When Feeding Becomes a Family Challenge: a narrative review on Parental Burden and Bidirectional Parent-Child Influences in Pediatric Feeding Difficulties

Background Pediatric Feeding Difficulties and disorders are prevalent conditions that can adversely affect wellbeing, growth, development, and overall health of children. The etiology of pediatric feeding disorders (PFD) is multifactorial, encompassing medical, nutritional, psychosocial and environmental factors in interactional dynamics. Beyond child-related outcomes, PFDs impose a substantial emotional, psychological, and practical burden on parents and other family members. Aims This review aims to examine parental and family burden in pediatric feeding difficulties and to synthesize evidence on how parent- and child-related factors interact to inform diagnosis and treatment. Methods A systematic literature search was conducted in PubMed, Scopus, and Web of Science. Articles were selected based on relevance, methodological quality, and explicit focus on parental burden, parental well-being, parental involvement, parent and child influences in feeding. Themes were integrated around: (1) Domains and severity of parental and family burden associated with pediatric feeding difficulties or disorders, and the factors influencing this burden. (2) Interactions between parental burden and broader parenting determinants and child-related factors in relation to feeding outcomes. Results The reviewed literature indicates that parents of children with pediatric feeding difficulties experience increased stress, internalizing symptoms, relational strain and social exclusion, diminished parental competence feeling, practical stressors, and globally reduced quality of life. The impact of feeding difficulties extends beyond the parents to other family members. There is a bidirectional influence between child and parent/environment factors in feeding difficulties. Child, parent and system level factors influence the parenting burden. Parental burden and diminished well-being are associated with maladaptive feeding practices, altered parenting behaviors, strained parent-child interactions, and reduced treatment adherence. Conclusion The burden experienced by parents and families is substantial and multidimensional. The interactive effects of parental burden, parenting factors, and child characteristics on feeding outcomes underscore the need to systematically address parental burden and relational dynamics in both assessment and treatment planning. Multidisciplinary, family-centered approaches are associated with improved child feeding outcomes and reduced parental stress, particularly when caregiver needs are explicitly recognized and addressed.