Seletividade alimentar em crianças e adolescentes: estudo exploratório das práticas em Terapia Ocupacional no Brasil

Abstract

Food selectivity is a heterogeneous phenomenon characterized by persistent patterns of food refusal, a limited food repertoire, and/or repetitive consumption of a restricted range of foods, and may be associated with sensory, oral motor, behavioral, clinical, environmental, and sociocultural factors. Although food preferences are expected throughout development, food selectivity becomes clinically relevant when dietary restriction affects the variety and quantity of food consumed, participation in mealtimes, daily routines, family relationships, or eating autonomy. Objective – To describe, from the perspective of occupational therapists, therapeutic practices carried out in Brazil in the care of children and adolescents with food selectivity, considering assessment procedures, intervention strategies, family participation, documentation practices, and professional satisfaction. Method – This was a descriptive and exploratory study using a mixed-methods approach with a predominantly descriptive focus, conducted with 42 occupational therapists practicing in Brazil. Data were collected through an online questionnaire containing open- and closed-ended questions. Responses to closed-ended questions were analyzed using absolute and relative frequencies, without inferential purposes, while responses to open-ended questions were subjected to inductive thematic analysis. Results – The sample was predominantly from the Southeast region of Brazil (n=23; 54.8%) and included professionals with varying levels of experience. Services were provided mainly to preschool-aged children (n=30; 71.4%) and children aged 7 to 12 years (n=29; 69.0%), whereas no professional reported providing services to adults or individuals aged 60 years or older. Autism Spectrum Disorder was the clinical condition most frequently associated with food selectivity. During the initial assessment, the most frequently reported procedures were family interviews (n=42; 100%), standardized scales (n=36; 85.7%), clinical observation (n=34; 81.0%), and food diaries (n=27; 64.3%). Participants reported interventions involving Ayres Sensory Integration®, exposure and gradual approaches to foods, play-based activities, cooking activities, behavioral strategies, environmental adaptations, and caregiver participation. Among adolescents, interventions focused on autonomy, food choices, meal preparation, and participation in community settings. Most participants considered it possible to promote active participation in food-related decision-making (n=40; 95.2%). The most frequently reported methods for documenting progress were written reports (n=27; 64.3%), spreadsheets (n=11; 26.2%), and videos (n=8; 19.0%). Regarding professional satisfaction with working in the field of food selectivity, 32 participants (76.2%) reported being satisfied, 5 (11.9%) very satisfied, and 5 (11.9%) dissatisfied. Conclusion – The practices described indicate a multifactorial and contextualized approach, with strong family involvement and attention to sensory, behavioral, functional, and occupational components. The findings also reveal conceptual and methodological heterogeneity, reinforcing the need for greater diagnostic precision in distinguishing food selectivity from Avoidant/Restrictive Food Intake Disorder and Pediatric Feeding Disorder, as well as the need for specific assessment instruments, continuing professional education, and longitudinal studies to further investigate the effectiveness of interventions.