Behavioral aspects of nutrition in children with cystic fibrosis.

PURPOSE OF REVIEW Nutritional status in cystic fibrosis is important to the health and long-term survival of patients; however, children with cystic fibrosis are not achieving the dietary recommendations or achieving normal growth. This paper reviews current knowledge about behavioral and environmental barriers to dietary adherence in this population. RECENT FINDINGS Children with cystic fibrosis do not have the same appreciation of the need to gain weight as their parents. Parents of children with cystic fibrosis describe meal times as 'battling' with the child. Direct observation studies of meal times demonstrate that school-aged children with cystic fibrosis do not differ from children without cystic fibrosis on the frequency of behaviors incompatible with eating, as was seen in younger age groups, but parents of school-aged children with cystic fibrosis continue to engage in ineffective management styles at a greater frequency than parents of children without cystic fibrosis. Assessment of family functioning during mealtime demonstrates that these interaction patterns have a negative effect on family functioning in families of children with cystic fibrosis compared with families of same-age peers in all age groups: infancy/toddler, preschool, and school age. SUMMARY Achieving the cystic fibrosis dietary recommendations is challenging, and typical parenting strategies to encourage eating not only are ineffective but may have a negative impact on family functioning. To improve dietary adherence and decrease conflict at meals, children with cystic fibrosis and their parents need to be taught more effective management strategies as part of dietary counseling.