Da mesa ao território: o papel da família e da gestão pública nas dificuldades alimentares e nas necessidades alimentares especiais em escolares

Abstract

INTRODUCTION: Nutrition in childhood is crucial for growth, biopsychosocial development, and health, especially during the school years, when eating habits and preferences are established. In this context, Special Dietary Needs (SDN) become relevant, requiring adaptations in the menu and care organization, including allergies, intolerances, specific dietary prescriptions, and eating difficulties (ED). The literature points to high prevalences of ED in neurotypical and neurodivergent children. In Brazil, the institutional response is organized in Food and Nutritional Security policies and in the National School Feeding Program (PNAE), but gaps persist in the use of administrative records to characterize the profile of SFN in public networks, which hinders intersectoral planning and the qualification of responses between family, school, and health network. OBJECTIVE: To investigate the influence of the family and the panorama of eating difficulties in neurotypical and neurodivergent schoolchildren in the municipal public school system of Belo Horizonte. METHODS: (1) integrative review in the Embase, Scopus, and PubMed databases, with descriptors on eating difficulties, family relationships, and age group, including randomized clinical trials with parents/caregivers of children aged 2 to 10 years, evaluating lifestyle or psychological interventions; (2) ecological time series study with 1,967 NAE reports from the Belo Horizonte Municipal Education Secretariat (2014–2023). Secondary data from medical reports filed in schools, provided by the Municipal Secretariat for Food and Nutritional Security, were used. Variables included year, gender, age, school location, and type of dietary restriction. Descriptive statistics and Prais-Winsten regression were applied. RESULTS: In the integrative review comprising 11 studies, it was found that interventions based on behavior analysis, combined with food education, sensory management, and parental training, were predominant and showed a favorable effect on FAs, such as increased acceptance of vegetables, improved instrument assessment scores, and reduced avoidant restrictive food intake disorder (ARFID), especially when family-centered. In the analysis of the temporal trend, a statistically significant upward trend was observed in reports of food allergies, lactose intolerance, and selectivity between 2014 and 2023. NAEs were more frequent in boys, in regions with greater social vulnerability, and among children who ate all their meals at school (54.6%). There was also a significant percentage of reports without clear specification of the type of NAE, highlighting limitations in administrative records and additional challenges for PNAE planning in a context of strong dependence on school meals. The response requires family and interdisciplinary interventions, improved records and health-education communication, strengthening of the PNAE, and longitudinal and culturally adapted research in low- and middle-income countries. CONCLUSION: Family-centered interventions have been shown to be effective in improving children's eating behavior, although evidence is still limited, requiring longitudinal RCTs, standardized instruments, and specific strategies for clinical subpopulations. In Belo Horizonte, allergies, lactose intolerance, and selectivity have increased in vulnerable areas, requiring strengthening of the PNAE/EAN, standardized screening, interdisciplinary care, parental support, professional training, health education for caregivers, and intersectoral coordination to ensure greater social equity.