Occupational Performance Coaching for parents of picky eaters: A mixed methods study.

BACKGROUND/AIM: Picky eating is a common childhood phenomenon that impacts many families' occupations surrounding mealtimes. Evidence of the effectiveness of Occupational Performance Coaching (OPC) for caregivers of children suggests it may represent a useful occupation-focused intervention for parents of picky eaters. Using an OPC-targeted intervention, this study aims to report preliminary effectiveness, explore the experience of parents' participation, and investigate factors that influence the OPC intervention. METHODS: This study used an explanatory mixed-method design. Parent participants (n = 8) were recruited via purposive sampling and engaged in three sessions of OPC delivered via an online platform between October and December 2022. Standardised assessments were completed before and after OPC and a qualitative semi-structured interview two weeks after the final OPC session. Variables were analysed descriptively, and independent t tests were performed to compare scores on each standardised assessment pre- and post-intervention. Pearson's correlation analyses were conducted to consider associations between resistance to change and the extent of change in each outcome measure. Reflexive thematic analysis was conducted on postintervention interview transcripts. CONSUMER AND COMMUNITY INVOLVEMENT: Consumer invovlement was limited to parents feedback on their experiences of the intervention. RESULTS: Improvements in occupational performance as measured by the COPM change score were statistically significant (p = <0.001). Child eating behaviours, as measured by the CEBQ Food Fussiness subscale change score (p = 0.01) and BPFAS change score (p = 0.02), demonstrated significant improvements. The extent to which parents viewed these behaviours as problematic as measured by the BPFAS problem change score, showed a significant reduction (p = <0.001). Three themes emerged from interviews with parents: small changes beyond nutrition, parents supported as the experts, and what parents value within an intervention. CONCLUSION: Targeted OPC intervention delivered online by an occupational therapist may be an effective intervention for parents of picky eaters. Future studies using randomised controls are required before OPC can be routinely recommended in a clinical setting for the management of picky eating in children.

Association of picky eating around age 4 with dietary intake and weight status in early adulthood: A 14-year follow-up based on the KOALA birth cohort study.

INTRODUCTION: A relatively common deviant type of eating behaviour among children is picky eating. Research on associations between picky eating and dietary patterns later in life is limited, and studies examining long-term effects on growth have yielded mixed results. The present study aimed to examine longitudinal associations of picky eating in early childhood with consumption of various foods, and weight status (body mass index, BMI) in young adulthood. METHODS: Data from the Dutch KOALA Birth Cohort was used. Picky eating was determined around age 4 (range 3-6 years) by a questionnaire completed by parents. At follow-up around children's age 18 (range 17-20 years), weekly food intake frequencies, weight and height were assessed with a questionnaire completed by the grown-up young adult children. In total, 814 participants were included. Multiple regression analyses were performed for food intake frequencies and weight status (BMI) with picky eating score as predictor, controlling for parental and child covariates. RESULTS: The mean picky eating score at age 4-5 was 2.24 (range 1-5). A 1-point higher picky eating score was associated with eating fruit 0.14 days less per week, raw vegetables 0.14 days less per week, cooked vegetables 0.21 days less per week, fish 0.07 days less per week and dairy products 0.23 days less per week (P-values all <0.05). Associations between picky eating and intake frequencies of meat, eggs, various snacks, sweet drinks, and weight status (BMI) were not significant. CONCLUSION: Picky eating in childhood is associated with lower intake frequencies of various healthy foods among young adults. It is therefore recommended to pay sufficient attention to picky eating in young children.

Effect of being a persistent picky eater on feeding difficulties in school-aged children.

Children who are picky eaters often develop feeding difficulties during preschool years. These difficulties may persist into adolescence in some children. The study aim was to examine feeding difficulties and maternal feeding strategies longitudinally from age 5.5-8.5 years in relation to persistent picky eating. Picky eating behaviour in children enrolled in the Avon Longitudinal Study of Parents and Children was assessed using questionnaires between 2 and 5.5 years of age. Feeding behaviours were evaluated using questionnaires between 5.5 and 8.5 years. Data were analysed using adjusted logistic regression models. Of the 7405 children with data on picky eating 1926 (26%) were classified as never picky eaters, 385 (5%) were non-persistent picky eaters and 564 (8%) were persistent picky eaters. At 5.5, 7 and 8.5 years both persistent picky eaters and non-persistent picky eaters were more likely than never picky eaters to indicate difficulties in eating what the mother wanted, deliberately eat insufficiently, refuse to eat what was on offer, be choosy, not over-eat, and be difficult to get into routine, but with the likelihood decreasing with age (e.g. in persistent picky eaters vs non-picky eaters: refused to eat offered food OR 44.2 (95% CI 29.1, 67.0) at 5.5 years, 15.5 (11.5, 20.8) at 7 years and 14.1 (10.7, 18.6) at 8.5 years). The families of children who are picky eaters at the time of entering the school system should be offered reassurance that the feeding difficulties are likely to slowly resolve over time.

'Fussy eating' and feeding dynamics: School children's perceptions, experiences, and strategies.

'Fussy eating' behaviours are associated with increased mealtime stress, fewer family meals, and are considered a barrier to improving children's diets. A better understanding of these behaviours is critical to enable families to have more nutritious and enjoyable meals. Children's perspectives have not been adequately reported due to parents being seen as sufficient proxies in the past, and ethical challenges associated with carrying out research with children. 'Fussy eating' research has shifted to a bi-directional relational model, calling for deeper insight into how children experience, and contribute to, feeding dynamics. This study aims to explore 1) how 'fussy eating' behaviours are perceived, experienced and managed by children and 2) how children experience feeding dynamics relating to these behaviours. Qualitative interviews were conducted using visual tools and vignettes. Participants included 16 children aged 7-10 years. Children did not have to be considered 'fussy eaters' to participate and represented a wide range of Food Fussiness scores on the Children's Eating Behaviour Questionnaire reported by parents. Thematic analysis generated three themes: 1) Paradoxical Perceptions: 'Normal', yet 'Bad' Behaviour; 2) Grappling with Internal Experience and External Expectations and 3) Navigating Food Refusal and Managing Dislikes. The conceptualisation of 'fussy eating' as 'bad' behaviour likely contributes to mealtimes stress. Children described tension between their internal experiences with food (sensory and emotional) and external expectations on their eating. Children are acutely aware of their parents' goals, emotions and practices at mealtimes. In light of these parental expectations, children develop their own strategies for navigating food refusal, negotiating with parents and overcoming dislikes. This study highlights the need to listen to children and work with them to develop meaningful, relevant and effective eating interventions.

Associations between childhood autistic traits and adolescent eating disorder behaviours are partially mediated by fussy eating.

OBJECTIVE: Previous literature shows an increased risk for eating disorders in autistic individuals. This study tested whether fussy eating contributes to the association between childhood autistic traits and adolescent eating disorder behaviours. METHOD: Using data from the Avon Longitudinal Study of Parents and Children, we estimated the intercept and slope of parent-rated autistic traits and fussy eating between 7 and 14 years (N = 8982) and their association with self-reported eating disorder behaviours at age 14 years, including the indirect path from autistic traits to eating disorder behaviours via fussy eating. Analyses were adjusted for child sex, maternal age at delivery, maternal body mass index and maternal education. RESULTS: Analyses found a small indirect pathway from autistic traits intercept to eating disorder behaviours via fussy eating slope (b = 0.017, 95% CI = 0.002-0.032, p = 0.026), with higher levels of autistic traits at age 7 years being associated with a shallower decline in fussy eating, which in turn was associated with greater eating disorder behaviours. CONCLUSION: Findings point towards fussy eating as a potential link between childhood autistic traits and later disordered eating. Addressing fussy eating patterns before they become entrenched may decrease risk for eating disorders later in development.

Taste education - A food-based intervention in a school setting, focusing on children with and without neurodevelopmental disorders and their families. A randomized controlled trial.

Children with neurodevelopmental disorders (ND) such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactive Disorder (ADHD) have high levels of fussy eating. However, no school-based food interventions exist for children with ASD and ADHD. To investigate the effect of Taste Education, 81 children with ND (n = 33), and without (n = 48), aged 8-12 years, and their parents, participated in a 7-week food intervention. Children were matched on age, ND, and sex, and randomized into Immediate-intervention and Delayed-intervention groups. Parents completed the Children's Eating Behaviour Questionnaire (CEBQ), and a food-variety questionnaire. After adjusting for baseline measures, repeated-measures analysis-of-variance with time-points, and condition as factors (Immediate intervention and Delayed intervention) were used to examine changes in CEBQ-scores, with a robust linear mixed-model fitted. Changes in percentage of accepted foods were tested using a logistic-regression model adjusting for baseline acceptance. Results showed superior results for Intervention compared to waiting, on Food fussiness, but not Enjoyment of food, with stable effects through six-months follow-up. There were non-significant differences between children with and without ND. Results also showed increased odds of accepting vegetables by a factor of 1.6 (95% Confidence Interval [CI]: 1.33-1.93, p < .001); nuts and seeds by a factor of 1.4 (95% CI: 1.27-1.6, p < .001), but no significant association for fruit (OR 1.12, 95% CI: 0.92-1.34, p = .244). Trends were similar for children regardless of ND-status. The Taste Education program, shows promise, as a simple, non-invasive way to decrease fussy eating and increase food variety in the long-term.

An investigation of the relationship between the eating behaviours of children with typical development and autism spectrum disorders and parent attitudes during mealtime eating behaviours and parent attitudes during mealtime.

BACKGROUND: Nutrition has significant importance in the course of growth and development in early childhood. Selective and fussy eating is prevalent among children with autism spectrum disorder and can have a profound impact on parents' mealtime actions. AIMS: The study aimed to investigate the relationship between parental mealtime actions and the eating behaviours of children aged 3-5 years with typical development (TD) and autism spectrum disorder (ASD). METHODS: A total of 180 parents of children between 3 and 5 years in Ankara participated in the study; 90 were parents of children with TD, and 90 were parents of children with ASD. We measured the variables using the Brief Assessment of Mealtime Behaviour in Children (BAMBIC), Children's Eating Behaviour Questionnaire (CEBQ), and Parent Mealtime Action Scale (PMAS). RESULTS: The results revealed that food refusal, disruptive behaviours, and limited variety in TD children were related to parental actions, such as the use of rewards. We also found a negative correlation between enjoyment of food and the use of rewards. Children with ASD displayed differences concerning food refusal, and their parents were found to prepare more special meals for them compared with children with TD. CONCLUSION: Despite differences, the eating behaviours of children with TD and ASD show similarities in some cases. If a child has a low interest in eating, then their parents tend to be more insistent, use more rewards, and offer special meals. On the contrary, a child's high interest in eating harms such parental behaviours. Because an acknowledgement that a relationship exists between the eating behaviours of children and parental actions would make intervening to shape parental attitudes easier, it is recommended that future studies should be carried out to respond to the eating problems of children by working with parents.

Fussy eating in toddlers: A content analysis of parents' online support seeking.

The development of healthy eating habits in childhood is essential to reducing later risk of obesity. However, many parents manage fussy eating in toddlerhood with ineffective feeding practices that limit children's dietary variety and reinforce obesogenic eating behaviours. Understanding parents' feeding concerns and support needs may assist in the development of feeding interventions designed to support parents' uptake of responsive feeding practices. A total of 130 original posts by parents of toddlers (12-36 months) were extracted from the online website Reddit's 'r/Toddlers' community discussion forum over a 12-month period. Qualitative content analysis was used to categorise the fussy eating topics that parents were most concerned about and the types of support they were seeking from online peers. The most frequently raised fussy eating concerns were refusal to eat foods offered, inadequate intake (quantity and quality), problematic mealtime behaviours and changes in eating patterns. Parents were primarily seeking practical support (69.2%) to manage emergent fussy eating behaviours. This consisted of requests for practical feeding advice and strategies or meal ideas. Nearly half of parents sought emotional support (47.7%) to normalise their child's eating behaviour and seek reassurance from people with lived experience. Informational support about feeding was sought to a lesser extent (16.2%). Fussy eating poses a barrier to children's dietary variety and establishing healthy eating habits. These results suggest parents require greater knowledge and skills on 'how to feed' children and support to manage feeding expectations. Health professionals and child feeding interventions should focus on providing parents with practical feeding strategies to manage fussy eating. Supporting parents to adopt and maintain responsive feeding practices is vital to developing healthy eating habits during toddlerhood that will continue throughout adulthood.

Childhood fussy/picky eating behaviours: a systematic review and synthesis of qualitative studies.

Fussy/picky eating behaviours are common across childhood. Recent reviews of the fussy eating literature focus on quantitative research and do not adequately account for families' subjective experiences, perceptions and practices. This review aims to synthesise the increasing volume of qualitative work on fussy eating. A systematic search of relevant databases was carried out. Studies were included if they were qualitative, published since 2008, with a primary focus on families' experiences, perceptions and practices regarding fussy eating, food neophobia, or food refusal in children (aged one to young adult). Studies with clinical samples, or relating to children under one year were excluded. Ten studies were eligible for this review and were synthesised using meta-ethnography (developed by Noblit and Hare). This review provides a comprehensive description and definition of fussy eating behaviours. A conceptual model of the family experience of fussy eating was developed, illustrating relationships between child characteristics (including fussy eating behaviours), parent feeding beliefs, parent feeding practices, mealtime emotions and parent awareness of food preference development. Our synthesis identified two ways in which fussy eating relates to mealtime emotions (directly and via parent feeding practices) and three distinct categories of parent beliefs that relate to fussy eating (self-efficacy, attributions and beliefs about hunger regulation). The model proposes pathways which could be explored further in future qualitative and quantitative studies, and suggests that parent beliefs, emotions, and awareness should be targeted alongside parent feeding practices to increase effectiveness of interventions. The majority of studies included in this review focus on pre-school children and all report the parent perspective. Further research is required to understand the child's perspective, and experiences of fussy eating in later childhood. PROSPERO Registration: CRD42017055943.

What children bring to the table: The association of temperament and child fussy eating with maternal and paternal mealtime structure.

Fussy eating is a nuanced, mealtime-specific behaviour associated with difficult temperament but has been rarely examined within the context of mealtime structure. The aim of this study was to a) examine associations between child temperament, and mothers' and fathers' structure-related feeding practices and b) explore whether these associations were mediated by child fussy eating. Cohabiting mother-father pairs (N = 205) of children aged between 2- to 5-years residing in a socioeconomically disadvantaged Australian city completed self-reported, validated measures of child temperament, food fussiness and structure-related feeding practices (structured meal timing, structured meal setting and family meal setting). Child temperament was associated with maternal and paternal structure-related feeding practices, such that more difficult temperament was associated with less mealtime structure. Mothers' perception of child food fussiness mediated the relationship between difficult temperament and increased provision of alternative meals to the child from the rest of the family. Additionally, mothers' and fathers' perception of child food fussiness mediated the relationship between difficult child temperament and lower frequency of sitting at a table together for family meals. Therefore, perceptions of child food fussiness may explain why mothers and fathers use less structure at mealtimes with children who have more difficult temperaments. These results suggests that similar intervention approaches can be used for both mothers and fathers from socioeconomically disadvantaged families to target fussy eating and structure the mealtime environment. Promoting mealtime structure to facilitate parents' appropriate responses to food refusal or difficult behaviour at mealtimes is indicated.

Fussy eating behaviours: Response patterns in families of school-aged children.

BACKGROUND: Fussy eating is the unwillingness to eat both familiar and novel foods. Childhood fussy eating can be a barrier to a healthful diet and is associated with mealtime stress and conflict. Research has primarily focused on parenting practices in response to fussy eating in pre-schoolers. Less is known about parenting practices and family processes such as setting goals and managing emotions in relation to fussy eating in older children. This research aims to explore how families respond to fussy eating behaviours in school-aged children and based on parents' retrospective accounts, to investigate how responses change over time. METHODS: 16 parents from 14 families of school-aged children (6-10 years) participated in semi-structured qualitative interviews. Interviews were analysed using inductive thematic analysis. RESULTS: Three family process themes were identified which explain how families respond to fussy eating behaviours: 1) Dynamic and Evolving Feeding Goals, 2) Managing Negative Emotions and 3) Parenting Practices: Figuring out What Works. Three distinct patterns were identified regarding how parent responses change over time: 1) Resistance-to-Acceptance Response, 2) Fluctuating Response and 3) Consistent Response. DISCUSSION: The family response to fussy eating behaviours is complex, dynamic and contextual. This has implications for the design and interpretation of quantitative studies, and for the development of guidelines and interventions.

A comparison of maternal feeding responses to child fussy eating in low-income food secure and food insecure households.

Children learn to like a wide variety of healthy foods through exposure in their early feeding environment. While some children may reject foods during this learning process, parents may perceive persistent refusal as 'fussy' or 'picky' eating. Low-income parents may provide fussy children with a narrow range of foods that they will like and accept to avoid food and economic waste; inadvertently limiting children's exposure to a variety of healthy foods. This 'risk aversion' to food rejection may be particularly salient in food insecure households where resources are further constrained. We aimed to examine if food insecurity modifies the relationship between child fussy eating and parents' food provision and feeding with respect to exposure to a variety of healthy foods. Australian mothers residing in a low-income community (N = 260) completed a cross-sectional survey on their preschool-aged child's 'food fussiness', household food insecurity and food exposure practices. Food exposure practices included the home availability of fruit and vegetables, and children's tasting of a variety of fruit and vegetables (food provision); and whether parents prepared alternative meals for their child (feeding). Mothers reporting food insecurity (11%) were less likely to have fruit frequently available in the home compared to mothers reporting food security. Food insecurity moderated the relationship between fussy eating and food exposure practices insofar that food secure mothers were more likely to prepare alternative meals for fussier children. Family resources and child fussy eating behaviours are identified as important contextual factors in food provision and feeding. Findings from the current study suggest that health professionals, researchers and policymakers tailor interventions to consider both the needs of families and child eating characteristics.

What's the fuss about? Parent presentations of fussy eating to a parenting support helpline.

OBJECTIVE: To characterise parent presentations of fussy eating and mealtime interactions at a point of crisis, through analyses of real-time recordings of calls to a parenting helpline. DESIGN: Qualitative analysis included an inductive thematic approach to examine clinical parent presentations of fussy eating and derive underlying themes relating to mealtime interactions. SETTING: Calls made to the Child Health Line regarding feeding concerns were recorded and transcribed verbatim. SUBJECTS: From a corpus of 723 calls made during a 4-week period in 2009, twelve were from parents of children aged 6-48 months. RESULTS: Parents of infants (≤12 months, n 6) presented feeding concerns as learning challenges in the process of transitioning from a milk-based to a solid-based diet, while parents of toddlers (13-48 months, n 6) presented emotional accounts of feeding as an intractable problem. Parents presented their child's eating behaviour as a battle (conflict), in which their children's agency over limited intake and variety of foods (child control) was constructed as 'bad' or 'wrong'. Escalating parent anxiety (parent concern) had evoked parent non-responsive feeding practices or provision of foods the child preferred. CONCLUSIONS: Real-time descriptions of young children's fussy eating at a time of crisis that initiated parents' call for help have captured the highly charged emotional underpinnings of mealtime interactions associated with fussy eating. Importantly, they show the child's emerging assertion of food autonomy can escalate parents' emotional distress that, in the short term, initiates non-responsive feeding practices. The current study identifies the importance of educational and emotional support for parents across the period of introducing solids.

Time to re-think picky eating?: a relational approach to understanding picky eating.

BACKGROUND: Estimates of picky eating are quite high among young children, with 14-50% of parents identifying their preschoolers as picky eaters. Dietary intake and preferences during the preschool years are characterized by slowing growth rates and children developing a sense of autonomy over their feeding and food selection. We argue that the current conceptualization of picky eating defines acts of resistance or expressions of preference (acts of autonomy) by a child as deviant behaviour. This conceptualization has guided research that uses a unidirectional, parent to child approach to understanding parent-child feeding interactions. OBJECTIVES: By reviewing the current feeding literature and drawing parallels from the rich body of child socialization literature, we argue that there is a need to both re-examine the concept and parent/clinician perspectives on picky eating. Thus, the objective of this paper is two-fold: 1) We argue for a reconceptualization of picky eating whereby child agency is considered in terms of eating preferences rather than categorized as compliant or non-compliant behaviour, and 2) We advocate the use of bi-directional relational models of causality and appropriate methodology to understanding the parent-child feeding relationship. DISCUSSION: Researchers are often interested in understanding how members in the parent-child dyad affect one another. Although many tend to focus on the parent to child direction of these associations, findings from child socialization research suggest that influence is bidirectional and non-linear such that parents influence the actions and cognitions of children and children influence the actions and cognitions of parents. Bi-directional models of causality are needed to correctly understand parent-child feeding interactions. CONCLUSIONS: A reconceptualization of picky eating may elucidate the influence that parental feeding practices and child eating habits have on each other. This may allow health professionals to more effectively support parents in developing healthy eating habits among children, reducing both stress around mealtimes and concerns of picky eating.

Perceived fussy eating in Australian children at 14 months of age and subsequent use of maternal feeding practices at 2 years.

BACKGROUND: Concerns about fussy eating are common amongst parents of young children. However, studies of the long-term impact of fussy eating show mixed results with regard to adequacy of dietary intake and child growth. This may be in part because there is no accepted definition of fussy eating and studies measure the construct in different ways, commonly relying on parent perception. This longitudinal analysis explores maternal and child characteristics associated with maternal perception of her toddler as a fussy eater in early toddlerhood and subsequent use of feeding practices at 2 years. METHODS: Mothers completed a self-administered questionnaire at child age 14 months, describing perception of their child as fussy/not fussy and child behaviour. Intake was assessed using a single 24-h recall and weight was measured by research staff. At child age 2 years mothers completed the validated 28-item Feeding Practices and Structure Questionnaire (FPSQ-28). Weight-for-age z-score (WAZ) was derived from WHO standards. Gram daily intake of fruit, vegetables and meat/alternative and a dietary diversity score were determined. Maternal/child characteristics independently associated (p ≤ 0.05) with perception of child as a fussy eater were determined using logistic regression. Variables were combined in a structural equation model assessing the longitudinal relationship between child/maternal characteristics, perception of child as a fussy eater and eight FPSQ factors. RESULTS: Mothers' (n = 330) perception of her child as a fussy eater at age 14 months, was associated with higher frequency of food refusal and lower WAZ (R 2 = 0.41) but not dietary intake. Maternal perception as fussy (age 14 months) was associated with four FPSQ factors at 2 years (n = 279) - Reward for Eating, Reward for Behaviour, Persuasive Feeding and Overt Restriction, x 2 /df = 1.42, TLI = 0.95, CFI = 0.95, RMSEA = 0.04(0.03-0.05), PCLOSE = 0.99. CONCLUSIONS: Lower relative child weight and food refusal prompted mothers to perceive their child as fussy. These behaviours in healthy weight children most likely reflect self-regulation of energy intake and neophobia. This perception was prospectively associated with use of non-responsive feeding practices, which may increase obesity risk. Future interventions could directly address perceptions of growth and fussiness, supporting parents to understand food refusal as developmentally appropriate behaviour in healthy young children. TRIAL REGISTRATION: ACTRN12608000056392 . Registered 29 January 2008.

Cows' milk exclusion diet during infancy: Is there a long-term effect on children's eating behaviour and food preferences?

BACKGROUND: Dietary restriction during infancy may influence later eating behaviour. The aim of this study was to determine whether consuming a cows' milk exclusion (CME) diet during infancy affects eating habits in later childhood, once cows' milk has been reintroduced into the diet. METHODS: Children were recruited from two large birth cohort studies in the UK. A small number of participants were recruited from allergy clinic. Two groups were recruited: an experimental group of children who had consumed a CME diet during infancy and a control group, who had consumed an unrestricted diet during infancy. Parents and children completed questionnaires regarding eating behaviour and food preferences. RESULTS: In total, 101 children of mean age 11.5 years were recruited (28 CME and 73 controls). The CME group scored significantly higher on 'slowness of eating' and on the combined 'avoidant eating behaviour' construct (p < 0.01). The number of foods avoided and symptoms was associated with higher levels of avoidant eating behaviour (p < 0.05). The CME group rated liking for several dairy foods (butter, cream, chocolate, full fat milk and ice cream) significantly lower than the control group (p < 0.05), although there were no significant differences seen for any other category of food. CONCLUSION: This study demonstrated that consuming a CME diet during infancy has persistent and long-term effects on eating habits and food preferences. To reduce future negative eating behaviours, children's exclusion diets need to be as varied as possible and reintroduction of cows' milk products closely monitored.

Food rejections in children: Cognitive and social/environmental factors involved in food neophobia and picky/fussy eating behavior.

Food neophobia and picky/fussy eating behavior are presented as the two main forms of children's food rejections which are responsible for a reduction of their dietary repertoire. We review the key factors, presented in the literature, that are involved in food rejections during childhood. We first consider a range of "cognitive factors", such as food perception, mental representations, categorization of food items, and emotions and feelings toward food. Next we focus on "social and environmental factors", as these might also significantly influence and modulate children's food rejections. We then summarize the findings to provide a comprehensive view of the factors involved in children's food rejections. Finally, we discuss the need for future studies on food rejections, regarding (i) the distinction between food neophobia and picky/fussy eating, and (ii) the potential link between food categorization abilities and children's food neophobia and pickiness.

Fussy eating and feeding difficulties in infants and toddlers consuming a cows' milk exclusion diet.

BACKGROUND: Cows' milk allergy (CMA) is the most common infant food allergy in the United Kingdom, requiring a strict exclusion diet. Feeding difficulties and fussy eating are also very common problems in young children and can negatively influence feeding and dietary intake in an infant with CMA. The aim of this study was to compare the levels of fussy eating and feeding difficulties in two groups of young children: a group consuming an exclusion diet for CMA and a control group of children consuming an unrestricted diet. METHOD: Participants were recruited from allergy and health visitor clinics on the Isle of Wight. Parents completed a number of questionnaires about their child's feeding behaviour. RESULTS: One hundred and twenty-six participants (mean age 13 months) were recruited. Participants consuming an exclusion diet for CMA had significantly higher scores for both fussy eating and feeding difficulties (p < 0.05), although overall both groups were within the normal range. A number of symptoms were found to be positively moderately correlated with higher feeding difficulty score (p < 0.05). A higher consumption of milk/milk substitute consumed per day was positively correlated to both feeding difficulties and fussy eating (p < 0.05). CONCLUSION: Participants consuming an exclusion diet for CMA have higher scores for feeding difficulties and fussy eating than those consuming an unrestricted diet; however, the majority of participants' scores were within the normal range and did not affect the growth.

Bits and pieces. Food texture influences food acceptance in young children.

BACKGROUND: Picky or fussy eating is common in early childhood and associated with a decreased preference for a variety of foods. The aim of the current study was to test experimentally which sensory food feature influences food acceptance, which, in turn is an indication for fussy eating, in young children (32 - 48 months). Another aim was to evaluate if the behavioural measurement of food acceptance is related to parental reports of their child's fussy eating behaviour, parental feeding styles and children's BMI. METHOD: In a repeated-measures-design, three sensory features were manipulated separately (i.e., colour, texture and taste) while keeping the other two features constant. The baseline measurement consisted of a well-liked yoghurt, which was presented before each manipulation variant. The number of spoons that children (N = 32) consumed from each variant were registered as behavioural indication for food acceptance. Parental reports of children's eating behaviour and parental feeding styles; and children's BMI were also measured. RESULTS: The manipulation of food texture caused a significant decrease in intake. Colour and taste manipulations of the yoghurt did not affect children's intake. Parental reports of children's fussy eating behaviour and parental feeding styles were not related to the behavioural observation of food acceptance. The behavioural measurement of food acceptance and parental accounts of fussy eating were not related to children's BMI. CONCLUSION: Food texture but not taste or colour alternations affected food acceptance, at least when consuming variations of a well-liked yoghurt. This knowledge is important for further research on picky-eating interventions. Parental reports of fussy eating did not concur with the behavioural observation of food acceptance. Further research is warranted to test whether these findings generalize to other food types.

Picky/fussy eating in children: Review of definitions, assessment, prevalence and dietary intakes.

Picky eating (also known as fussy, faddy or choosy eating) is usually classified as part of a spectrum of feeding difficulties. It is characterised by an unwillingness to eat familiar foods or to try new foods, as well as strong food preferences. The consequences may include poor dietary variety during early childhood. This, in turn, can lead to concern about the nutrient composition of the diet and thus possible adverse health-related outcomes. There is no single widely accepted definition of picky eating, and therefore there is little consensus on an appropriate assessment measure and a wide range of estimates of prevalence. In this review we first examine common definitions of picky eating used in research studies, and identify the methods that have been used to assess picky eating. These methods include the use of subscales in validated questionnaires, such as the Children's Eating Behaviour Questionnaire and the Child Feeding Questionnaire as well as study-specific question(s). Second, we review data on the prevalence of picky eating in published studies. For comparison we present prevalence data from the UK Avon Longitudinal Study of Parents and Children (ALSPAC) in children at four time points (24, 38, 54 and 65 months of age) using a study-specific question. Finally, published data on the effects of picky eating on dietary intakes (both variety and nutrient composition) are reviewed, and the need for more health-related data and longitudinal data is discussed.