Keeping egg and peanut off the plate is one job. In a Sydney study, one in six young children with food allergies also screened at risk of a feeding disorder, and their parents carried far more stress

When a small child is diagnosed with a food allergy, the advice is about what to keep away: egg, milk, peanut, sesame, whatever the tests showed. Less is said about what happens to the rest of eating. A child who has been sick after meals for months before anyone worked out why may come to expect that food hurts. A parent who is frightened of a reaction may stop offering anything new. A team of speech pathologists and allergy specialists from the University of Queensland and Sydney hospitals set out to measure how often that tips into real feeding trouble. Their paper was published online in Pediatric Allergy and Immunology on 7 October 2026.

Between February 2023 and July 2024, posters in the paediatric allergy clinics of three Sydney hospitals invited the parents of children aged six months to four years eleven months, each with at least one diagnosed IgE-mediated food allergy (the fast kind that can cause anaphylaxis), to fill in an online survey on their phone. Children with autism, non-IgE allergies or other conditions that affect eating were left out. Of 191 parents who opened the survey, 107 ended up in the analysis. Six in ten children had more than one food allergy, and just over half had already had anaphylaxis. Egg (54%), milk (42%), tree nuts (30%) and peanut (28%) were the most common.

The main tool was the Behavioural Pediatric Feeding Assessment Scale, 35 questions on how often things happen at meals: whether the child enjoys eating, tries new foods, comes to the table, stays there, has tantrums. A total above 84 is the usual flag for a child at risk of a clinically significant feeding problem. Seventeen children, 15.9%, were above it. Three were infants, six were toddlers and eight were preschoolers. When parents were simply asked whether they had ever been worried about their child's mealtime behaviour, 27.1% said yes, nearly twice the number the questionnaire flagged.

The parents who said they were worried described a recognisable picture. Compared with the others, their children more often did not enjoy eating, would not try new foods, did not come readily to the table, got up during meals, ate no vegetables, had tantrums at mealtimes and had a poor appetite. The number of behaviours parents counted as a problem also rose with age, from an average of about 2 in infants to about 5 in toddlers and preschoolers.

The striking numbers are about the parents. Across the whole group, general parenting stress was ordinary: an average of 35.8 on the Parental Stress Scale, against about 37 in the families the scale was built on. But mealtime-related quality of life, measured with the Feeding Swallowing Impact Scale, averaged 30.5, which the authors say is above the 95th percentile of a recent UK sample of 904 children aged one to seven. In other words, most of these families were not stressed in general, but feeding was weighing on them. For the 17 children over the feeding cut-off, it was heavier still: their parents averaged 44.4 on the stress scale against 34.3 for the rest, and 43.9 against 28.1 on the feeding impact scale, with the worry subscale highest of all. The authors note that a stress level around 45 is similar to what has been reported by parents of children with developmental delay, paediatric bipolar disorder or autism.

The authors are open about the limits. Everything came from parents; no child was examined by a feeding therapist, and the questionnaire cannot diagnose paediatric feeding disorder, which needs a medical, nutritional, skills and psychosocial assessment. Some children may fit avoidant/restrictive food intake disorder (ARFID) instead. Parents filled in the survey on the day their child was having an oral food challenge, a test that can bring on a reaction, which is hardly a calm moment. Parents already worried about eating may have been more likely to take part. Three in four preschoolers had a history of anaphylaxis, more than in children with food allergy generally. And with only 17 children over the cut-off, the team could not work out which factors predicted the risk.

A few things we noticed ourselves. The paper sets its 16% beside a general-population rate of diagnosed feeding disorder of 2.7% to 4.1%. Those are different yardsticks, a screening score against a clinical diagnosis, and the study had no group of children without allergies scored the same way in the same clinics, so the size of the gap is uncertain. Close to half of the parents who opened the survey did not end up in it (84 of 191), most of them because they never started. And the stress table gives a lowest score of 0, which the Parental Stress Scale's usual scoring (18 items, each scored 1 to 5) cannot produce; it is probably a slip, but it is one we could not check.

Our reading: this is a small first look rather than a prevalence figure, but its practical point holds. Allergy care tends to be about what a child must not eat. For a minority of families, the harder daily problem is getting the child to eat at all, and that strain shows up in the parents. If mealtimes with an allergic toddler have become a battle, or the list of foods the child accepts keeps shrinking, that is worth raising at the allergy clinic. Feeding therapy from a speech pathologist or occupational therapist, alongside a dietitian, is a recognised kind of help, and the authors argue it should be offered more readily to these families.