Avoidance, Anxiety, and Allergy: Correlates for Problematic Mealtime Behaviors
Amy J. Majewski, Kathryn S. Holman, & W. Hobart Davies
University of Wisconsin-Milwaukee
INTRODUCTION
METHODS – MEASURES
 Childhood food allergies are an increasingly common health
concern that affects approximately 6% to 8% of children in
the United States (Gupta et al., 2009).
 About Your Child’s Eating (AYCE; Davies et al., 2006). The AYCE is a 20-item parent-report measure
that assesses positive, negative, and neutral parent-child interactions during mealtimes. The AYCE
generates three subscale scores: Child Resistance to Eating, Positive Mealtime Environment, and
Parent Aversion to Mealtime.
 Reaction to food allergens can range from mild to severe and
may even result in death due to anaphylaxis (Branum &
Lucaks, 2008).
 Due to the life-threatening nature of food allergies, parents
(Williams et al, 2009) and children (Avery et al., 2003) often
experience increased levels of anxiety and develop avoidance
behaviors as a means of protection from the food allergen.
 Mealtimes may therefore be a specific time of heightened
anxiety. Although avoidance behaviors may be necessary to
prevent a life-threatening reaction, it is possible that the
avoidance behavior may extend beyond the allergen to the
mealtime itself.
DISCUSSION and SUMMARY
 Mealtime Behavior Questionnaire (MBQ; Davies et al., 2005). The MBQ is a 33-item parent-report
measure used to assess problematic child behaviors at mealtime. The MBQ generates a total score
from four subscales: Distraction/Avoidance, Food Manipulation, Mealtime Aggression, and
Choking, Gagging, Vomiting.
RESULTS
Table 1. Percentages of Children who Scored in the Clinical Range on the AYCE and MBQ Subscales
 Mealtime behavior problems are common among
younger children (Crist & Napier-Phillips, 2001)
which may elucidate why younger children with
food allergies in this study only differ significantly
from their healthy peers on the MBQ Subscale of
Choking, Gagging, and Vomiting.
 Typically, problems with feeding will resolve as
children age (Greer et al., 2007); however, in this
study, older children with food allergies were
significantly more likely to experience problematic
mealtime behaviors as compared to healthy peers.
 Avoidance behaviors are a commonly documented behavior
exhibited by children with feeding problems, and given the
likelihood for these behaviors in children with food allergies,
they may be at increased risk for feeding problems as well.
 Parents reported that their children exhibited
greater levels of avoidance and distraction
behaviors such as pushing food away or refusing to
come to the table. Parents also reported increased
child resistance to eating such as they have to force
their child to eat or that their child hates eating.
 To date, there is limited research on the behavioral patterns
of children with food allergies and whether they may be at
risk for increased behavioral or emotional problems.
 Parents reported themselves as having increased
aversion to mealtimes such as dreading mealtimes
and difficulty eating due to their child’s behavior.
Parents may sense their child’s resistance to eating
which may result in parents having negative
attitudes regarding the mealtime and feeding
interaction.
AIM OF PROJECT
 This study aims to examine how the anxiety and avoidance
behaviors associated with food allergies affects the
mealtime behaviors of children and their caregivers as
compared to healthy children.
METHODS
Participants
 N = 426 : Parents of children in the community were
recruited to participate in this study.
 Parents
 67.2% Female
 Age: M = 36.12, SD = 7.94
 Majority Caucasian (83.5%)
 Data was collected on children in two age groups: 2 to 6 and
6 to 12 years of age. Children were then assigned to either
the food allergy group or the healthy group based on their
reported medical history. Children with any history of other
chronic conditions were excluded.
 Children: 2-6 years (n = 122)
 50.8 % Male
 Age: M = 3.87, SD = 1.52
 Food Allergy Group (n = 18); Healthy Group (n = 104)
 Children: 6-12 years (n = 304)
 55.3% Female
 Age: M = 8.89, SD = 2.09
 Food Allergy Group (n = 45); Healthy Group (n = 259)
 The results of the current study suggest that
children with food allergies exhibit more
problematic mealtime behaviors as compared to
healthy peers, and the behavioral issues may be
persistent.
Table 2. Means and Standard Deviations for
Children Ages 2 to 6 Years
Food
Allergy
Group
Table 3. Means and Standard Deviations for
Children Ages 6 to 12 Years
Healthy
Group
Food
Allergy
Group
Healthy
Group
I. About Your Child’s Eating
I. About Your Child’s Eating
Child Resistance to Eating
21.22(9.27)
21.07(7.32)
Child Resistance to Eating**
18.54(6.46)
16.57(5.58)
Positive Mealtime Environment
18.44(4.05)
18.28(3.94)
Positive Mealtime Environment
19.18(4.39)
19.78(4.11)
7.82(3.36)
8.38(3.16)
Parent Aversion to Mealtimes**
7.41(2.40)
6.60(2.05)
Parent Aversion to Mealtimes
II. Mealtime Behavior Questionnaire
II. Mealtime Behavior Questionnaire
Distraction/Avoidance
Food Manipulation
22.29(7.51)
12.14(3.01)
21.98(7.57)
10.47(3.73)
Distraction/Avoidance**
Food Manipulation**
19.13(5.97)
9.05(3.15)
16.59(5.58)
8.16(1.91)
Mealtime Aggression
12.62(2.84)
12.46(4.60)
Mealtime Aggression
11.74(3.16)
10.74(3.08)
4.25(1.61)
3.49(1.10)
3.30(1.09)
3.25(.70)
Choking, Gagging, Vomiting**
Total Mealtime Behavior Problems
56.91(9.44) 53.15(15.20)
Note. ** denotes significant difference between group means, p < .05
Choking, Gagging, Vomiting
Total Mealtime Behavior Problems**
47.78(10.31) 42.14(10.01)
Note. ** denotes significant difference between group means, p < .05
Poster presented at the 2010 American Psychological Association Convention in San Diego, CA
Correspondence for this project: Amy J. Majewski at amyjmajewski@gmail.com
 Previous studies report that children with food
allergies and their caregivers experience greater
levels of stress and anxiety related to daily
management of their condition, these types of
reactions may be affecting the child’s behavior at
mealtimes as well as parents’ perceptions of
feeding. Behavioral problems and negative parentchild interactions caused by the stress of the
condition often contribute to the maintenance of
feeding problems (Fischer & Silverman, 2007).
 The overall findings of the current study suggest
that children with food allergies may be at an
increased risk for developing feeding problems and
maintaining these problems over time.
 It may be important for health professionals to
educate parents of children with food allergies
about the difficulties that may arise during
mealtimes. This may help to better prepare parents
to respond to these behaviors and have more
positive perceptions of mealtime in order to avoid a
more pervasive problem.