**Background:** Feeding problems (FP) in children range from mild transient difficulties to severe feeding disorders, typically starting between 6 months and 4 years of age. Prevalence estimates vary widely (1.4% to 45%) due to inconsistent definitions. The 2019 pediatric feeding disorder (PFD) consensus definition introduced ICD-10 codes in 2021, but population-based prevalence data for young children remain scarce. In Sweden, the last FP prevalence study was from 1986 (1.4% in infants 3–12 months). This study aimed to describe FP prevalence and severity in typically developing children <3 years in Sweden using the validated Behavioral Pediatrics Feeding Assessment Scale (BPFAS).
**Methods:** This descriptive cross-sectional study was conducted at child health care centers (CHCCs) in western Skåne, Sweden (population ~1.4 million). CHCCs were stratified into four quartiles using the Care Need Index (CNI), a socioeconomic index. Parents of children attending regular 10-, 18-, and 36-month health visits were recruited consecutively from January 2020 to January 2022. Inclusion criteria: parents >18 years, able to understand spoken/written Swedish. The questionnaire included demographic items and a Swedish version of BPFAS (35 items; 25 on child eating behaviors, 10 on parental reactions). BPFAS yields a total frequency score (TFS; range 35–175) and total problem score (TPS; range 0–35). Clinically significant FP thresholds were TFS >84 and TPS >9. Power analysis (estimated 25% prevalence, 5% margin of error, 95% CI) required 289 children; aiming for 376 to account for 30% non-participation. Chi-square and Kruskal–Wallis H-tests were used for group comparisons. Ethical approval was obtained (191105/2019-04577).
**Key Results:** Of 268 returned questionnaires, 238 had complete BPFAS frequency data (115 girls, 123 boys). Parents were aged 23–47 years (median 34); 85.3% were female; 67.9% had tertiary education. Seventeen children (7.1%) had prior healthcare contact for FP; 14 (5.9%) had food allergies. Overall, 8.4% (n=20) had TFS >84 and 9.3% (n=22) had TPS >9, indicating clinically significant FP. By age group: 10-month group—4% above threshold for both TFS and TPS; 18-month group—6% (TFS) and 7.2% (TPS); 36-month group—15% (TFS) and 16.3% (TPS). Age differences were significant for TFS (χ²=7.02, df=2, p=0.03) and TPS (χ²=7.43, df=2, p=0.024). Mean TFS for all children was 62.7 (SD=12.4, median 60, range 41–100); mean TPS was 2.2 (SD=4.6, median 0, range 0–22). The 36-month group had significantly higher TPS (mean 3.7, median 1, SD=6) than younger children (p<0.001), but TFS did not differ significantly by age (p=0.072). No significant associations were found for gender (girls 9.6% vs boys 7.3% above TFS threshold; 12.2% vs 6.5% for TPS), parental education, or CNI group. Among the 17 children with prior FP healthcare contact, mean TFS was 74.3 (median 74, SD=12.8) and mean TPS was 6.12 (median 4, SD=6.2); 4 were above TFS threshold and 5 above TPS threshold.
**Clinical Implications:** This first Swedish BPFAS prevalence study since 1986 found that approximately 8–9% of children aged 10–36 months have FP warranting referral, comparable to rates in Greece (8.2%) and other Western countries. The significant increase at 36 months (15–16%) suggests that FP becomes more apparent as developmental expectations for independent feeding increase. The lack of association with socioeconomic factors or gender supports universal screening approaches. The authors recommend using BPFAS or shorter screening tools in child health services for early detection, noting that BPFAS may not fully capture the medical domain of the newer PFD consensus definition. Limitations include the untested Swedish BPFAS version, lower-than-expected participation (potentially due to COVID-19), and underrepresentation of the highest CNI quartile. Nevertheless, the study provides contemporary prevalence data to inform resource allocation and clinical pathways for FP and PFD in Swedish primary care.