Feeding, dysphagia, weight, and sleep in pediatric patients: mediation analysis and comparison of autism and non-autism
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2025-07-25
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Autism
Feeding
Dysphagia
Sleep
Weight
Feeding
Dysphagia
Sleep
Weight
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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.