The study complied with the ethical standards of the Medical Research Ethics Committee and the Declaration of Helsinki. Ethical approval of this study was obtained from the Biomedical Ethics Committee of West China Second University Hospital, Sichuan University (Ethics approval document number: 2023060). Written informed consent was obtained from the children's feeders before the study. Participation in the study process is fully respectful of parents' opinions. Participants could decline or withdraw from the study at any time.

This quasi-experimental study was conducted at a tertiary Grade A women's and children's hospital in Chengdu, Sichuan, China from March 2023 to June 2023. A total of 52 children aged 6–24 months and their respective feeders were included in the study. According to the outpatient registration numbers, participants were allocated to groups using a 1:1 ratio: children with odd registration numbers were assigned to the intervention group, while those with even registration numbers were assigned to the control group.

The sample size calculation in this study was based on the formula for “comparison of means between two independent samples”: n1 = n2 = 2 [(μα + μβ)²·σ²)/δ²], with α = 0.05 and β = 0.1. Using MCH-FS as the primary measurement indicator and adopting values from literature reports (δ = 6.31, σ = 6.4) (12), the minimum sample size per group was calculated to be 22 cases. Accounting for a 20% potential loss to follow-up, each group required at least 26 participants.

The inclusion criteria were as follows: (1) the infant or young child was in the self-feeding transition period; (2) feeding disorders were found in their feeder's chief complaints and the Montreal Children's Hospital Feeding Scale (MCH-FS) score was >50; (3) the infant or young child had weight loss or no weight gain for at least 1 month; (4) non-organic feeding disorders were diagnosed.

The exclusion criteria were as follows: (1) infant or young child who was born prematurely; (2) infant or young child who had congenital diseases, gastrointestinal diseases, intellectual disability, cerebral palsy, genetic diseases, endocrine or metabolic diseases; or (3) infant or young child who had acute illness in the recent 1 month.

According to the feasibility and effectiveness of the study, the research team formulated the following removal criteria: (1) incomplete data due to poor compliance of feeder; (2) participant declined participation or withdrew from the study; or (3) the number of the shared medical appointment interventions that the participant attended was ≤2 times. In clinical practice, organic and non-organic factors often coexist. For instance, children with a history of allergies are more prone to behavioral food refusal. To avoid over-idealization of study population, this research included infants and young children with histories of allergies, diarrhea, and vomiting, all of whom were in non-acute symptomatic phases.

This study adopted multidisciplinary shared medical appointment as a new intervention method. The shared medical appointment is a group visit in which 5–15 patients see a multidisciplinary team of 2 or more healthcare professionals online or offline. A shared medical appointment lasts 90–120 min, and patients need to attended 3–12 shared medical appointments for interventions (13). Compared with traditional intervention methods, shared medical appointments involve individual diagnosis and health care in a group setting as well as group lectures and discussions. This approach can effectively utilize healthcare resources, implement continuous planning, and set clear goals, improving patient experience and self-management of disease (14). The multidisciplinary team in our study consisted of 10 healthcare professionals who were pediatricians, specialist nurses, registered dietitians, psychotherapists, and rehabilitation therapists. Infants and young children in the experimental group needed to attend 3 shared medical appointments, with a 1-month interval between the appointments. Each appointment lasted about 120 min.

All participants completed the MCH-FS, ICFI and SAS before the intervention (T1) and 1 month after the intervention (T2). Body measurements of the children were measured before the intervention (T1), 1 month after the intervention (T2), and 3 months after the intervention (T3), respectively. The physical growth indicators were measured by specialist nurses from the research team using the calibrated child height and weight measurement scales and head circumference measuring tape. The feeding questionnaires were filled in by the feeders under the instructions of specialist nurses in accordance with unified standards. The returned questionnaires were checked one by one to ensure their completeness and validity.

SPSS Statistics 25.0 was used for data analysis. The α level was set as 0.05. A statistically significant difference was identified by P < 0.05. The baseline data was described by frequency, constituent ratio, mean ± standard deviation, and M (P25, P75). The inter-group comparison was performed using the t-test, Chi-square test, Mann–Whitney U test, and Fisher's precision probability test. The physical growth indicators were described with the mean ± standard deviation. The t-test, one-way analysis of variance, and repeated measures analysis of variance were used in this study. The MCH-FS, ICFI and SAS scores were described using mean ± standard deviation and compared using the t-test. A multivariate regression analyses was employed to account for potential confounding variables that might influence the results.

In the intervention group, 2 cases were removed from the study due to insufficient intervention time, and 1 case was lost to follow-up. In the control group, 1 case was lost to follow-up due to moving home, and 2 cases withdrew from the study because feeders declined the follow-up. Therefore, 46 cases were finally included in this study (23 cases in the intervention group and 23 cases in the control group (37 aged 6–11 and 9 aged 12–24). The average age of the 46 investigated children was 8.7 months. The youngest participant was 6 months old, and the oldest was 17 months old. Of the 46 cases, the average age at which complementary foods were added first time was 6 months, 43.5% did not receive continued breastfeeding, 28.3% had a history of allergy, 54.3% had a history of eczema, 32.6% had a history of constipation, and 69.6% had sleep problems. No statistically significant differences were identified in baseline data between the two groups. Details are presented in Table 2. We conducted further multivariate regression analyses, taking into account the potential influence of certain covariates (caregiver's type/age/education, household income) on the outcomes. The results showed no statistically significant differences after adjusting for these confounding factors.

The results of repeated measures analysis of variance showed that time had an effect on the changes in weight, height, and head circumference in infants and young children in the two groups, as shown in Table 3. The results of the inter-group comparison showed that no statistically significant differences were identified in physical growth indicators between the two groups at different time points (P > 0.05). One-way analysis of variance was used for intra-group comparison. The results showed that the Z-scores for the three physical growth indicators in the intervention group after the intervention were higher than those before the intervention (P < 0.05); a statistically significant difference was identified in the Z-scores for height-for-age in the control group before and after the intervention (F = 5.370, P = 0.008); no statistically significant differences were identified in the Z-scores for weight-for-age and head circumference-for-age before and after the intervention (P > 0.05), as shown in Table 4. The results of the intra-group pairwise comparison are shown in Table 5.

After the intervention, statistically significant differences were identified in scale scores, feeding behavior scores, and eating behavior scores between the two groups (t = −2.073, P value for scale scores = 0.046; t = −2.106, P value for feeding behavior scores = 0.042; t = −2.558, P value for eating behavior scores = 0.016). The results of the intra-group comparison showed that scale score, feeding behavior score, and eating behavior score in the experimental group after the intervention were significantly lower than those before the intervention (t = 3.650, P value for scale scores = 0.001; t = 4.981, P value for feeding behavior scores < 0.001; t = 3.283, P value for eating behavior scores = 0.003), as shown in Table 6. The mean scores for the MCH-FS items in the two groups before and after the intervention are shown in Figures 2 and 3.

The results of the inter-group comparisons showed that a statistically significant difference was identified in the ICFI score after the intervention (t = 5.814, P < 0.001); the results of the intra-group comparisons showed that the ICFI score of the experimental group after the intervention was higher than that before the intervention (t = −3.689, P = 0.001); no statistically significant differences were identified in feeders' SAS scores before and after the intervention. Details are shown in Table 7.

The results of this study showed that, after the shared medical appointment interventions, the eating behavior score of the infants and young children in the intervention group went down (items 3, 4, and 6), but their ICFI score went up. This indicates that the multidisciplinary shared medical appointment interventions can effectively improve the clinical manifestations of feeding disorders in infants and young children and improve the overall quality of infant and young child feeding. This is consistent with the results shown by Owen et al. (26). Eating behaviors are acquired through continuous learning and practice, and good eating behaviors can meet the nutritional needs of normal growth of infants and young children. The multidisciplinary shared medical appointment interventions applied in this study included health education on feeding knowledge and guided feeders to follow feeding principles (such as reasonably limiting each meal duration to 30 min). Parents were provided with actionable measures (such as sand timer) and recommended to avoid distracting activities during meals (such as watching TV, using mobile phones, and playing with toys). It also provided the feeders with convenient, age-appropriate, and economical recipes and conducted on-site simulation exercises to prepare complementary foods. This is conducive to the daily practice of feeders. Previous studies have confirmed that the severity of feeding disorders is negatively correlated with the Z-scores for weight-for-age, height-for-age, and head circumference-for-age, and improving related symptoms can benefit physical growth (27, 28). The results of our study showed that the Z-scores for physical growth indicators in the experimental group increased after the intervention. This indicates that multidisciplinary shared medical appointment interventions positively affect the physical growth of infants and young children with non-organic feeding disorders during the self-feeding period. With the change of time (except for the similar Z-scores for height-for-age between the two groups), the Z-scores for weight-for-age and head circumference-for-age in the experimental group increased more than the control group, showing an upward trend. This is consistent with the results of Wang et al. (29). The eating behaviors changed, and the types and amount of food intake increased after the interventions for non-organic feeding disorders in the infants and young children during the transition period from exclusive breastfeeding to family foods. Hence, the weight and head circumference increased significantly. Comparably, height increase lagged behind weight increase and are affected by genetic and environmental factors. Our data collection primarily focused on the immediate effects and short-term retention (T1-T2) of behavioral interventions. This approach is theoretically grounded in the understanding that behavior changes always take precedence over improving physical growth indicators, as the latter tend to demonstrate a certain cumulative effect and lagging effect (T3).

Feeding behavior refers to a series of specific measures or behaviors taken by the feeders, which may affect children's food choice, intake amount, and eating behaviors. It is an important environmental factor that can be changed and interfered with. During the transition period, the main feeders are in the dominant position in the feeding process. It is necessary and feasible to intervene in feeders' feeding behaviors to change the eating behaviors and nutritional outcomes of infants and young children. There has been several literature on the effects of behavioral interventions in improving feeding problems (30). The results of our study showed that after the main feeders in the experimental group received shared medical appointment interventions, their feeding behavior scores were significantly reduced (items 6, 9, and 10). This was consistent with the results of Sharp et al. (31). Crucially, our data reveal that traditional counseling (control group) failed to induce feeding difficulties changes over time, as evidenced by stable scores in MCH-FS [pre-intervention: 62.39 (7.49); post-intervention: 63.39 (4.75); P = 0.557]. This stagnation contrasts sharply with the progressive improvements observed in the intervention group, underscoring the inadequacy of conventional approaches. These findings provide empirical justification for changing conventional health care in children paradigms. In addition, we used items 2 and 4 of the MCH-FS scale as a proxy for self-efficacy. The results showed that caregivers in the intervention group exhibited reduced scores in both “concerns about eating” (Item 2) and “impact of feeding difficulties on family relationships” (Item 4).

The results of our study showed that the SAS scores for feeders in the experimental group did not change significantly after receiving the shared medical appointment interventions, possibly because the shared medical appointment interventions should ultimately have a comprehensive multidisciplinary effect, which may focus on providing feeding knowledge, developing good feeding behaviors of the feeders and establishing a reasonable feeding mode to help feeders build scientific feeding concepts and confidence while reducing parenting stress. The anxiety of feeders can be affected by various factors, such as family environment and the feeders' psychological state. Studies are showing that feeders of infants and young children who have feeding disorders have greater parenting stress and are more likely to suffer from anxiety and depression (32). The effects of the main feeders' emotional responses on feeding interactions and feeding quality should not be ignored and must be further verified.