Abstract

Background: Children with food allergy (FA) may develop eating difficulties that extend beyond medically required allergen avoidance, including food neophobia, selective eating, and avoidant/restrictive food intake disorder (ARFID)-related symptoms. This mixed-methods study aimed to assess ARFID symptoms, food neophobia, diet quality, and food-related psychological experiences in children with FA. Methods: Seventy children with confirmed FA were enrolled in an observational cross-sectional mixed-methods study conducted at a tertiary pediatric allergy center. Quantitative assessment included the Eating Disorders in Youth-Questionnaire (EDY-Q), the Italian Child Food Neophobia Scale (ICFNS), and the Mediterranean Diet Quality Index for Children and Adolescents (KIDMED). Qualitative data were collected from a purposive subsample of 26 children through semi-structured child-friendly interviews and drawing-based elicitation activities and were analyzed using inductive thematic analysis. Results: A positive EDY-Q screening result for ARFID-related symptoms was observed in 3 children (4.3%). Selective Eating showed the highest median EDY-Q domain score (median 1.50, IQR 0.67–4.00), followed by Food Avoidance Emotional Disorder (median 1.00, IQR 0.00–2.00) and Functional Dysphagia (median 0.00, IQR 0.00–2.00). Moderate food neophobia was observed in 45 children (64.3%), while 24 children (34.3%) were classified within the high food-neophobia category. KIDMED score was negatively correlated with EDY-Q total score (Spearman’s ρ = −0.302; p = 0.011), Selective Eating (ρ = −0.356; p = 0.002), and Functional Dysphagia (ρ = −0.238; p = 0.048). In an exploratory hierarchical regression, Selective Eating remained inversely associated with KIDMED after adjustment for demographic and FA-related covariates (β = −0.386; p = 0.002); however, the overall model did not reach statistical significance (p = 0.081), and the additional clinical covariates did not significantly improve model fit. Accordingly, the fully adjusted findings should be interpreted as exploratory. Qualitative analysis identified five themes: anticipatory fear of food and tasting, emotional memory of allergic reactions and generalization of risk, selective avoidance and food rigidity, reassurance-seeking and decision-making dependence, and ambivalent parental dynamics. Conclusions: Within this tertiary-care sample, positive EDY-Q screening results were uncommon, whereas broader food-related difficulties were identified. Pediatric FA assessment may benefit from attention to eating behavior, diet quality, and avoidance extending beyond confirmed allergens.

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