Changes in Problematic Mealtime behaviors among 3- to 6-Year-Old Children Following Sapere-Based Sensory Education: A Pre-Post Intervention Study

Yaeko  Kawaguchi; Junichiro  Somei; Masayuki  Domichi; Akiko   Suganuma; Naoki  Sakane

doi:10.6000/1929-4247.2026.15.01.1

Authors

Yaeko Kawaguchi Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto Japan
Junichiro Somei Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto Japan
Masayuki Domichi Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto Japan
Akiko Suganuma Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto Japan
Naoki Sakane Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto Japan

DOI:

https://doi.org/10.6000/1929-4247.2026.15.01.1

Keywords:

Preschool children, mealtime behavior, Sapere method, sensory education

Abstract

Introduction: Feeding difficulties are commonly observed in children, especially those with developmental concerns. This study aimed to evaluate the effects of Sapere-based sensory education on mealtime behavior and food acceptance in preschool-aged children using a pre-post intervention design.

Methods: A quasi-experimental, multi-site prospective study was conducted with 148 children aged 3 to 6 years. Participants were divided into two groups: 74 children with problematic mealtime behavior (PMB), assessed using the ASD-Mealtime Behavior Questionnaire, and74 age- and sex-matched non-PMB in contrast. Food pickiness and neophobia were evaluated using a validated food rejection scale. The intervention consisted of sensory-based dietary education using the Sapere method, with assessments conducted before and six months after the intervention.

Results: Significant improvements were observed in the PMB group following the intervention. Specifically, reductions were observed in clumsiness/manners (–4.2 ± 0.8, p < 0.001), interest/concentration during eating (–1.7 ± 0.7, p = 0.014), and oral motor function difficulties (–1.0 ± 0.5, p = 0.039). Food pickiness also showed a significant decrease (–1.4 ± 0.4, p =0.002). Although selective eating and food neophobia showed downward trends, the changes were not statistically significant. In contrast, no significant changes were noted in the non-PMB group for any behavioral or food rejection measures.

Conclusion: Sapere-based sensory education may effectively reduce problematic mealtime behaviors and food pickiness among preschool-aged children. These findings support the potential utility of sensory-based interventions for promoting healthy eating behaviors in early childhood.

References

Grady A, Jackson J, Wolfenden L, Lum M, Yoong SL. Assessing the scalability of healthy eating interventions within the early childhood education and care setting: secondary analysis of a Cochrane systematic review. Public Health Nutr 2023; 26(12): 3211-29. DOI: https://doi.org/10.1017/S1368980023002550

Scaglioni S, De Cosmi V, Ciappolino V, Parazzini F, Brambilla P, Agostoni C. Factors influencing children's eating behaviours. Nutrients 2018; 10(6): 706. DOI: https://doi.org/10.3390/nu10060706

Hodges A, Davis TN, Kirkpatrick M. A review of the literature on the functional analysis of inappropriate mealtime behavior. Behav Modif 2020; 44(1): 137-54. DOI: https://doi.org/10.1177/0145445518794368

Öz S, Bayhan P. An investigation of the relationship between the eating behaviours of children with typical development and autism spectrum disorders and parent attitudes during mealtime. Child Care Health Dev 2021; 47(6): 877-85. DOI: https://doi.org/10.1111/cch.12899

Panerai S, Suraniti GS, Catania V, Carmeci R, Elia M, Ferri R. Improvements in mealtime behaviors of children with special needs following a day-center-based behavioral intervention for feeding problems. Riv Psichiatr 2018; 53(6): 299-308. DOI: https://doi.org/10.1708/3084.30763

Taylor CM, Emmett PM. Picky eating in children: causes and consequences. Proc Nutr Soc 2019; 78(2): 161-9. DOI: https://doi.org/10.1017/S0029665118002586

Cole NC, Musaad SM, Lee SY, Donovan SM; STRONG Kids Team. Home feeding environment and picky eating behavior in preschool-aged children: a prospective analysis. Eat Behav 2018; 30: 76-82. DOI: https://doi.org/10.1016/j.eatbeh.2018.06.003

Blomkvist EAM, Wills AK, Helland SH, Hillesund ER, Øverby NC. Effectiveness of a kindergarten-based intervention to increase vegetable intake and reduce food neophobia amongst 1-year-old children: a cluster randomised controlled trial. Food Nutr Res 2021; 65: 7679. DOI: https://doi.org/10.29219/fnr.v65.7679

Ishikawa M, Eto K, Miyoshi M, Yokoyama T, Haraikawa M, Yoshiike N. Parent-child cooking meal together may relate to parental concerns about the diets of their toddlers and preschoolers: a cross-sectional analysis in Japan. Nutr J 2019; 18(1): 76. DOI: https://doi.org/10.1186/s12937-019-0480-0

Nakaoka K, Tanba H, Yuri T, Tateyama K, Kurasawa S. Convergent validity of the Autism Spectrum Disorder Mealtime Behavior Questionnaire (ASD-MBQ) for children with autism spectrum disorder. PLoS One 2022; 17(4): e0267181. DOI: https://doi.org/10.1371/journal.pone.0267181

Nakaoka K, Takabatake S, Tateyama K, Kurasawa S, Tanba H, Ishii R, et al. Structural validity of the mealtime behaviour questionnaire for children with autism spectrum disorder in Japan. J Phys Ther Sci 2020; 32(5): 352-8. DOI: https://doi.org/10.1589/jpts.32.352

Nakaoka K, Tateyama K, Yuri T, Harada S, Takabatake S. Predictive validity and cutoff score of the Mealtime Behavior Questionnaire for children with autism spectrum disorder. Res Autism Spectr Disord 2024; 10102290. DOI: https://doi.org/10.1016/j.rasd.2023.102290

Rioux C., Lafraire J., Picard D. L’échelle de Rejets Alimentaires Pour Enfant: Développement et Validation d’une Nouvelle Échelle Pour Mesurer La Néophobie et La Sélectivité Alimentaire Chez Les Jeunes Enfants Français de 2 à 7 Ans. Rev. Eur. Psychol. Appl 2017; 67: 67-77.

Tada Y, Ueda Y, Sasaki K, Sugiura S, Suzuki M, Funayama H, et al. Mealtime regularity is associated with dietary balance among preschool children in Japan - a study of lifestyle changes during the COVID-19 pandemic. Nutrients 2022; 14(14): 2979. DOI: https://doi.org/10.3390/nu14142979

Monaghan M, Herbert LJ, Wang J, Holmes C, Cogen FR, Streisand R. Mealtime behavior and diabetes-specific parent functioning in young children with type 1 diabetes. Health Psychol 2015; 34(8): 794-801. DOI: https://doi.org/10.1037/hea0000204

Osorio NG, Vik FN, Helle C, Hillesund ER, Øverby NC, Helland SH, et al. Implementing an early-life nutrition intervention through primary healthcare: staff perspectives. BMC Health Serv Res 2024; 24(1): 1106. DOI: https://doi.org/10.1186/s12913-024-11582-z