Associations between regulatory problems in early childhood and parental feeding practices, child eating behaviour, and weight: A systematic review and narrative synthesis.
While eating problems in early childhood are linked to feeding practices and weight, the evidence is less clear on the role of emotion and sleep regulation difficulties in shaping these trajectories.
Key Findings
Results
There was insufficient level of evidence for associations between emotion regulation problems and feeding practices, eating behaviour, and weight outcomes in early childhood.
Best evidence synthesis methodology was used to evaluate the level of evidence across all included studies.
Emotion regulation was one of three regulatory problem domains examined alongside sleep and eating.
The insufficient evidence rating reflects both limited study numbers and methodological heterogeneity across available studies.
Children aged 3-36 months were the target population across all included studies.
Results
There was moderate level of evidence for a cross-sectional association between sleep problems and eating behaviour in early childhood.
The association between sleep problems and eating behaviour was rated as moderate level of evidence using best evidence synthesis.
Notably, there was moderate level of evidence for no association between sleep problems and weight outcomes.
The cross-sectional nature of the evidence limits causal inference about the direction of this association.
Sleep was assessed as one of the three regulatory problem domains in this review.
Results
There was moderate level of evidence for an association between eating problems in early childhood and both parental feeding practices and child weight.
Eating problems were associated with both feeding practices and weight outcomes, the only regulatory problem domain with evidence linking to both outcome categories.
This finding was rated as moderate level of evidence according to best evidence synthesis.
Eating problems represent one of three regulatory problem domains (alongside emotion and sleep regulation) examined in this review.
The association between eating problems and feeding practices suggests potential bidirectional pathways between child eating difficulties and caregiver responses.
Methods
Thirty-eight studies met eligibility criteria for inclusion in the systematic review, with most being of moderate methodological quality.
38 studies were eligible for inclusion in the final review.
The majority of included studies were rated as moderate quality (n = 33).
Methodological quality was assessed using the National Institutes of Health Quality Assessment Tool.
Databases searched included MEDLINE, EMBASE, and PsycINFO, from inception to September 2025.
Eligible studies required children aged 3-36 months with a measure of regulatory problems and at least one outcome measure of parental feeding practice, child eating behaviour, or weight.
Discussion
The review identifies a lack of high-quality longitudinal research with homogeneous methodology as a critical gap in understanding early childhood regulatory problems and their effects on feeding, eating, and weight.
The authors describe early childhood as 'a critical yet underexplored period' for understanding these developmental pathways.
Methodological heterogeneity across studies was identified as a limiting factor in drawing firm conclusions.
The review calls for research to clarify 'whether early-life RPs represent modifiable intervention targets supporting healthy feeding, eating, and weight.'
PROSPERO registration number CRD42023463391 confirms this was a pre-registered systematic review.
A narrative synthesis approach was undertaken due to the heterogeneity of available evidence.
Background
Early difficulties in the regulation of emotion, sleep, and eating are described as common in early childhood and may shape developmental pathways of eating behaviours and weight.
The review conceptualises regulatory problems (RPs) as encompassing three domains: emotion regulation, sleep regulation, and eating regulation.
The age range of 3-36 months was selected as the focus period for early childhood regulatory problems.
Understanding these pathways is described as 'key to identifying modifiable targets for promoting healthy eating and growth.'
The review was designed to synthesise evidence linking all three RP domains to feeding, eating, and weight outcomes.
What This Means
This research systematically reviewed 38 studies to understand whether difficulties that some very young children have with regulating their emotions, sleep, or eating (in the first three years of life) are connected to how parents feed their children, how children behave around food, and children's weight. The researchers rated the quality of evidence for each type of regulatory difficulty separately. They found that early eating problems were linked to both how parents feed their children and to child weight, with a moderate strength of evidence. Sleep problems in infancy and toddlerhood appeared to be associated with how children behave around food, but not with weight, also at a moderate evidence level. For emotion regulation difficulties, the evidence was too limited and inconsistent to draw any conclusions.
This research suggests that not all types of early regulatory problems have the same relationship to later eating and growth outcomes. Early eating difficulties appear to be the most clearly connected to feeding practices and weight in the first three years of life, which may make them a particularly relevant focus for early intervention. The link between sleep problems and eating behaviour is also notable, though what drives this relationship is not yet clear from the available research.
An important takeaway from this review is that the existing research in this area is limited in quality and consistency, making it difficult to draw strong conclusions. Most studies examined relationships at a single point in time rather than following children over time, which means it is hard to know whether regulatory problems cause changes in eating or weight, or whether the reverse is true. The authors call for better-designed, longer-term studies to understand these early developmental pathways and determine whether addressing regulatory problems in infancy could be a practical way to support healthier eating and growth in young children.
Parellada C, Asmussen J, Olsen A, Skovgaard A, Teilmann G, Micali N, et al.. (2026). Associations between regulatory problems in early childhood and parental feeding practices, child eating behaviour, and weight: A systematic review and narrative synthesis.. Appetite. https://doi.org/10.1016/j.appet.2026.108491