# Diet Diversity and Feeding Practices in Toddlers with and Without Food Allergy—A Cross-Sectional Study

## TL;DR

Toddlers with food allergies have less diverse diets compared to those without allergies, despite similar rates of feeding difficulties.

## Contribution

The study identifies reduced diet diversity and over-restriction of allergenic foods in toddlers with food allergies.

## Key findings

- Children with food allergies had significantly lower diet diversity compared to non-FA peers.
- Most children with cow’s milk and egg allergy reintroduced baked forms of these foods.
- Over-restriction of allergenic foods was observed despite only a minority having confirmed allergies to nuts, peanuts, and sesame.

## Abstract

Background/Objectives: This study aimed to evaluate diet diversity and feeding practices in toddlers with food allergy (FA) compared to healthy peers. Methods: This cross-sectional survey was conducted in Polish nurseries and included children aged 13–36 months with and without FA. Parents completed a questionnaire assessing feeding practices, anthropometric measurements, diet diversity using the Food Frequency Questionnaire, and feeding difficulties using the Montreal Children’s Hospital Feeding Scale. Results: Data from 388 children (predominantly from Warsaw and from families with high socioeconomic status) were analyzed. Among them, 61 (16%) had FA confirmed by a physician (however, an oral food challenge was performed only in one-third of cases). The proportion of underweight children (≤third percentile) was similar between the FA and non-FA groups (3.4 vs. 0.9%, respectively). Compared with the non-FA group, children with FA had significantly lower median overall diet diversity, food group diversity (≥nine food groups), food item diversity, and mean food allergen diversity. We found no difference in the proportion of children with feeding difficulties between the FA and non-FA groups (median = 18% vs. 13.5%). Although a lower proportion of children with FA had introduced cow’s milk, hen’s egg, tree nuts, nuts, and sesame compared with the non-FA group, only a minority had confirmed allergies to nuts, peanuts, and sesame. Most children with cow’s milk and hen’s egg allergy reintroduced baked milk (48.9%) and egg (40%). Conclusions: Children aged 13–36 months with FA are at risk of reduced overall diet diversity and over-restriction of potentially allergenic foods.