A child presenting with fussy eating can be a source of stress, worry and frustration for parents. While it is a normal part of child development to display reluctance to accept new foods, the consequences of such behaviour may result in a lack of variety in the diet, lower intake of fruits and vegetables and poor nutrient intakes. If left unaddressed this may, although not in all cases, lead to poor growth and increased risk of under or overweight and subsequent adverse health outcomes.
As highlighted in a recent review, fussy eating is hard to define; at present there is no widely accepted definition and little consensus on the most appropriate method of assessment.1 Therefore, there is wide variation in reports on the prevalence across the globe, ranging from 5% to as many as 50% of young children being labelled as fussy eaters by their parents.1
In order to tackle the problem, it is useful to understand the underlying causes. A number of factors have been suggested to influence whether a child becomes picky with their food, which include genetics, personality traits and parental influences, as well as how and when the child was introduced to complementary foods, and whether or not they were exclusively breastfed. Ultimately, most cases are more about behavioural responses and associations made when learning to eat new foods, such as the parent-child interaction or the feeding situation, rather than an innate feature in the child. Research has shown that early and repeated exposure can help to increase familiarity, eradicate fear and facilitate the acceptance of new foods. Despite parents being reluctant to offer a rejected food more than once, studies have shown that some foods may need to be offered in excess of 10 times before being accepted.2
Food refusal can present in different ways and healthcare professionals need to be well equipped to offer advice, reassurance and effective solutions in response to any fussy eating behaviour. Understanding the family feeding environment, practices and mealtime interactions can help identify appropriate strategies that are specific to the child and their particular situation. This is a crucial time to shape flavour preferences and get young children used to eating a healthy, balanced diet containing a variety of foods. Laying the foundation for healthy eating during the preschool years is particularly important as later interventions appear to have minimal impact.3 Hence, healthcare professionals should support parents to adopt feeding styles that are conducive to establishing healthy food preferences during early life. For example, discouraging the use of restrictive or pressurised feeding methods and foods as a reward, and instead encouraging patience, family interaction and exposure to role modelling, whereby the child sees their parent or carer enjoying the foods themselves. Infant and young child feeding is complex but with the right support and guidance, it is possible to manage and resolve the issue of fussy eating and pave the way for good health in later childhood and beyond.
1. Taylor CM, Wernimont SM, Northstone K et al. Picky/fussy eating in children: Review of definitions, assessment, prevalence and dietary intakes. Appetite 2015;95:349-359.
2. Mennella JA, Trabulsi JC. Complementary Foods and Flavor Experiences: Setting the Foundation. Annals of Nutrition Metabolism 2012;60(Suppl 2):40-50.
3. Evans CE, Christian MS, Cleghorn CL et al. Systematic review and meta-analysis of school-based interventions to improve daily fruit and vegetable intake in children aged 5 to 12 y. The American Journal of Clinical Nutrition 2012;96(4): 889-901.
Carruth BR, Ziegler PJ, Gordon A et al. Prevalence of picky eaters among infants and toddlers and their caregivers’ decisions about offering a new food. Journal of the American Dietetic Association 2004;104:s57-64.
Ayela Spiro, Helena Gibson-Moore and Sarah Coe are all nutrition scientists at The British Nutrition Foundation. All three work together to be expert bloggers in the Nursing in Practice nutrition resources centre. Individual descriptions are below:
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