Undernutrition affects over 30% of hospitalized children in France, with 10% severely
malnourished yet only half of the cases are diagnosed. Undernutrition deteriorates
children's health during hospital stays, weakening immunity and hindering recovery.
Children suffering from acute malnutrition can stay in the hospital 45% longer than
non-malnourished patients.
One of the primary causes of malnutrition is the reduction in children's food intake.
Several researchers have emphasized that the young age of patients is associated with
reduced food intake. For example, data on 923 children aged 1 day to 16 years indicates
that patients under 8 years old are at a higher risk of undernutrition than older
children.
The MEDIC project aims to investigate if increased food rejection dispositions contribute
to reduced food intake in hospitalized children. Food rejections are typically observed
between 2 and 8 years. Some children are more challenging and eat only a few different
foods, while others try everything. Around the age of 2, children become more selective
about the foods they consume. This is largely due to two common dispositions in young
children: food neophobia and food pickiness. Food neophobia is defined as the reluctance
to eat or even try foods that appear new, whereas food pickiness is defined as the
rejection of a substantial number of familiar foods, including foods previously tasted.
Both pickiness and neophobia have been associated with a significant reduction in food
consumption (especially of vegetables), a decrease in food variety, and less enjoyment
derived from food. A study showed that children aged 2 to 5 were twice as likely to be
underweight if they were picky eaters.
Studies have shown that the socioeconomic status has a significant impact on food
rejection in children. For instance, longitudinal studies reveal a higher proportion of
picky eaters in low-income families. Parental education was also found to be inversely
associated with children's food rejection levels.
The MEDIC project seeks to assess health inequalities by studying the impact of food
rejection dispositions on the nutritional status of children in pediatric services. A
qualitative study supports the notion that food rejection is heightened during the
hospitalization: half of the parents of hospitalized children interviewed reported that
foods accepted outside the hospital were rejected in the ward. Parents indicated that
their child's food preferences were more limited, and they only alternated between a few
foods after entering the hospital. According to the majority of interviewed nurses,
children refuse any food other than that provided by parents.
The research hypotheses of the MEDIC project focus on understanding the moderating
effects of food rejection dispositions and socioeconomic backgrounds on children's food
intake during hospitalization. Two hypotheses are formulated: (H1) the
pre-hospitalization food rejection levels predict the amount of food consumed during the
hospital stay, and (H2) children from disadvantaged socioeconomic backgrounds are more
likely to refuse food during their hospital stay than those from more advantaged
backgrounds. To test these hypotheses, parents of children aged 2 to 8 will complete
questionnaires on food rejection dispositions upon admission, and food consumption (in
grams and calories) will be assessed through weighing and photographs of meal trays taken
48 hours (± 24 hours) post-admission. The project aims to shed light on the complexities
of childhood malnutrition, addressing social inequalities and contributing valuable
insights for interventions and public health policy.