Emotional-behavioral difficulties and maternal psychosocial factors in preschool children with food allergy: a cross-sectional case-control study.

Food allergy (FA) is a common chronic condition, yet its behavioral and psychosocial impact in early childhood remains insufficiently understood. This cross-sectional study assessed emotional-behavioral outcomes, maternal anxiety, and perceived child vulnerability (PCV) in preschoolers with FA versus healthy controls, with subgroup analyses for food-related anaphylaxis and respiratory allergic comorbidities. A total of 186 children aged 1.5-5 years (84 with FA and 102 age- and sex-matched controls) and their mothers were included. Behavioral functioning was assessed using the Child Behavior Checklist, while maternal anxiety and PCV were measured with the State-Trait Anxiety Inventory-Trait and Child Vulnerability Scale. Children with FA demonstrated higher levels of emotional reactivity, somatic complaints, and sleep problems compared with healthy peers (all p < 0.05). Mothers of affected children reported higher PCV. Within the FA group, children with respiratory allergic comorbidity exhibited more pronounced internalizing, externalizing, and total behavior problems, whereas those with a history of anaphylaxis had lower attention problem scores (all p < 0.05). Maternal anxiety and PCV were positively associated with children's internalizing, externalizing, and total behavioral difficulties (all p < 0.05). In multivariate analyses, FA was associated with higher PCV (OR = 4.31, 95% confidence interval: 1.81-10.27, p = 0.001), and this association was stronger in children with respiratory allergic comorbidity (OR = 8.34, 95% CI: 2.15-32.32, p < 0.01).

conclusionPreschool children with FA may be at increased risk for emotional and behavioral difficulties, accompanied by heightened PCV, particularly when respiratory comorbidities are present. Integrating developmental and behavioral monitoring and parent-focused psychosocial support within the clinical care may help improve outcomes for both children and their families. WHAT IS KNOWN: • Social and behavioral difficulties are well described in school-aged children and adolescents with food allergy, but data on preschoolers are limited. • Parental perceptions of child vulnerability influence behavioral outcomes, yet this has scarcely been studied in young children with food allergy. WHAT IS NEW: • Preschoolers with food allergy exhibit more emotional and behavioral difficulties, and their mothers report higher perceived vulnerability. • Respiratory comorbidities are linked to stronger perceived vulnerability and more pronounced emotional and behavioral symptoms.