偏食行为儿童的临床干预效果及其影响因素研究

Effect of clinical intervention on and influencing factors of young picky eaters

目的 研究不同的临床干预方法对1～5岁儿童偏食行为的干预效果,并分析影响干预效果的相关因素.方法 2010年10月至201 1年5月,将247名偏食儿童按照就诊顺序随机分为儿童饮食行为问题诊断干预（IMFeD）组（n=147）和常规指导组（n=100）.IMFeD组给予阶段性的处方指导,每个月在门诊进行1次干预随访,共指导3次；常规指导组使用目前临床常规的喂养指导内容给予指导,比较干预前后儿童偏食行为的评分,并按照不同的干预后效果分析干预效果的影响因素.结果 IMFeD干预组的偏食儿童行为干预评分结果,基线调查时为（4.7±1.1）分,终末调查时为（9.5±2.6）分；常规指导组基线调查时为（4.9±1.1）分,终末调查时为（6.6±2.3）分.IMFeD干预方法优于常规保健指导方法（F=32.99,P＜0.05）.单因素分析显示,不同的干预方法是影响干预效果的显著因素（x2=52.76,P＜0.05）.多因素统计结果显示,IMFeD法的干预效果优于常规指导方法（OR =6.171,95％CI：3.652 ～ 10.428）,1年中与父母相处时间能有10个月以上的儿童干预效果优于相处时间不足10个月的儿童（OR=0.448,95％ CI：0.264 ～0.761）.结论 以家庭为单位的阶段性儿童饮食行为临床干预方法优于常规的保健指导方法,应予以推广和完善.

Objective To evaluate the effects of different interventions on and influencing factors of picky eaters aged 1 to 5 years old.Methods Two hundred and forty-seven individuals were randomly assigned to the Identification and Management of Feeding Difficulties （IMFeD） group （n =147） and the control group （n =100）.The IMFeD group received comprehensive guidance once a month,3 times in total;while the control group had traditional eating guidance.Scores of the IMFeD group were compared with the control group.Multivariate method was used for data analysis.Results Behavior scores of the IMFeD group were 4.7 ± 1.1 at baseline and 9.5 ± 2.6 after the intervention ; although behavior scores of the control group were 4.9 ± 1.1 at baseline and 6.6 ± 2.3 following the routine guidance （F =32.99,P ＜ 0.001）.Univariate analysis showed that those two interventions significantly affected the outcomes of intervention （x2 =52.76,P ＜0.05）.Regression analyses revealed an odds ratio （OR） of 6.171 （95％ confidence interval （CI） 3.652-10.428） or 0.448 （95％ CI：0.264-0.761） for intervention strategy and time with parents during their 1 year.Conclusion Family-based periodicity intervention may play an important role in eating behavior change and should be widely conducted in child health care.