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ARE YOU CONCERNED YOUR CHILD IS A PICKY EATER?
If you answered ‘yes’, you are not alone! Most parents are concerned about their child being a picky eater at some point in their childhood. Despite its prevalence, there is actually no formal definition for picky eating.
The most widely accepted definition of picky eating is children, ‘who consume an inadequate variety of foods through rejection of a substantial amount of food that are familiar (as well as unfamiliar) to them’ (1). This can look like food avoidance, longer feeding times, favoring preferred foods, and/or wanting food prepared or presented in a certain way.
Common Picky Eating Misconceptions
Picky eating can often be confused with food neophobia. While both are related, children can be picky eaters and have food neophobia at the same time, but they are generally regarded as different. Food neophobia is the rejection of or reluctance to try new or unfamiliar foods (3), or to put it simply, the fear of new foods.
This is a normal phase in a child’s development and usually happens between the ages of 2-5 (4). Food neophobia is thought to be a biological protective mechanism against children potentially ingesting something harmful. In most cases, children with food neophobia are still able to get the nutrients they need, but at times it can lead to more serious feeding disorders.
Most children experience food neophobia and it should not be confused with picky eating, which is a more significant concern.
Picky eating is also not the same as Avoidant Restrictive Food Intake Disorder (ARFID). ARFID is a type of eating disorder where there is a recurring inadequate nutritional intake. This disorder involves limited food intake and variety, often due to sensory sensitivities or other negative associations with eating or food, but it is not driven by a desire to lose weight (5). This is a recent diagnosis that is not fully understood, resulting in difficulty diagnosing and treating.
Similarly, Pediatric Feeding Disorder (PFD) is another relatively new feeding disorder, without an agreed upon definition. The most accepted definition comes from the World Health Organization: “PFD is impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction” (6). These are medical conditions that require the help of a multidisciplinary team of experts. More research needs to be done in these areas.
Reiterating here that it is normal for children to go through periods of food neophobia, however, picky eating and extreme picky eating behaviors and conditions like ARFID and PFD can lead to nutrient deficiencies and growth problems.
What causes picky eating in children?
There are a variety of causes of picky eating in children – some we can influence, and some we may have no control over. Due to the complexity of picky eating, it is likely not caused by just one factor – but a combination. It is important to remember all children are different and you might ‘do all the right things’ and still have a picky eater.
Babies are first exposed to different flavors in the womb. What a mother eats changes the taste of amniotic fluid. Some studies have found this can affect a child’s eating as they grow. Similarly, breast milk changes flavor based on what a mother eats, again exposing babies to different tastes (8). However, the research is conflicting on whether breastfeeding or formula feeding can influence picky eating. One study found that only breastfeeding for a short time was a predictor of picky eating while another study found no difference in breastfeeding or formula feeding as a cause of picky eating (2).
The age at which complementary foods are introduced and the type of foods provided affect the development of picky eating behaviors. There is a critical time around 6 months to start introducing foods when babies are more willing to try new things. Babies who were first introduced to foods after 10 months had less variety in their diet, particularly with fruits and vegetables, and had more problems feeding. Delayed introduction (after 9 months) of textured foods increased the likelihood of children becoming picky at 3 years old (8).
Parents can play a role in a child’s picky eating as well. Studies have shown that when caregivers are stressed about their child’s picky eating and pressure them to eat, it is more likely that the child’s picky eating will continue. Another study found parenting styles in regards to feeding can affect a child’s eating (8). Parenting styles that were too forceful – pressuring the child to eat, or too lenient, no structure around mealtime, and letting the child decide what foods are provided, all showed an increase in picky behaviors and a decrease in fruit and vegetable intake.
Very interestingly, picky eating does have a genetic component. There is a gene that determines a person’s sensitivity to tasting bitter vegetables. Individuals who are more sensitive to bitter taste are called ‘tasters’ and those less sensitive are ‘nontasters’. Studies comparing this found that nontasters consumed more bitter vegetables than tasters (10). Babies are born with a preference for sweet tastes because typically, sweet foods are more energy dense which is needed for growth. Due to this, it is common for children to prefer starches and fruits, and struggle with meats and vegetables (9). Research has also found food neophobia is inheritable, and picky eating that is linked to genetics is out of our control.
With all this information, you may be thinking… well what can be done to help my child’s eating?
Best Practices for Picky Eating
Understand the caregiver’s role in feeding
- Caregivers decide what food is offered: a wide variety of both preferred and nonpreferred foods.
- Caregivers decide where food is provided: sitting at the table in a child-friendly chair that provides optimal support. (Find my High Chair Positioning Guide here). Everyone eating the same meal together. Parents role model the foods they want their kids to consume.
- Caregivers decide when food is offered: ideally 3 meals a day with 2-3 snacks around the same time each day for children 12 months+.
- When a caregiver does these things, the child can decide what food is eaten, how much to eat, and if they are going to eat the food at all. This practice is called responsive feeding. You can find more information about this method endorsed by the American Academy of Pediatrics here.
Prepare foods in different ways
- Try fresh, canned, and frozen versions of vegetables!
- Try different cooking methods like steaming or roasting vegetables.
- Serve foods in different ways: serve eggs either scrambled, French-toast style, or hard-boiled. Serve sweet potatoes as sweet potato fries, mashed sweet potatoes, or sweet potato waffles! You never know which one will excite your kid.
- 101beforeOne has a cookbook full of child-friendly meals that can aid you in offering foods in a variety of different ways using different flavors and textures.
*Personal Note:
When offering my kids sandwiches like egg salad, tuna salad, or PB&J’s, sometimes just cutting the sandwich in a different shape (or using a cookie cutter) can be enough to help the food be more exciting to increase food acceptance.
Re-offer the food
- Research shows it can take 10-15 times of offering a certain food before a child might like it.
- Reintroducing foods helps make the food more familiar and less scary.
*Personal Note:
Children will go through periods where they love some foods and highly dislike some foods. If we stop offering the non-preferred foods, we may never give them the opportunity to re-like the food. My oldest child went three years without touching a bell pepper, then one day I had some pre-cut bell peppers on the table and asked if he wanted to have a “crunch” contest. Now he eats bell peppers again! I understand that exposure is tiring and we want to avoid food waste. Try only offering tiny portions to underwhelm the child and don’t pressure them to eat it. Just have it available to touch, feel, smell, and discuss.
Provide a ‘safe’ food
When providing a new food or a non-preferred food, offer it alongside a favorite food.
If the child has food they enjoy eating, it is more likely they will try the new or non-preferred food. This also helps reduce a child fully refusing a meal and reduce a parent’s fear the child will leave the meal hungry.
*Personal note: I know 100% that if I offer my kids a plate of all new or non-preferred foods, I most likely will get a negative response from them when they come to the table. Just by adding a preferred food to the plate can help prevent this and help your child feel excited to come to the table once they see their safe foods.
Messy play
Eating is a whole sensory experience. Children need to be able to explore foods through sight, smell, and touch. Research shows that babies who are able to explore the food with their hands and play with their food are more receptive to consuming that food later on and are less likely to develop texture aversions.
Source: De Cosmi V, Scaglioni S, Agostoni C. Early Taste Experiences and Later Food Choices. Nutrients. 2017 Feb 4;9(2):107. doi: 10.3390/nu9020107. PMID: 28165384; PMCID: PMC5331538.
The 101beforeOne App has a new section called T.A.S.T.E.R.S. that provides parents with the tools to help their children explore all the sensory aspects of eating.
Involvement
Get your child involved in grocery shopping and food preparation! Children are more likely to try new foods when they have helped make it!
- Have them wash fresh fruits and vegetables.
- Let them help pack their lunch or snack.
- Encourage them to pick out foods they want to try from a grocery store ad or choose a recipe they would like to try from a magazine.
Modeling
- Eat a wide variety of foods yourself – role modeling is a powerful tool to increase food acceptance!
- When possible, sit down and eat the same meal with your child.
Make Food Fun
- Cut foods into fun shapes.
- Use fun utensils and divided plates to encourage food exploration
- Make associations with new foods and items they are comfortable with, like broccoli trees, carrot pencils, or mashed potato mountains.
- Talk about the different characteristics of foods like color, shape, size, whether they think the food will be sweet or sour, crunchy or soft.
- Stack cucumbers into towers or put raspberries on your fingers as a finger “hat” – food activities are key!
Note: Picky eating usually resolves with implementing these practices or as the child gets older, but sometimes it doesn’t and requires additional support from feeding specialists.
When to seek help?
- If your child only eats a very limited amount of foods.
- If your child is extremely selective with foods based on color, texture, and taste.
- If your child is not eating whole food groups. For example: won’t eat any vegetables.
- If your child refuses to eat what is provided and demands only preferred foods.
- If your child is losing weight or you are concerned about their growth.
- If your child is routinely gagging on foods or having difficulty chewing.
- If your child is having physical symptoms like nausea or stomach pain.
- If your child persistently has a poor appetite.
- If your child has recurring disruptive mealtime behaviors like tantrums, hitting, and yelling.
There are also screening tools that can help assess if your child’s eating habits are considered normal. Here is a helpful questionnaire: https://www.feedingmatters.org/family-support-resources/
Takeaway
Food neophobia is common and normal among most children. The feeding approaches we use when we go through this normal development phase can help us move through this phase more easily to avoid our children developing more fussy eating habits that can lead to true picky eating. While it can be very stressful for parents – it doesn’t have to be.
Implementing a few fun strategies can help you move through the food neophobia phase and avoid more extreme picky eating behaviors. If food neophobia or picky eating persists or seems abnormal for the child’s age, help is available! Reach out to a pediatric dietitian or pediatrician with any feeding concerns.
References
1- Dovey TM, Staples PA, Gibson EL, Halford JC. Food neophobia and ‘picky/fussy’ eating in children: a review. Appetite. 2008 Mar-May;50(2-3):181-93. doi: 10.1016/j.appet.2007.09.009. Epub 2007 Sep 29. PMID: 17997196.
2- Taylor CM, Emmett PM. Picky eating in children: causes and consequences. Proc Nutr Soc. 2019 May;78(2):161-169. doi: 10.1017/S0029665118002586. Epub 2018 Nov 5. PMID: 30392488; PMCID: PMC6398579
3- Białek-Dratwa A, Szczepańska E, Szymańska D, Grajek M, Krupa-Kotara K, Kowalski O. Neophobia-A Natural Developmental Stage or Feeding Difficulties for Children? Nutrients. 2022 Apr 6;14(7):1521. doi: 10.3390/nu14071521. PMID: 35406134; PMCID: PMC9002550.
4- Torres TO, Gomes DR, Mattos MP. FACTORS ASSOCIATED WITH FOOD NEOPHOBIA IN CHILDREN: SYSTEMATIC REVIEW. Rev Paul Pediatr. 2020 Nov 6;39:e2020089. doi: 10.1590/1984-0462/2021/39/2020089. PMID: 33175005; PMCID: PMC7649857.
5- Fonseca NKO, Curtarelli VD, Bertoletti J, Azevedo K, Cardinal TM, Moreira JD, Antunes LC. Avoidant restrictive food intake disorder: recent advances in neurobiology and treatment. J Eat Disord. 2024 Jun 7;12(1):74. doi: 10.1186/s40337-024-01021-z. PMID: 38849953; PMCID: PMC11157884.
6- Goday PS, Huh SY, Silverman A, Lukens CT, Dodrill P, Cohen SS, Delaney AL, Feuling MB, Noel RJ, Gisel E, Kenzer A, Kessler DB, Kraus de Camargo O, Browne J, Phalen JA. Pediatric Feeding Disorder: Consensus Definition and Conceptual Framework. J Pediatr Gastroenterol Nutr. 2019 Jan;68(1):124-129. doi: 10.1097/MPG.0000000000002188. PMID: 30358739; PMCID: PMC6314510.
7- Mennella JA, Beauchamp GK. Flavor experiences during formula feeding are related to preferences during childhood. Early Hum Dev. 2002 Jul;68(2):71-82. doi: 10.1016/s0378-3782(02)00008-7. PMID: 12113993; PMCID: PMC2987582.
8- Patel MD, Donovan SM, Lee SY. Considering Nature and Nurture in the Etiology and Prevention of Picky Eating: A Narrative Review. Nutrients. 2020 Nov 6;12(11):3409. doi: 10.3390/nu12113409. PMID: 33171966; PMCID: PMC7694604.
9- Bell KI, Tepper BJ. Short-term vegetable intake by young children classified by 6-n-propylthoiuracil bitter-taste phenotype. Am J Clin Nutr. 2006 Jul;84(1):245-51. doi: 10.1093/ajcn/84.1.245. PMID: 16825702.
10- Cooke LJ, Haworth CM, Wardle J. Genetic and environmental influences on children’s food neophobia. Am J Clin Nutr. 2007 Aug;86(2):428-33. doi: 10.1093/ajcn/86.2.428. PMID: 17684215.
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Cinthia Scott is a Registered Dietitian (RD) and International Board Certified Lactation Consultant (IBCLC) with over 7 years experience in the field of dietetics. Cinthia focuses on ensuring optimal nutrition in the first 1000 days of life to ensure optimal growth and development as well as set the stage for long-term health. Cindy is an author, starting solids expert, and advocate for caregivers receiving evidence based education and support surrounding breastfeeding and starting solids.
Cinthia is co-author of the 101beforeone Starting Solids Book, “101beforeone -baby-led feeding cookbook,” and is the founder and owner of The Baby Dietitian LLC which is her private practice built to provide virtual 1:1 services for caregivers surrounding infant nutrition, toddler nutrition, and breastfeeding support. Cinthia is also the creator of the Starting Solids 101 Program which provides caregivers 1:1 support from a Pediatric Dietitian on how to provide optimal nutrition from the start and create healthy eating habits that will last their whole lifetime. To work with Cinthia, you can access her services here.
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