeding difficulties and dysphagia predicted sleep disorders in the sample; however, those with autism were 3.83 times more likely to have feeding difficulties than patients without autism and 2.19 times more likely to have dysphagia. In the autism group, obesity and abnormal weight gain partially mediated the relationship between feeding difficulties and sleep disorder, and between dysphagia and sleep disorder.

Conclusions

In a sample of children referred for polysomnography, both feeding difficulties and dysphagia were associated with sleep disorders and were more likely in children with autism. The relationship between feeding difficulties, dysphagia, and sleep disorder in autism was enhanced by the presence of obesity and abnormal weight gain. Prospective longitudinal studies are recommended to help reveal causal relationships between these variables.

Note on language: This paper refers to those diagnosed with Autism Spectrum Disorder using a mix of identity-first language (i.e., autistic child) and person-first language (i.e., child with autism). Identity-first language emphasizes that autism is an integral part of one’s identity and is preferred by most autistic people, while person-first language aims to highlight the humanity of people with autism and is primarily used by professionals and parents (Brown, Identity-first language, n.d.; National Autistic Society, How to talk and write about autism, n.d.; Wooldridge, Writing respectfully: person-first and identity-first language, n.d.).