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Prevalence of picky eaters among,Infants and toddlers and their caregivers' decisions about offering a new food
Abstract
To determine the prevalence of infants and toddlers who were considered picky eaters, the predictors of picky eater status and its association with energy and nutrient intakes, food group use, and the number of times that caregivers offered a new food before deciding their child disliked it.
Cross-sectional survey of households with infants and toddlers (ages four to 24 months) was conducted.
National random sample of 3,022 infants and toddlers.
Data included caregiver's socioeconomic and demographic information, infants' and toddlers' food intake (24-hour recall), ethnicity, and caregivers' reports of specified times that new foods were offered before deciding the child disliked it.
For picky and nonpicky eaters, t tests were used to determine significant mean differences in energy and nutrient intakes. Logistic regression was used to predict picky eater status, and chi(2) tests were used for differences in the specified number of times that new foods were offered.
The percentage of children identified as picky eaters by their caregivers increased from 19% to 50% from four to 24 months. Picky eaters were reported at all ages for both sexes, all ethnicities, and all ranges of household incomes. On a day, both picky and nonpicky eaters met or exceeded current age-appropriate energy and dietary recommendations. Older children were more likely to be picky. Those in the higher weight-for-age percentiles were less likely to be picky. The highest number of times that caregivers offered a new food before deciding the child disliked it was three to five.
Dietetics professionals need to be aware that caregivers who perceive their child as a picky eater are evident across gender, ethnicity, and household incomes. When offering a new food, mothers need to provide many more repeated exposures (eg, eight to 15 times) to enhance acceptance of that food than they currently do.
... From the post-weaning period, children become more involved in food-decision making and exert greater selectivity in their consumption of foods (Addessi et al., 2005;Cashdan, 1994;Cooke et al., 2003). Witnessed in concomitance to this increased independence, is a greater level of food rejection in children (Carruth et al., 2004;Levene & Williams, 2017). The two correlated dispositions of food neophobia and food pickiness heavily account for food rejection tendencies in children between 2 and 7-years-old (Carruth et al., 2004;Levene & Williams, 2017). ...
... Witnessed in concomitance to this increased independence, is a greater level of food rejection in children (Carruth et al., 2004;Levene & Williams, 2017). The two correlated dispositions of food neophobia and food pickiness heavily account for food rejection tendencies in children between 2 and 7-years-old (Carruth et al., 2004;Levene & Williams, 2017). ...
... Intake of fruits and vegetables is alarmingly low in young children, and dietary variety is problematic in the early years (Carruth et al., 2004;Levene & Williams, 2017). Food neophobia and food pickiness are two of the greatest barriers to food acceptance and dietary variety, but the mechanism underpinning these dispositions remains elusive. ...
Insufficient dietary variety in children leads to significant nutrient deficiencies and health issues, both in childhood and later life (DeCosta et al., 2017). Cognitive mechanisms, such as categorization and conceptual knowledge, play an important role in understanding and appropriately accepting or rejecting foods (Mura Paroche et al., 2017). The food domain lends itself to many concepts and categories, such as taxonomic (i.e., lamb is meat), thematic (i.e., lamb goes on a plate), or script (i.e., lamb is eaten at dinner). Such knowledge aids accurate recognition, understanding, and appropriate interaction when confronted with foods situated in context. If conceptual knowledge is underdeveloped, the possibility to understand food and eating situations is mired. When faced with such uncertainty in the food domain, children with increased food rejection tendencies are likely to reject a substance, regardless of whether it is edible or not. It thus stands to reason that impoverished conceptual knowledge in the food domain will lead to increased displays of food rejection in children. Previous evidence demonstrated that food rejections (food neophobia and picky/fussy eating) are associated with impoverished knowledge of taxonomic categories in the food domain (such as the food groups: fruits or vegetables). However, young children have access to other forms of conceptual knowledge to help interpret situations and objects, such as script categories (i.e., breakfast foods) or thematic associates (i.e., soup and spoon). The overarching aim of my research, beginning in October 2018, was to expand upon these previous findings by determining whether food rejection is related to deficits in specific knowledge structures (script and thematic categories), or a global deficit in knowledge of food. The first step of the research required determining at what age children acquire certain types of knowledge and categories in the food domain. The second step was to determine how food rejection influences such knowledge acquisition. Four empirical studies were conducted over the past three years with children between 3 and 7 years old. My findings show that young children first master functional and co-occurring food relations (i.e., soup and spoon), and later master food scripts (i.e., food to expect at breakfast). This indicates that children as young as 3 and 4 years old may already rely on common cooccurrence to guide their food acceptance in eating situations, while older children may depend on script norms. As with taxonomic knowledge, children with poorer conceptual knowledge of both script and co-occurring relations in the food domain exhibit increased levels of food rejection. The research findings provide compelling evidence that educating children about conceptual knowledge and food norms could be an effective strategy for increasing familiarity and subsequently promoting greater food acceptance. The research concludes by suggesting opportunities for developmental psychologists and public health professionals to develop educational initiatives to improve children’s knowledge of food and foster increased dietary variety.
... Food neophobia refers to the reluctance to eat or even try foods that appear novel (Pliner & Hobden, 1992). Most researchers agree that food neophobia peaks between 2 and 6 years of age (Carruth et al., 2004;Cashdan, 1994;Dovey et al., 2008;Dubois et al., 2007;Lafraire et al., 2016a;Mascola et al., 2010). Before the neophobic onset, children are very willing to accept foods, even new ones, especially from caregivers. ...
... Cooke, 2007;Wardle et al., 2003). This is a number greater than most parents are willing to provide (Carruth et al., 2004). ...
... Further analysis of this data revealed that childhood severe food rejection was associated with increased risk for anorexia nervosa compared to less severe and more transient food rejection (Herle et al., 2019). On the other hand, it has been argued that since food rejection significantly reduces the consumption of fruits and vegetables, food neophobia and pickiness may, instead, lead children to restrict themselves largely to palatable, energy-dense, high-fat, high-sugar foods, which in turn could put children at risk for excess weight gain (Carruth et al., 2004). Recent evidence from Finnish (Knaapila et al., 2015) and Italian (Proserpio et al., 2018) adults populations suggests that participants suffering from obesity were significantly more neophobic (food neophobia was measured using the Food Neophobia Scale, Pliner & Hobden, 1992) compared to a healthy control group. ...
Food neophobia and pickiness are two strong psychological obstacles to young children’s consumption of fruits and vegetables, which are necessary components of a diet that facilitates normal and healthy development. It is therefore of critical importance to investigate the cognitive underpinnings of these two kinds of food rejection to promote the adoption of healthy eating behaviors. Food acceptance and rejection appear to be partly conditioned by children’s knowledge of the food domain. Knowledge allows children to recognize a given food, categorize it, and make inference-based decisions on its properties and possible consequences of consumption. Underdeveloped knowledge may cause food stimuli or situations to appear uncertain. Uncertainty will increase the likelihood of food being rejected, regardless if it is edible or previously accepted under another method of preparation. To tackle food rejection, interventions had, thus, aimed to increase children’s familiarity and knowledge through educational-based programs or repeated exposures to target foods.However, despite overall successes, such interventions had limited benefits for highly neophobic and picky children. High levels of food rejection have been associated with strong emotional and physiological responses, similar to reactions found in phobias. This fear may inhibit children’s learning ability. Consequently, neophobic and picky children may be unable to develop their knowledge of the food domain. Previous evidence, indeed, demonstrated that children’s food rejection was inversely related to their knowledge of food categories.In this context, the first objective of the present thesis was to investigate the twofold driver of food rejection: the gaps in food knowledge and the fear-conditioned withdrawal strategies in uncertain food situations. The food processing variable was also manipulated to test the hypothesis that children could rely on visual cues such as slicing to overcome their fear. The results revealed that food rejection was related to decreased categorization performance and heightened caution. Neophobic and picky children over-executed caution and, compared to their more neophilic and less picky counterparts, did not rely upon the variable of food processing as a safety cue. To develop the knowledge of children with high food rejection, it might be first necessary to overcome their fear of the learning situation.The second objective was to investigate whether executive functions (i.e., working memory, inhibition, and cognitive flexibility) were implicated in food rejection. Underdeveloped executive functions would explain neophobic and picky children’s difficulties to extract information from food-related learning opportunities, rigid behaviors toward dietary variety or meal preparations, and appropriate use of previous knowledge. This investigation revealed negative relations between food rejection and executive functions, more precisely decreased inhibition and cognitive flexibility in highly neophobic and picky children. Cognitive flexibility was also found to mediate the relationship between food rejection and categorization abilities. The results add to the body of evidence that executive functions play an important role in food-related behaviors.The thesis contributes to the understanding of the development of food rejection in young children and sheds light on different factors influencing children’s learning ability in the food domain. This contribution is valuable for our understanding of neophobic and picky children’s difficulties to learn and to act appropriately about foods and the development of interventions aiming at improving their eating habits.
... A seletividade alimentar infantil (SAI), consiste em uma complexa manifestação comportamental que se caracteriza pela recusa persistente de determinados alimentos ou grupos alimentares, limitando, assim, a diversidade e a qualidade nutricional da dieta da criança (Carruth, et al., 2004). O fenômeno tem sido objeto de estudos interdisciplinares, uma vez que sua etiologia abrange aspectos biológicos, psicológicos, sociais e culturais (Birch, 1998;Dovey, et al., 2008). ...
... . ResultadosA seletividade alimentar infantil é um fenômeno relevante que tem despertado considerável interesse na pesquisa científica devido às implicações diretas para a saúde, nutrição e crescimento das crianças. A SAI trata-se de uma manifestação comportamental identificada pela recusa persistente a determinados alimentos ou grupos de alimentos, impactando na oferta de nutrientes e no estado nutricional do público infantil(Carruth, et al., 2004).As causas associadas a SAI incluem fatores genéticos, predisposições sensoriais e preferências inatas por certos sabores e texturas. Além disso, fatores ambientais, como a exposição limitada a diferentes alimentos durante a primeira infância e a influência do ambiente familiar, também desempenham um papel importante na formação dos padrões seletivos de alimentação(Ramos & Coelho, 2017).Dentro dos fatores desencadeadores da SAI, encontra-se a introdução tardia de alimentos mastigáveis durante o processo de introdução alimentar(Emmett, et al., 2018;Taylor & Emmett, 2019). ...
Objetivo: O artigo teve como objetivo analisar as principais causas associadas a Seletividade Alimentar Infantil (SAI) e discutir as estratégias de conduta utilizadas para o controle do quadro. Materiais e Métodos: Para a elaboração dessa revisão integrativa, foram selecionados artigos científicos publicados em periódicos indexados em duas bases de dados: SciELO (Scientific Electronic Library Online) e portal BVS (Biblioteca Virtual em Saúde). As buscas foram realizadas a partir dos termos feeding difficulties, food selectivity e picky eaters, adjunto as palavras children e childhood, no idioma inglês; e dificuldades alimentares, seletividade alimentar, exigências alimentares, adjunto as palavras crianças e infância, para o idioma português; tendo como operadores booleanos AND e OR. Resultados: Os resultados mostraram que as causas associadas a SAI incluem fatores genéticos, predisposições sensoriais e preferências inatas por determinados sabores e texturas. Fatores ambientais, como a exposição limitada aos alimentos na primeira infância e hábitos familiares, se mostraram relevantes. Essa condição pode ser controlada através da associação entre estratégias nutricionais e comportamentais, pautadas na introdução gradual de novos alimentos e o envolvimento da criança no processo de seleção e preparo das refeições. Conclusão: A SAI é um fenômeno multifacetado, influenciado por fatores biológicos, socioeconômicos e culturais. Sua abordagem deve ser multimodal e pautada na participação do profissional nutricionista, com o incentivo ao consumo de alimentos saudáveis e ainda, educação parental.
... Fussy eating most commonly begins in early toddlerhood (12 to 24 months) and peaks in intensity in later toddlerhood (24 to 36 months) [21,22]. The evidence suggests that most toddlers described as 'fussy eaters' by their parents are likely exhibiting developmentally typical eating behaviours that are likely to resolve as children age [20]. ...
... The target behaviours were feeding practices identified in the literature as helpful versus problematic in the context of fussy eating. Responsive behaviours to promote included: repeated exposure (exposing children repeatedly to a wide variety of healthful foods, even those they have previously refused) [22,46,47], family meals [48], role modelling [49,50], and meal and snack routines [51,52]. Nonresponsive practices to discourage included pressure [11,53], catering (offering children alternative foods when initial foods are rejected or offering a limited number of foods per child's current taste preferences [7,8,11,51,54], and using food to reward eating or good behavior [7,11]. ...
Background
Fussy eating is most often a developmentally typical behaviour, generally presenting during toddlerhood. However, up to half of parents of young children are concerned about fussy eating, and this concern may mediate the use of nonresponsive feeding practises, such as coercive or unstructured feeding and using food to reward eating. Despite the high prevalence of parental concern for fussy eating and the negative impacts nonresponsive feeding practises have on children’s health and diets, no previous digital intervention to improve the feeding practises of parents of toddlers concerned about fussy eating has been evaluated.
Aim
This article describes the protocol of a randomised controlled feasibility pilot aiming to evaluate Fussy Eating Rescue, a purely web app based intervention for parents of toddlers. The primary aim is to investigate feasibility and acceptability; secondary aims are to explore indications of intervention effect on parents’ feeding practises or children’s eating behaviours.
Methods
Fussy Eating Rescue features include: (1) a Tracker, that allows parents to track repeated offers of food, (2) Topics, providing information on fussy eating, effective feeding strategies, and general nutrition, (3) Rescues, containing quick references to material supporting Topics contents, (4) Recipes, and (5) SMS notifications. Parents of toddlers (12–36 months old, n = 50) who have concerns about fussy eating will be recruited via Facebook. Parents will be randomised to an intervention group, which receives access to the app for 6 weeks, or to wait-listed control. Outcomes will be assessed at baseline and 6 weeks after app use, using online questionnaires and app usage statistics. Primary outcomes include participant retention rate, intervention engagement, app usability, perceived ease in using the app, perceived usefulness of the app, and user satisfaction. Secondary outcome measures include parents’ feeding practises and children’s eating behaviours.
Discussion
Results will inform whether Fussy Eating Rescue is a feasible way to engage parents concerned for their toddler’s fussy eating behaviours. If feasible and acceptable to users, a larger trial will further examine the efficacy of the Fussy Eating app in improving parents’ feeding practises and children’s eating behaviours.
Trial registration
Prospectively registered with the Australian New Zealand Clinical Trials Registry on 15 July, 2021 (ACTRN12621000925842).
... Potential underlying causes can relate to the child, parent/caregiver and child-parent interaction, including factors such as heredity, breastfeeding duration, parental psychopathology and parental feeding practices (Ammaniti et al., 2004;Lucarelli et al., 2018;. Estimates of prevalence of picky eating in early childhood range from 5.6% (Tharner et al., 2014) to 50% (Carruth et al., 2004), and this wide range is presumably due to differences in eating culture and differences in methods to assess picky eating (Taylor et al., 2015). ...
... Another strength is that picky eating was determined with three questions from a validated questionnaire (Birch et al., 2001), and a high internal consistency (α = 0.74). This differs from some other studies that used only one (for children validated) question (e.g., Carruth et al., 2004;Mascola et al., 2010). Furthermore, the analyses were adjusted for relevant covariates, which may confound the relationship between picky eating and dietary intake frequency. ...
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.
... Feeding problems (FPs) in children can be understood as a spectrum, ranging from mild, transient difficulties, via picky or selective eating to severe behavioral and/or medical feeding disorders (FDs), including tube feeding dependency (1)(2)(3)(4). The age period up until 2 years of age is critical in feeding development, and FP typically starts early, at 6 months to 4 years of age (2,(5)(6)(7). FPs are common, but a plethora of definitions and classifications complicates comparing prevalence numbers (2,8). ...
... In line with other studies (7,8,14), there was no significant differences regarding socioeconomic factors and FPs in the present study. This is important when allocating public resources. ...
Abstract
Objectives:
To describe the prevalence of feeding problems (FPs) in children aged 10, 18, and 36 months who visited Swedish Child Health Services.
Methods:
Parents of children attending regular 10-, 18-, and 36-month visits at the child health care centers (CHCCs) in Sweden answered a questionnaire including a Swedish version of the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) as well as demographic questions. CHCCs were stratified according to a sociodemographic index.
Results:
Parents of 238 girls (115) and boys (123) completed the questionnaire. Using international thresholds for FP detection, 8.4% of the children had a total frequency score (TFS) indicating FP. Based on the total problem score (TPS), the result was 9.3%. The mean score for all children was 62.7 for TFS (median 60; range 41–100), and 2.2 for TPS (median 0; range 0–22). Children aged 36 months had a significantly higher average TPS score than younger children, but TFS scores did not differ by age. There were no significant difference in gender, parents’ education, or sociodemographic index.
Conclusion:
Prevalence numbers found in this study are similar to those found in studies with BPFAS in other countries. Children 36 months of age had a significantly higher prevalence of FP than children aged 10 and 18 months. Young children with FP should be referred to health care specializing in FP and PFD. Creating awareness of FP and PFD in primary care facilities and child health services may facilitate early detection and intervention for children with FP.
... Escalating concern and anxiety at mealtimes evokes non-responsive or indulgent feeding practices, which do not improve children's acceptance of new or non-preferred foods [45]. Strategies which help a child try (and like) a variety of foods include serving a familiar and accepted food alongside a new or refused food, repeatedly offering foods, and having caregivers or others model enjoyment in eating the food [46][47][48][49][50][51]. As a child grows, food selectivity generally subsides. ...
Purpose of review
This review seeks to define caregiver practices that impact childhood eating behaviors and identify ways to utilize these relationships to prevent childhood obesity.
Recent Findings
Childhood obesity, which correlates with adult obesity and increased cardiovascular risk, is increasing in prevalence and severity. Caregivers play a significant role in shaping a child's eating behaviors and their predisposition to obesity. Maternal influences during pregnancy and infancy impact a child's future food preferences. Caregiver feeding styles (authoritarian, authoritative, indulgent, and uninvolved) are associated with distinct effects on children's eating behaviors and self-regulation. Authoritative feeding styles promote child autonomy while setting boundaries in the feeding environment. Early caregiver education and coaching regarding nutrition and feeding practices is beneficial to establishing healthy eating behaviors for children. Various caregivers, including parents, grandparents, siblings, teachers, and others, influence a child's eating habits at different stages of development. These caregivers can both positively and negatively impact a child's diet. Comprehensive interventions involving these various caregivers to promote healthy eating practices in children is ideal. Such interventions should be sensitive to cultural and environmental factors.
Summary
Childhood obesity is a complex issue with long-term health effects. Early intervention using comprehensive approaches including all caregivers, community support, and public policies to address the social determinants of health will be beneficial. Future research should focus on valid outcome measures and equitable interventions that encompass all aspects of a child's life.
... Factors affecting food neophobia include the food choices of parents and peers, hereditary factors, environment, sex, age, educational status, and place of residence [12][13][14][15]. Food neophobia is more prevalent among preschoolers and older people, while young individuals are more open to trying new foods [16,17]. Research suggests that there is a higher prevalence of food neophobia among males [18][19][20]. ...
Food neophobia, known as an avoidance of the consumption of unknown foods, can negatively impact nutritional quality. In orthorexia nervosa, there is an excessive mental effort to consume healthy food. Individuals exhibiting symptoms of food neophobia and orthorexia nervosa may experience food restrictions. This study aimed to assess food neophobia levels and orthorexia nervosa tendencies among university students, investigate the potential association between the two constructs, and explore the effect of the demographic characteristics of the participants on the variables. This is a descriptive cross-sectional study. The study sample consisted of 609 students enrolled at Recep Tayyip Erdoğan University. The data were collected through Google Forms using a sociodemographic information form, the Food Neophobia Scale, and the ORTO-11 scale. Ethics committee approval and institutional permission were obtained for the study. Of the students participating in the survey, 71.9% were female, 14.6% were classified as neophobic, and 47.1% had orthorexia nervosa symptoms. The mean scores from the Food Neophobia Scale (39.41 ± 9.23) and the ORTO-11 scale (27.43 ± 5.35) were in the normal range. Food neophobia was significantly higher among those who did not consume alcohol. Orthorexia nervosa symptoms were significantly more common among married people. In the correlation analysis, no significant relationship was found between age, food neophobia, and orthorexia nervosa. It can be said that food neophobia in this study is similar to in other studies conducted on university students. In addition, about half of the participants had symptoms of orthorexia nervosa. This result is higher compared to other studies conducted with university students. The findings of this study indicate that the participants care about the healthfulness of food.
... Some limitations of studies should also be taken into account. Some studies simply use a parental description of picky eating [35,36]. Despite variation on the definition of problematic eating behaviours, these include food refusal (of certain types of foods), food fussiness or pickiness (refusal of new and familiar foods, accepting only a narrow range of foods), refusal of new foods (neophobia), grumpiness during mealtime and inadequate self-feeding skills [36][37][38][39]. ...
Background
Parental complaints about feeding difficulties (FD) during childhood are frequent in pediatrics. Behavioral factors about children’s feeding and parental aspects are fundamental in solving these problems, but research in this area lacks information considering the joint presence of fathers and mothers. Thus, this study aimed to investigate the features of children, parents and mealtime practices related to FD reported by fathers and mothers and to identify parenting styles, mealtime actions, practices and factors associated with FD in children.
Methods
323 parents (226 mothers and 97 fathers) of children aged 1 to 7 years were recruited in the emergency waiting room at Sabará Hospital Infantil, in São Paulo, Brazil, and self-completed electronic questionnaires on parenting style (Caregiver’s Feeding Styles Questionnaire), parents’ mealtime actions (Parent Mealtime Action Scale), socioeconomic information, personal and children’s health data and routine meal practices.
Results
The prevalence of FD in children was 26.6%. Indulgent parenting style was the most frequent (44.2%), followed by authoritarian (25.1%), authoritative (23.8%), and uninvolved (6.9%) styles. Most parents (75.8%) reported presence during meals, and 83.6% used distractions. Regression analyses after adjustments showed, as factors associated with FD, female children (OR: 2.06; 95%CI: 1.19–3.58), parents’ FD history (OR: 3.16; 95%CI: 1.77–5.64), and greater frequency of parents’ behavior of offering many food options (OR: 2.69; 95%CI: 1.18–6.14). Parents with indulgent styles had decreased chances of reporting FD in their children (OR: 0.13; 95%CI: 0.06–0.27). Furthermore, the practice of children sharing the family menu (OR: 0.43; 95%CI: 0.18–0.99) and higher frequency of parents’ behavior of setting snack limits (OR: 0.44; 95%CI: 0.23–0.85) were inversely associated with FD.
Conclusions
This study reinforces the multifactorial aspects involved in the feeding difficulties context. It points out the importance of expanding knowledge of the individual role of fathers and mothers to compose a scenario that can guide future studies and interventions.
Trial registration
CAAE #99221318.1.0000.5567 with registration number 2,961,598.
... For example, 3 of the 6 apps that target nutrition and mealtime behaviors had predefined goal options on child consumption of specific healthy and unhealthy food options, such as increasing intake of vegetables, fruit, or water, and decreasing intake of junk food (eg, fast food and sugar-sweetened beverages). Promoting goals targeting these behaviors has the potential to positively influence child dietary patterns based on the existing scientific evidence related to these broad behaviors [23,[30][31][32][33][34][35]. Similarly, 4 apps offered predefined goal options for increasing physical activity (eg, general exercise, outdoor play, and practicing sports) and 2 apps included goal options for limiting screen time, reducing total screen time, and contingent access to electronic devices. ...
Background
Goal setting and tracking are well established behavior change techniques. Little is known about the extent to which commercially available mobile apps are designed to guide parents in using these strategies, their evidence base, and their quality.
Objective
This study aims to review commercially available apps that target parents in relation to setting and tracking behavioral goals for their children. The objectives were to classify the apps’ general characteristics, features, evidence base, and target behaviors and assess app quality overall and separately for apps that target health-related behaviors (HRBs) and apps without a health-related behavior (WHRB).
Methods
Apps were identified using keyword searches in the Apple App Store and Google Play in the United States. Apps were included if their primary purpose was to assist with setting goals, tracking goals, tracking behaviors, or giving feedback pertaining to goals for children by parents. App characteristics and common features were documented and summarized. Two reviewers assessed app quality using the Mobile App Rating Scale (MARS). Descriptive statistics summarized the MARS total score, 4 quality subscales, and 6 app-specific items that reflect the perceived impact of the app on goal setting and tracking, overall and with subgroup analysis for HRB and WHRB apps.
Results
Of the 21 apps identified, 16 (76%) met the review criteria. Overall, 9 apps defined and targeted the following HRBs: nutrition and mealtime (6/16, 38%), physical activity and screen time (5/16, 31%), sleep (7/16, 44%), and personal hygiene (6/16, 38%). Three apps targeted specific age groups (2 apps were for children aged 6-13 years and 1 app was for children aged ≥4 years). None of the apps provided tailored assessments or guidance for goal setting. None of the apps indicated that they were intended for the involvement of a health professional or had been tested for efficacy. The MARS total score indicated moderate app quality overall (mean 3.42, SD 0.49) and ranged from 2.5 to 4.2 out of 5 points. The Habitz app ranked highest on the MARS total score among HRB apps (score=4.2), whereas Thumsters ranked highest (score=3.9) among the WHRB apps. Subgroup analysis revealed a pattern of higher quality ratings in the HRB group than the WHRB group, including the mean MARS total score (mean 3.67, SD 0.34 vs mean 3.09, SD 0.46; P=.02); the engagement and information subscales; and the app-specific items about perceived impact on knowledge, attitudes, and behavior change.
Conclusions
Several high-quality commercially available apps target parents to facilitate goal setting and tracking for child behavior change related to both health and nonhealth behaviors. However, the apps lack evidence of efficacy. Future research should address this gap, particularly targeting parents of young children, and consider individually tailored guided goal setting and involvement of health professionals.
... Many parents are not aware of the prolonged process of food acceptance in children. In a study by Carruth et al. (2004) about 25% of the mothers reported offering a new food to their children once or twice and about half of the women offered a new food three-five times before they decided their children liked or disliked it. Home environment plays an important role in shaping children's eating habits. ...
Parents can use food (sweets, junk food) and drinks to calm the child when their children are crying, bored, etc. With this method, children are more sensitive to external stimuli and prefer unhealthy foods more. Therefore this study was performed to reveal the use of food to soothe preschoolers and feeding behaviors of mothers having children aged 3–6 years. The study had a qualitative design and was conducted in preschools a western city part of Turkey. The study sample included 25 mothers having children aged 3–6 years. Data were collected at four focus group interviews. Two themes were emerged from the data analysis; i.e. reasons why mothers offer food to soothe their children and feeding behaviors. The mothers use food to regulate feelings of their children. They face problems while feeding their children and utilize several strategies to solve them. Mothers should be provided with information about using methods other than food to soothe their children when they whine or cry and with support to develop coping strategies. Preschools should offer education about child nutrition, feeding behaviors of parents and overcoming problems with feeding to parents and family members.
... In contrast, appetitive traits in which the child eats a limited amount of food and/or is unwilling to try new foods are also relatively common [12]. Picky eaters typically show persistent food refusal resulting in a lower dietary diversity [13] and a lower intake of specific foods, such as vegetables [14,15]. These strong food preferences often lead parents to provide the child with different food options from those eaten by other family members [14]. ...
Purpose:Appetite can influence children’s dietary choices; however, this relationship in school-aged children is still unclear. We aimed to explore the prospective associations between child appetitive traits at age 7 and food consumption at 10 years of age.
Methods:
The study included 3860 children from the Generation XXI birth cohort, recruited in 2005/2006 in Porto, Portugal. The Children’s Eating Behaviour Questionnaire was used to evaluate children’s appetitive traits at 7 years. Food consumption was measured at 10 years through a validated Food Frequency Questionnaire. Logistic regression models were performed and adjusted for possible confounders.
Results:
Children with greater Enjoyment of Food at 7 years were 36% more likely to eat fruits ≥ 2 times/day and 54% more likely to eat vegetables > 2.5 times/day at 10 years compared to those with less frequent consumption. Children who ate more in response to negative emotions had higher odds of consuming energy-dense foods (OR = 1.33; 99% CI 1.13–1.58) and salty snacks (OR = 1.28; 99% CI 1.08–1.51) 3 years later. Those with less ability to adjust intake (higher Satiety Responsiveness) and more selective about foods (higher Food Fussiness) at 7 years were less likely to consume vegetables frequently, and were more likely to consume energy-dense foods and sugar-sweetened beverages.
Conclusions:
Children’s appetitive traits at 7 years were associated with the consumption of several food groups at 10 years of age. Eating more in response to negative emotions (Emotional Eating), with less ability to adjust intake (Satiety Responsiveness) and more food selectivity (Food Fussiness) were associated with worse dietary choices (in general, lower fruit and vegetables, and higher energy-dense foods and sugar-sweetened beverages consumption).
... Age was negatively associated with Appetite and Fear subscales but unexpectedly not with Picky Eating. Studies in picky eating trajectories indicated that picky eating is predominantly present in preschool children, and picky eating is usually a transient behaviour and part of normal development in preschool children (22)(23)(24). Prevalence of picky eating was highest at three years of age (27.6%) and lowest at six years of age (13.2%) in the population-based cohort (23). However, a prospective study reported that picky eating was often a chronic problem affecting 40% of children for more than two years (25). ...
Background and aims: The current study aimed to evaluate the psychometric properties of a Turkish version of The Nine Item Avoidant/Restrictive Food Intake Disorder Screen Parent Report (NIAS-PR), which measures the avoidant/restrictive food intake disorder (ARFID) symptoms by parents. NIAS-PR includes three subscales picky eating, poor appetite/limited interest in eating, and fear of aversive consequences from eating. Also, our secondary aim was to assess the relationship between ARFID-related eating behaviours and emotional-behavioural symptoms of children and parents' psychological status. Methods: The NIAS-PR was translated into Turkish with standard procedures. Two hundred sixty-eight children (133 girls, 49.6%; mean age 8.62, age range from 2 to 18 years) and parents (175 mothers, 65.2%) were included in the study. The factor structure was confirmed using confirmatory factor analysis (CFA). The results were compared to the validated Turkish Children’s Eating Behavior Questionnaire (CEBQ) to determine the convergent validity. Internal consistency (Cronbach alpha coefficient) analysis was used to determine the reliability of the NIAS-PR. Results: The current study provided evidence for the validity of the translated Turkish version of the NIAS-PR in the pediatric population. The three-factor structure of the NIAS—Picky eating, Appetite, and Fear—was replicated in the Turkish NIAS-PR. The NIAS-PR subscales showed the expected patterns of correlations with the CEBQ subscales. The reliability of the Turkish version of NIAS-PR proved to be satisfactory (total Cronbach's alpha=0.90) in the pediatric population (2-18 years). Conclusions: This study demonstrated a good internal consistency of the Turkish version of the NIAS-PR. We confirmed the three-factor structure of the Turkish version of NIAS-PR. NIAS-PR is a brief, reliable instrument for ARFID research in Turkish children and adolescents. The NIAS-PR is developed as a screening questionnaire, so health professionals should use it to investigate ARFID-related eating behaviours further. It is worth mentioning that deepening these eating symptoms with clinical interviews is necessary.
... The prevalence of picky-eating in children is observed to be highest during the age range of 2-5 years, when it ranges from 10 to 50% [7,[10][11][12][13] in different published studies, globally. Picky-eating is defined variably in literature [12]; however, it includes aspects like lack of dietary diversity [14][15][16], the eating of inadequate amounts of food, strong food likes and dislikes [7,10], neophobia [10], and difficult mealtimes [17], causing major concerns for parents. Reduction in food consumption and low variety in diet predispose these children to various nutritional deficiencies [13,18,19], lower weights [7,13,20] and heights [7,20], and lower IQs [21]. ...
Nutrient inadequacies among picky-eaters have adverse effects on growth and development. Oral nutritional supplements (ONS) along with dietary counseling (DC), rather than DC alone as reported in our earlier publication, promoted growth among picky-eating Indian children aged from >24 m to ≤48 m with weight-for-height percentiles lying between the 5th and 25th (based on WHO Growth Standards) over 90 days. This paper presents the contribution of ONS to nutrient adequacy, dietary diversity, and food consumption patterns in children (N = 321). Weight, height, and dietary intakes, using 24-h food recalls, were measured at baseline (Day 1) and at Days 7, 30, 60, and 90. Nutrient adequacy, dietary diversity score (DDS), and food intake adequacy were calculated in both the supplementation groups (ONS1 + DC and ONS2 + DC; n = 107 in each group) and the control group (DC-only; n = 107). Supplements increased nutrient adequacy in both of the ONS + DC groups relative to control (p < 0.05). The proportions of children with adequate nutrient intakes increased significantly at Day 90 in the supplemented groups as compared to in the control group (p < 0.05), especially for total fat, calcium, vitamin A, vitamin C, and thiamin. Although no significant differences were observed in DDS in any of the groups, the percentage of children consuming ≥4 food groups in a day had increased in all the groups. Consumption of fruit and vegetables and cereals had increased significantly from baseline to Day 90. ONS along with dietary counseling was found to have improved nutritional adequacy without interfering with the normal food consumption patterns of picky-eating children at nutritional risk.
... Many parents consider their children picky eaters (1). In one cohort study that included 4,018 children, the prevalence of picky eating was 26% at 1.5 years of age, 28% at age 3, and 13% at age 6 (2). ...
Background
Pediatric feeding disorders (PFDs) are common, and their great phenotypic variability reflects the breadth of the associated nosological profiles. PFDs should be assessed and managed by multidisciplinary teams. Our study aimed to describe clinical signs of feeding difficulties in a group of PFD patients assessed by such a team, and to compare them with children in a control group.
Methods
In this case-control study, case group patients 1 to 6 years old were consecutively recruited through the multidisciplinary unit for the treatment of pediatric feeding difficulties based at Robert Debré Teaching Hospital in Paris, France. Children with an encephalopathy, severe neurometabolic disorder, or genetic syndrome (suspected or confirmed) were excluded. Members of the control group, consisting of children with no feeding difficulties (i.e., Montreal Children's Hospital Feeding Scale scores below 60) or severe chronic diseases, were recruited from a day care center and 2 kindergartens. Data from medical histories and clinical examination related to mealtime practices, oral motor skills, neurodevelopment, sensory processing, and any functional gastrointestinal disorders (FGIDs) were recorded and compared between groups.
Results
In all, 244 PFD cases were compared with 109 controls (mean ages: cases, 3.42 [±1.47]; controls, 3.32 [±1.17]; P = 0.55). Use of distractions during meals was much more among PFD children (cases, 77.46%; controls, 5.5%; P < 0.001), as was conflict during meals. While the groups did not differ in their members’ hand-mouth coordination or ability to grab objects, cases began exploring their environments later; mouthing, especially, was less common in the case group (cases, n = 80 [32.92%]; controls, n = 102 [94.44%]; P < 0.001). FGIDs and signs of visual, olfactory, tactile, and oral hypersensitivity were significantly more frequent among cases.
Conclusion
Initial clinical assessments showed that, in the children with PFDs, normal stages of environmental exploration were altered, and that this was often associated with signs of sensory hypersensitivity and digestive discomfort.
... Repeated taste exposure is an effective approach to increase acceptance of vegetables into a child's diet. However, up to 10 to 15 taste exposures may be necessary for a food to be accepted (Birch et al., 1982;Wardle, Cooke, et al., 2003,b) and parents tend to offer their child a food only three to five times before giving up (Carruth et al., 2004). Therefore, alternative strategies are required to support parents in increasing children's vegetable intake. ...
Vegetable consumption in young children in the UK is well below the recommended five child-sized portions per day. Effective and practical strategies are therefore needed to encourage vegetable consumption in young children. In this exploratory study, we examine the effects of visual familiarization to foods via See & Eat ebooks, which show vegetables on their journey from ‘field to fork’. As part of a larger study, in which 242 British families completed a range of measures about their family's eating habits, child's food preferences and potential parent and child predictors of these (Masento et al., 2022), parents were invited to download a See & Eat ebook about a vegetable their child did not eat. Thirty-six families participated in the intervention, looking at the ebook with their child for two weeks and reporting on their child's willingness to taste, intake and liking of the vegetable targeted by the ebook and a matched control vegetable before and after the intervention period. Results showed significant increases in parental ratings of children's acceptance of the target vegetable. Willingness to taste and intake ratings improved for the target vegetable, but not the control vegetable, while liking was reported to increase for both vegetables. These results corroborate previous research demonstrating the benefits of familiarising children with vegetables before they are offered at mealtimes and suggest that ebooks can be added to the set of tools parents can use to support children's vegetable consumption.
... However, PE evaluation was used as a confounding factor or an outcome measure in eight of the eleven studies to assess the efficacy of the interventions. The instrument used for the assessment was the Child Eating Behavior Questionnaire (CEBQ) [31,37,39,41,42], the modified version of Carruth, et al. [46,51], the Lifestyle Behaviour Checklist (LBC) [39] and the Child Food Neophobia Scale (CFNS) [32,33,37,42], which were carried out by parents of the subjects. ...
Picky eating in children is often a major source of concern for many parents and caregivers. Picky eaters (PEs) consume limited foods, demonstrate food aversion, and have a limited food repertoire, which hinders their growth and health. These behaviours are common in children with special health care needs despite the rise in typically developing children. This leads to less attention being given to intervention programmes for typically developing children. Therefore, this scoping review aims to investigate the key concept of an existing intervention programme for PE among typically developing children, primarily on the types and approaches selected. A thorough literature search was conducted on three primary databases (PubMed, Emerald In-sight, and Web of Science) using predefined keywords. The literature was then appraised using the Joanna Briggs Institute’s guidelines and protocols, and the PRISMScR checklist. Inclusion and exclusion criteria were also specified in the screening procedure. Results showed that the majority of the interventions in these studies were single-component interventions, with the sensory approach being the type that was most frequently utilised, followed by the nutrition approach and parenting approach. Single and multiple intervention components improved the assessed outcome, with a note that other components may or may not show a similar outcome, as they were not assessed in the single-component intervention. Given the evidence that picky eating is influenced by various factors, a multi-component intervention can provide a substantial impact on future programmes. In addition, defining picky eaters using standardised tools is also essential for a more inclusive subject selection.
... obsesivo-compulsivos, trastorno por déficit atencional y otros 4,10-12 . Por su parte, un estudio transversal reporta que las dificultades en comer en cantidad o calidad que emergen con mayor frecuencia son las que ocurren en las transiciones alimentarias 13 , lo que instala la importancia de los aspectos ambientales cotidianos. ...
Objetivo:
determinar asociación entre las estrategias parentales utilizadas en la alimentación, con la conducta de rechazo a los alimentos en niños/as ARFID.
Pacientes y Método:
Investigación de corte transversal. Para la selección de los participantes se utilizó un muestreo no probabilístico. Participaron 24 padres/madres cuyos hijos habían sido diagnosticados con un ARFID. Se consideraron los subtipos de ARFID segun criterios del DSM-5: Apetito limitado, Ingesta selectiva y Miedo a la alimentación. Criterios de exclusión fueron ARFID de causa orgánica y/o trastornos generalizados del desarrollo. Para la recolección de datos se utilizaron el Child Eating Behaviors Questionnaire y el Child Feeding Questionnaire.
Resultados:
Se evidenció una asociación entre la estrategia alimentaria parental de presión para comer con la conducta de rechazo a los alimentos, y con conductas alimentarias infantiles de subalimen tación emocional (p = 0,046), lentitud para comer (p = 0,016), rechazo frente a los alimentos (p = 0,019) y respuesta de saciedad (p = 0,003).
Conclusión:
Las conductas alimentarias frecuentemente percibidas por los padres con hijos diagnosticados con ARFID se relacionan con la dimensión de enfoque negativo hacia la comida, como respuesta de saciedad, rechazo alimentario, lentitud para comer y subalimentación emocional.
... 8 Kwon et al, 2017, observou a prevalência de alguns comportamentos alimentares específicos para que uma criança seja diagnosticada com seletividade, entre eles se encontram um comportamento neofóbico, comer em quantidades pequenas, recuso em comer grupos alimentares ou texturas específicas, além de apresentar preferência por um método de preparo específico de um alimento. 5 Brazilian Journal of Health Review, Curitiba, v. 5, n. 6, p. 24188-24197, nov./dec., 2022 ...
O propósito desse estudo foi analisar os desafios familiares e nutricionais no desenvolvimento da seletividade alimentar em crianças. Através de estudo de caráter de revisão bibliográfica, por de artigos com crianças de até 5 anos, utilizando-se os termos, seletividade alimentar, características familiares e nutrição, nas plataformas do Scielo, LILACS e Google Acadêmico, dando-se preferência para estudos dos últimos 6 anos, entretanto não houve descarte de trabalhos mais antigos, dada a relevância do tema. RESULTADOS: No quadro clínico da SA (seletividade alimentar), nota-se uma primazia por alimentos de sabor suave e tonalidade clara, como batata, pães e biscoitos, a preferência por determinadas texturas também é comum, é possível verificar a escolha por determinadas temperaturas, podendo acontecer da criança não tolerar o cheiro de alimentos que não compõem a lista de preferências. Nota-se que em padrões nutricionais, existe uma inadequação principalmente de cálcio, ferro, cobre, vitamina E, vitamina D e zinco, além de uma discrepância em relação ao peso e estatura, se comparado com crianças saudáveis. CONCLUSÃO: A seletividade alimentar (SA), mostra-se complexa devido a relação entre aspectos familiares e contextos sociais, portanto, caso não haja um aconselhamento condizente, poderá levar a criança a prejuízos tanto orgânicos (comprometimento das funções do organismo), quanto sociais (afetando o convívio afetivo), ou até mesmo psicológico e o desenvolvimento de fobias.
... In line with the optimal-level of stimulation model, exposure during infancy increases the appeal of a novel food (Appleton et al., 2016;Birch, 1998;Birch et al., 1987;Carruth et al., 2004;Gerrish & Mennella, 2001;Maier et al., 2007;Maier-Nöth et al., 2016;Mennella et al., 2008) but excessive familiarity may lead to "monotony" (Rozin & Vollmecke, 1986;Wadhera & Capaldi-Phillips, 2014). Other studies comparing food complexity and hedonic responses found either a negative relationship, or were inconclusive (Palczak et al., 2019). ...
Phenomena such as engagement, attention and curiosity rely heavily on the “optimal-level of stimulation (or arousal)” model, which suggests they are driven by stimuli being neither too simple nor too complex. Two points often overlooked in psychology are that each stimulus is simultaneously processed with its context, and that a stimulus complexity is relative to an individual’s cognitive resources to process it. According to the “optimal-level of stimulation” model, while familiar contexts may decrease the overall stimulation and favour exploration of novelty, a novel context may increase the overall stimulation and favour preference for familiarity. In order to stay closer to their optimum when stimulation is getting too high or too low, individuals can explore other stimuli, adopt a different processing style or be creative. The need and the ability to adopt such strategies will depend upon the cognitive resources available, which can be affected by contextual stimulation and by other factors such as age, mood or arousability. Drawing on empirical research in cognitive and developmental psychology, we provide here an updated “optimal-level of stimulation” model, which is holistic and coherent with previous literature. Once taken into account the role of contextual stimulation as well as the diverse factors influencing internal cognitive resources, such model fits with and enriches other existing theories related to exploratory behaviors. By doing so, it provides a useful framework to investigate proximate explanations underlying learning and cognitive development, and to develop future interventions related, for example, to eating, and learning disorders.
... Around 50% of children show selective eating in early childhood, but many of them will outgrow this behaviour later in life. When food aversion is present, though, it can impact the child's growth and create conflict and anxiety regarding mealtimes [3,4]. ...
Food Aversion (FA) is a strong refusing behaviour to the oral assumption of food that can affect children with Short Bowel Syndrome (SBS). Management includes behavioural and Messy Play treatments, with few reports on systematic strategies to return the patient to enjoyable eating. We conducted a systematic review to better understand this complex and vital issue. (1) Materials and Methods: We investigated publications using MEDLINE, Embase, and the Web of Science to include articles published up to July 2022. The inclusion criteria were original articles including paediatric patients (aged < 18 years old) affected by SBS and Intestinal Failure (IF) who underwent treatment for FA. (2) Results: A total of 24 patients received treatment—15 (62.5%) patients were male and 9 (37.5%) were female. The age range was from 1 month to 16 years. Treatment of FA was carried out by behavioural therapy in 2 patients and Messy Play Therapy in 12 patients already surgically and pharmacologically managed for SBS. The treatment results showed complete weaning from Parenteral Nutrition in 9/14 cases (64%) using the behavioural treatment and 7/12 cases using Messy Play Therapy. (3) Conclusions: FA is a rare but disabling condition that often affects SBS patients, worsening their overall health and quality of life. This condition should be addressed in an Intestinal Rehabilitation Centre context. Our review sheds light on the literature gap regarding FA, and further studies are required to understand better which treatment options best suit SBS paediatric patients.
... Whilst this finding might indicate that fussy children are refusing to eat the vegetables offered to them, it might also indicate that parents of fussy children (or of children who are perceived to be fussy) are providing them with fewer vegetables at mealtimes; indeed both may be true. It is, of course, natural for parents to cease offering a food that their child has rejected several times previously (99). Many parents cannot afford food waste, while others may wish to avoid the mealtimes scenes that can occur when a disliked food is provided. ...
This paper compared the vegetable intake of preschool children from three European countries (Italy, Poland & UK) and explored the parent, child and environmental factors that predicted intake in each country. 408 parents of preschoolers (Italy: N = 61; Poland: N = 124; UK: N = 225; child mean age = 32.2 months, SD = 9.47) completed an online survey comprising a set of standardized questionnaires. In all three countries, questionnaires included measures of children’s vegetable intake (VegFFQ), child eating behaviour (CEBQ-FF), parents’ mealtime goals (FMG), and socio-demographic questions about the family background and environment. In the UK and Italy, additional questionnaires assessed child temperament (EAS-T) and parents’ feeding practices (CFPQ). Results showed that the number of child-sized portions of vegetables consumed per day varied significantly across countries; Polish children consumed the most (~3 portions) and Italian children the least (~1.5 portions). Between-country differences were seen in parents’ goals for family mealtimes; compared to Italian parents, Polish and UK parents were more motivated to minimize mealtime stress, increase family involvement in meal preparation and for family members to share the same foods. UK and Italian parents also adopted different feeding practices; parents in UK reported more use of healthy modeling behaviours and more use of foods to support their child’s emotion regulation. In terms of child factors, Italian children were reported to be more emotional and more sociable than UK children. Analyses of the relationships between the parent, child and environmental factors and children’s vegetable intake revealed both similarities and differences between countries. Negative predictors of vegetable intake included child food fussiness in UK and Poland, child temperament (especially, shyness) in Italy, and the use of food as a reward and child emotionality in UK. Positive predictors included the parental mealtime goal of ‘family involvement’ in UK. These results highlight differences in the extent to which European preschoolers achieve recommended levels of vegetable intake and in the factors that influence whether they do. The results suggest a need to develop healthy eating interventions that are adapted to meet the specific needs of the countries in which they are implemented.
... In terms of special meals, it is common that caregivers to stop reoffering a given food after only three to five failed attempts and begin to make special meals (45). Meals separate from the family often include palatable high-calorie foods which are more likely to be accepted. ...
Food avoidant behaviours are common concerns amongst individuals with Tourette syndrome, with high levels of food selectivity reported in children and food neophobia and avoidant restrictive eating behaviours in adults. However, less is known about food approach behaviours. The current study aimed to explore differences in food approach and food avoidant eating behaviours in children with Tourette syndrome (TS) and their relationship to caregiver mealtime actions. Thirty-seven caregivers of children with Tourette syndrome were compared with children with Autism Spectrum Disorders, children with Attention-Deficit/Hyperactivity Disorder and a control group. Caregivers completed the Child Eating Behaviour Questionnaire and Parent Mealtime Action Scale-Revised. Caregiver-reported findings revealed that children with Tourette syndrome exhibited more food approach behaviours, specifically greater food responsiveness, emotional overeating and desire to drink, compared to controls. Children from the three neurodiverse groups had similar levels of emotional overeating and food selectivity, which were all significantly higher than the control group. Positive persuasion was uniquely identified as a mealtime strategy adopted by caregivers of children with Tourette syndrome. The results suggest that children with Tourette syndrome are at more risk of showing a broader array of food difficulties than previously reported, including food avoidant and approach behaviours. It is encouraged that clinicians monitor eating behaviour in appointments with children with Tourette syndrome.
... The development of healthy dietary variety via repeated taste exposure may be weakened by individual child eating traits such as food 'neophobia' (suspicion of novel foods) and 'fussiness' (very selective eating), which affect many young children to varying degrees, especially between 2 and 5 years of age [27][28][29]. Many exposures may be needed to change preferences, and exposure effects may be specific to the target vegetable [30]. ...
Background
Many children would benefit from a diet richer in vegetables and fruit. ‘Flavour School’ is a programme of ‘sensory food education’, which aims to increase children’s confidence and curiosity in exploring foods and flavours, especially vegetables and fruit. This study will conduct a cluster-randomised controlled trial to assess the outcomes of the Flavour School programme in primary school children aged 4–7 years.
Methods
Four hundred plus children from 4+ schools will either complete the Flavour School programme (experimental group) or have no intervention with normal school teaching (control group), cluster-randomised within-schools, by school class. Baseline data collection will consist of video recorded behavioural observation during a tasting activity, and post-intervention data collection will repeat this activity after the experimental group have completed the intervention. Process measures will be assessed using a teacher engagement feedback questionnaire.
Discussion
This study will provide causal data on the efficacy of a sensory food education intervention for increasing children’s confidence and curiosity in exploring foods and flavours, especially vegetables and fruit. This new knowledge will help educators and policy makers to make evidence based decisions on uptake of sensory food education.
Trial registration
ISRCTN: 40249947 Date assigned 17 March 2020 Last edited 22 September 2021 Version 1.2
Trial Acronym OASES (Outcomes Assessment of Sensory Education in Schools)
... As dificuldades alimentares são um problema que tem se tornado comum nos ambientes familiares em todo o mundo, causando impacto negativo para a criança e para o relacionamento familiar, podendo ser a causa de conflitos frequentes nas relações (3) . Diferentes estudos mostram que 20% a 50% das crianças são exigentes ou seletivas para comer, de acordo com seus cuidadores (4) . ...
Purpose
To understand the training, knowledge, demand and clinical performance of speech-language pathologists on the subject of pediatric feeding disorders in the interior of Rio Grande do Sul.
Methods
cross-sectional study, descriptive of quantitative approach. The population of this study was composed of Speech-Language Pathology professionals working on health and education institutions in the 42 cities of Midwest macro-region of Rio Grande do Sul. The contact with the participants was obtained from a register made available by the Regional Health Coordinations of this macro-region. The data collection occurred through an online quiz made available on the Google Forms platform.
Results
the knowledge for working with the pediatric population with feeding disorder proved to be insufficient for proper handling of cases. The biggest doubts of speech-language pathologists are about the etiology and treatment of the disease, in addition to 74.1% of the participants reporting lack of confidence to assess and treat patients with this condition.
Conclusion
most of the speech-language pathologists of the Midwest macro-region of Rio Grande do Sul do not feel up to handle cases with pediatric feeding disorder and report little knowledge about the subject. Thus, the investment in continuing training is considered necessary, in order to improve the creation of common knowledge, providing scientific subsidies and technical elements for replication in their workplaces.
Keywords:
Eating behavior; Child; Speech-Language Pathology; Health Knowledge; Attitudes and Practice; Health education
... Feeding problems in children could be defined as the inability or refusal of children to eat certain foods [2,3]. Approximately 20-50% of normally developing children [4][5][6][7][8][9][10] and 70-89% of children with developmental disabilities, [11][12][13] are reported to experience some type of feeding problems. The consequences of an untreated feeding difficulty can include failure to thrive, nutritional deficiencies, impaired parent/child interactions and chronic aversion with socially stigmatizing mealtime behaviour [14]. ...
The objective of this study is to assess feeding problems among under-two children in Ibadan South West Local Government Area in Oyo state, Nigeria. Method: Two hundred and seventy mother-child pairs were recruited for the study from selected primary health-care centres in Ibadan South West local government Area. A semi-structured questionnaire was used to collect information on socioeconomic characteristics, feeding patterns and feeding behavior of children and mothers' perception and coping feeding behavior. Results: The mean age of the children surveyed was 11.03± 4.21months with 52.2% being males. The average age of mothers was 29 years (29.7 ± 5.77), 92% married, 54.1% had secondary education and 37.0% were traders. The most common feeding problems observed among the surveyed children were picky eating, food nephobia, intake of limited variety, food refusal, under-eating and over-eating. About 31.5% of the children had one or more feeding problems. Force-feeding and the use of rewards were the major coping strategies used by the mothers. Conclusion: There exists a spectrum of feeding problems among infant and children in this study population. There is a great need for early detection of feeding problems in children and provision of all round support to children with feeding problems and their mothers to be able to achieve success in feeding.
... The limited variety presentation can be initially mistaken for selective or 'picky' eating, which is common in early childhood [38,39]. Even where this selective eating reaches the threshold for ARFID diagnosis, individuals tend not to be underweight [13] but instead they may suffer from micronutrient malnutrition [15]. ...
Avoidant/restrictive food intake disorder (ARFID) was introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Unlike anorexia nervosa, ARFID is characterised by avoidant or restricted food intake that is not driven by weight or body shape-related concerns. As with other eating disorders, it is expected that ARFID will have a significant genetic risk component; however, sufficiently large-scale genetic investigations are yet to be performed in this group of patients. This narrative review considers the current literature on the diagnosis, presentation, and course of ARFID, including evidence for different presentations, and identifies fundamental questions about how ARFID might fit into the fluid landscape of other eating and mental disorders. In the absence of large ARFID GWAS, we consider genetic research on related conditions to point to possible features or mechanisms relevant to future ARFID investigations, and discuss the theoretical and clinical implications an ARFID GWAS. An argument for a collaborative approach to recruit ARFID participants for genome-wide association study is presented, as understanding the underlying genomic architecture of ARFID will be a key step in clarifying the biological mechanisms involved, and the development of interventions and treatments for this serious, and often debilitating disorder.
... Dubois found that picky eaters ate fewer calories and were twice as likely to be underweight than non-picky eaters. 2,3 A previous study of 135 children aged 5 years from the Stanford Infant Growth Study found that picky eaters consumed fewer calories than non-picky children and showed a less vigorous sucking style as an infant, suggesting that picky eating has trait-like characteristics. 4 Finally, a German study of 426 children 8 to 12 years of age found that picky eaters were more likely to exhibit behavioral problem behaviors than non-picky eaters. ...
Background: Picky eating is a relatively common problem during childhood. Picky eating may cause parents considerable concern leading to physician visits and may cause conflict between parents regarding handling of their child’s eating behavior. Objectives: The present study was conducted to compare the nutritional status and daily calorie consumption among children with and without picky-eating-behavior. Methods: The present study was conducted out in the Department of Paediatrics, Sir Salimullah Medical College and Mitford Hospital, Dhaka and private chambers of paediatrician, general physician from July 2013 to December 2013. The case was defined as a child who had anorexia or took one or two favorite foods as explained by the parents in an otherwise healthy child with picky eating disorder, while a control was defined as a child without having picky eating disorder. Results: Thirty percent of the parents of cases complained that their children were not growing well as opposed to only 4% of the control group (p<0.05). Complaint of abdominal pain was considerably higher in the former group than that in the latter group (p<0.05). The history of forceful feeding was present in 20% of the cases compared to none in the control (p>0.05). The mean 24 hours intake of calorie was lower in the cases than that in the control, but the difference did not reach the level of significance (p>0.05). In terms of nutritional status very few children (8%) with picky eating behavior were wasted (low weight-for-height) (p>0.05). However, 26% of the picky-eaters were underweight in terms of BMI compared to 7% of the controls, but the difference was not statistically significant (p>0.05). Conclusion: The study concluded that the children with picky-eating-behavior are almost similar to their control counterparts in terms of nutritional status (wasting, stunting and BMI) and calorie consumption. DS (Child) H J 2021; 37(1): 59-63
... The development of healthy dietary variety via repeated taste exposure may be weakened by individual child eating traits such as food 'neophobia' (suspicion of novel foods) and 'fussiness' (very selective eating), which affect many young children to varying degrees, especially between 2-5 years of age [27][28][29]. ...
Background: Many children would benefit from a diet richer in vegetables and fruit. ‘Flavour School’ is a programme of ‘sensory food education’, which aims to increase children’s confidence and curiosity in exploring foods and flavours, especially vegetables and fruit. This study will conduct a cluster-randomised controlled trial to assess the outcomes of the Flavour School programme in primary school children aged 4-7 years.
Methods: 400+ children from 4+ schools will either complete the Flavour School programme (experimental group) or have no intervention with normal school teaching (control group), cluster-randomised within-schools, by school class. Baseline data collection will consist of video recorded behavioural observation during a tasting activity, and post-intervention data collection will repeat this activity after the experimental group have completed the intervention. Process measures will be assessed using a teacher engagement feedback questionnaire.
Discussion: This study will provide causal data on the efficacy of a sensory food education intervention for increasing children’s confidence and curiosity in exploring foods and flavours, especially vegetables and fruit. This new knowledge will help educators and policy makers to make evidence based decisions on uptake of sensory food education.
Trial registration: ISRCTN: 40249947 Date assigned 17/03/2020 Last edited 22/09/2021 Version 1.2
Trial Acronym OASES (Outcomes Assessment of Sensory Education in Schools)
... This trait could indicate a lower intake of main meals and being fussy about eating certain food groups, such as meat, cheese [37], fruit and vegetables [38]. However, individuals may not be selective with regard to ultra-processed foods [39], sweets, sweetened beverages and desserts [40]. This behavior seems to measure a different food avoidant trait and it is important to mention that it is not protective against excessive weight gain in obesogenic food environments [19]. ...
The Adult Eating Behavior Questionnaire (AEBQ) is a tool developed in the UK, used in the investigation of appetitive traits in adults and adolescents, and later validated in a number of countries. To date, the validity of the AEBQ has not been tested on Portuguese-speaking popula-tions. The aim of this study was to validate the AEBQ in a sample of Portuguese adolescents. Participants were 4483 13-year-olds enrolled in the population-based cohort study Generation XXI. Appetitive traits were self-reported by adolescents through the AEBQ and parents also reported adolescent eating behaviors. Confirmatory and exploratory factor analyses were conducted. Construct validity was tested through correlations between AEBQ subscales and parent-reported eating behaviors, and linear regressions between AEBQ subscales and adolescent body mass index z-scores were performed. Adequate internal consistency and several associations with parent-reported eating behaviors and measured adolescent body mass index z-scores were found. This study supports the validity of a five-factor AEBQ (Food Responsiveness and Enjoyment of Food; Slowness in Eating; Food Fussiness; Emotional Over- and Undereating) to measure appetitive traits among Portuguese adolescents and provides a convenient and easy-to-use tool to be used in large-scale research.
... There is a growing awareness that picky eating can have psychological and physiological consequences for parents and their children. The literature on picky eating has focused upon incidence and prevalence (Carruth et al., 2004), and physiological correlates (Taylor et al., 2016), rather than psychological and social experiences. Although some studies have examined parenting picky eaters generally (Wolstenholme et al., 2020), there has been no research to examine the experience of having a child with sensory sensitivities and picky eating. ...
"Picky eating" is a common behaviour seen in childhood in both clinical and nonclinical populations. Sensory processing difficulties have been repeatedly associated with food refusal and picky eating behaviours. The aim of this study was to explore the lived experiences of parents/caregivers who have a child displaying both sensory processing differences and picky eating behaviours utilising Interpretative Phenomenological Analysis (IPA). Participants were recruited from social media support groups for parents of picky eating children. Pre-selection criteria utilised an adapted short sensory profile questionnaire to ensure the children displayed probable/definite taste-smell, audio-visual and tactile sensory sensitivities. Twelve participants fulfilling the required criteria were interviewed face to face utilising a semi-structured interview schedule. Interviews were transcribed and analysed following IPA guidelines and three common themes are presented here: Battling for control of the sensory environment, Living with stigma and, disapproval, and Staying positive and moving forward. The findings show the very considerable day-to-day challenges of parenting a child with sensory issues with food, including a lack of support and criticism from others. It was apparent that the parents in our study gradually adopted a positive and accepting attitude to their child's eating. This acceptance allowed them to have positive interactions around food with their child such as cooking and playing with food, suggesting that experiential activities serve an important purpose in this population. Further research should examine whether parental interventions based on acceptance of child eating behaviour, and commitment to gradual positive food interactions would be the best strategy to support parents and children.
... 4,10 A few studies have reported that children growing up in single-parent households may manifest problematic eating behaviors through emotional parenting, maladaptive feeding behaviors, and exposure to excessive stress. 4,8,11,12 However, there is limited evidence regarding the effect that siblings may have on shaping eating behaviors among children. 13 Some studies reported that having a greater number of siblings is associated with less pickiness among preschoolers and lower appetite restraint among school-age children. ...
Development of eating habits and patterns during childhood can have life-long effects on weight and health status. Family structure, functioning, and interactions during mealtimes may influence the development of eating behaviors among children. The objective of this study was to examine the association between sibship composition and child eating behaviors among preschoolers in Saudi Arabia. One hundred and fifteen mothers were recruited through various preschools around the city of Jeddah, Saudi Arabia. A previously validated Arabic version of the Children's Eating Behavior Questionnaire (CEBQ) was completed over the telephone along with questions assessing sibship composition and demographic characteristics. Spearman correlations and adjusted linear regression models were examined to assess the association between sibship composition and child eating behaviors. Adjusting for covariates, number of older siblings was positively associated with emotional over eating, food responsiveness, and the desire to drink. Number of older sisters was positively associated with the desire to drink but negatively associated with food fussiness. Having a greater number of older (rather than younger) siblings may be associated with food-approach eating behaviors. Having a greater number of older sisters may be associated with less food fussiness. Focusing on older siblings in encouraging healthy eating habits and appropriate food choices may be beneficial in promoting adaptive eating behaviors and prevention of excessive energy intake and weight gain. Future longitudinal and mixed-methods research studies with larger sample sizes are needed in order to better understand the underlying mechanisms for the associations between sibship composition and child eating behaviors.
Background:
Research on feeding in early childhood has focused primarily on parent-child dyadic interactions, despite parents enacting these practices within the complex dynamic of the family system.
Objective:
Using a sibling design, this study aimed to assess how parents may adapt their food parenting practices for siblings in response to differences in their eating behaviours.
Design:
A cross-sectional online survey was conducted between October and December 2022.
Participants/setting:
Data were collected from parents (97.5% females) in Australia with two children aged 2 to 5 years (n=336 parents, n=672 children).
Main outcome measures:
Survey items were completed for each sibling, and included four subscales of the Children's Eating Behaviour Questionnaire (CEBQ) and seven subscales of the Feeding Practices and Structure Questionnaire-28 (FPSQ-28).
Statistical analyses performed:
Multiple linear regression models examined associations between within-sibling pair differences in child eating behaviours and food parenting practices, adjusting for differences in child body mass index z-score (BMIz), age, gender, and early feeding method.
Results:
Within-sibling pair differences in eating behaviours were associated with differences in some food parenting practices. For the fussier sibling, parents reported using more control-based practices, including persuasive feeding, reward for eating, and reward for behaviour, and less of the structure-based practice, family meal settings (ps<0.001). Similar directions of associations were found for persuasive feeding, reward for eating, and family meal settings with siblings who were slower eaters or more satiety responsive (ps<0.007); however, no significant differences in reward for behaviour were observed in relation to sibling differences in these eating behaviours. For the more food responsive sibling, parents reported using more control-based practices, including reward for behaviour and overt restriction (ps<0.002).
Conclusions:
Within families, parents may adapt certain practices in response to differences in their children's eating behaviours. Interventions promoting responsive feeding should be designed to acknowledge the integral role of siblings in shaping parents' feeding decisions.
This study aimed to investigate the prevalence of childhood picky eating (PE) and to identify risk factors associated with different PE trajectories using data from the Growing up in Scotland research survey. PE was operationalised using three items across three study sweeps, at ages 2, 5 and 10 years respectively. We found 13.5 % of children with PE at age 2, 22.2 % at age 5, and 6.4 % at age 10. From these, we defined three PE categories: transient PE in early childhood (23.3 %), persistent PE into late childhood (3.7 %) and PE absent (73.0 %). Using multinomial logistic regression, we investigated associations between child and family characteristics and transient and persistent PE, adjusting for potential confounders. Various factors were associated with increased risk of persistent pickiness, including mothers who smoked during pregnancy and children whose mothers reported feeding challenges at 9-12 months. These findings support the view that PE behaviours are common and tend to remit by adolescence although a small number of children are at risk of experiencing longer term problems. Families of children who are exposed to such risks may benefit from preventative interventions.
Preference for vegetables is influenced by various factors, including demographic, psychological, socio-environmental, and genetic factors. This study confirmed that age, pickiness, and perceptual attributes were predictors of preference for vegetables and examined how preference for vegetables and their perceptual attributes varies with age and pickiness. Children (8-14 years, n = 420), youth (15-34 years, n = 569), middle-aged adults (35-64 years, n = 726), and older adults (65-85 years, n = 270) were asked which vegetables they liked (or disliked) and which perceptual attributes of each vegetable they liked (or disliked). On the basis of their responses, an overall preference score and a preference sub-score for each perceptual attribute were calculated. Participants in each age group were classified into four statuses (non-, mild, moderate, and severe) according to their pickiness scores. Multiple regression analysis revealed that age and preference sub-scores for eight perceptual attributes (sweetness, sourness, bitterness, umami, pungency, orthonasal aroma, texture, and appearance) were positive predictors of overall preference score and that pickiness score and four perceptual attributes (saltiness, astringency, retronasal aroma, and aftertaste) were negative predictors. In addition, overall preference score and preference sub-scores for perceptual attributes other than saltiness increased with increasing age group and decreasing picker status; however, preference sub-scores for at least one of the six perceptual attributes (bitterness, astringency, pungency, orthonasal aroma, retronasal aroma, and aftertaste) exhibited negative values in children, youth, and pickers (mild, moderate, and severe). The increase in preference for these perceptual attributes might be an indicator of the adultization of food perception and the expansion of food acceptance.
Parent feeding practices influence a child's dietary intake. Many studies examining how parents react to children's fussy eating behaviours have been limited to questionnaire measures, which assess a limited number of feeding practices. There is a lack of research exploring the range of strategies parents use when their child is being fussy and/or refusing to eat. Therefore, the aims of this study are to describe the strategies used by mothers when their child is being fussy or refusing to eat, and to assess differences in the strategies depending on the child's trait fussiness levels. In 2018, 1504 mothers of children aged 2-5 years completed an online survey. Trait fussiness was assessed using the Children's Eating Behaviour Questionnaire. Mothers were also asked the open-ended question "What are the strategies you use when your child is being fussy or refusing to eat?". Inductive thematic analysis was conducted using NVivo. Themes were compared by child trait fussiness levels. Seven main themes were identified: child-led feeding/trust in child's appetite, spectrum of pressure, home or family strategies, different types of food offerings, communication, avoid certain strategies, and never or rarely fussy. Mothers of children with severe trait fussiness levels reported more pressuring or persuasive strategies. This study provides novel information regarding the diverse range of feeding practices parents use in response to children's fussy eating behaviours. Mothers used more feeding strategies typically associated with unhealthy dietary intake for children of high levels of trait fussiness. It is important that future interventions tailor the information to provide support to parents of children with high levels of trait fussiness regarding the use of feeding practices recommended to support healthy dietary intake.
Background
Complementary foods are required to be given timeously, in adequate amounts, prepared safely and must be nutritious. Caregivers play a vital role in ensuring that the complementary feeding transition and beyond happens optimally to achieve normal growth and development in their children.
Objective
The aim was to explore what factors influenced the primary caregivers’ choices during the complementary feeding transition period.
Methods
A cross-sectional qualitative study was conducted using focus-group discussions and interviews with caregivers of children enrolled in the Optimal Child Growth and Development (OrCHID) study, which included participants from the Mother and Child in Environment (MACE) cohort and SONKE mother and child cohort.
Results
During the analysis of the focus-group discussions (FGDs) and interviews, nine themes were identified including: (i) starting complementary feeding; (ii) food choices; (iii) family meals; (iv) food preparation methods; (v) meal composition; (vi) texture; (vii) education source; (viii) food source; and (ix) nutrition knowledge. These themes and the key concepts associated with them were categorised into timing and transition, meal preparation, and knowledge and choices.
Conclusion
The caregivers relied largely on advice from family members who advised on their customs and cultural belief systems, which then impacted when the caregivers started complementary foods, food choices, texture, meal composition and transition to family meals. The caregivers sourced complementary foods based on accessibility, convenience and affordability. The caregivers described having a responsive feeding style, where their decisions were influenced by their sensitivity to how their child was responding emotionally and/or physically to the foods they were receiving.
Keywords
focus group discussion, complementary feeding practices, caregivers
Objectives
The prevalence of feeding disorders (FDs) and picky eating in children is high in our region, based on the parents’ perceptions. Although organic disease or a nutritional impact is rarely observed in these children, the problem frequently has an effect on family dynamics. We aimed to estimate the impact of these disorders on the stress level, quality of life and psychological health of families.
Methods
Study of cases (FDs) and controls (healthy controls and controls with digestive disorders or other illness). We assessed parental stress and the risk of psychological distress in these families using validated scales (Parent Stress Index Short Form [PSI-SF] and Goldberg's General Health Questionnaire [GHQ-28]) and a parental opinion survey.
Results
We collected a total of 238 surveys, 102 corresponding to healthy controls, 88 to controls with digestive disorders and 48 to children with FDs. We found that 45.8% of parents in the FD group felt neglected by their paediatricians and 47.9% did not agree with the paediatrician’s recommendations. In addition, 54.2% reported limitations to their social life, 25% problems in their relationship, 47.9% feeling judged by others (12.5% by their own partner) for how they managed mealtimes, and 37.5% having sought or considered seeking psychological support. All these problems were significantly more frequent compared to controls. Based on the GHQ-28, the risk of anxiety and depression was more frequent in parents in the FD group: 54.2% compared to the reference (adjusted odds ratio [aOR] compared to controls, 4.18; 95% confidence interval [CI], 1.96−8.87; OR compared to sick controls, 6.25; 95% CI, 2.79−13.98) and 33.3% compared to the healthy control group. They also had higher stress scores (PSI-SF) compared to the healthy control group (adjusted mean difference [AMD], 21; 95% CI, 12.19−29.81) and the sick control group (AMD, 20; 95% CI, 9.81−30.19).
Conclusions
Parents of children with FDs have a high level of stress and risk of anxiety and depression, with repercussions at the social, family, couple and work levels. The relationship with the paediatrician may also be affected.
Parents often have concerns regarding anorexia in their children and visiting medical institutions for the intervention of it. This study aimed to investigate the clinical practice patterns of Korean medicine doctors (KMDs) for anorexia in children using a web-based survey. A link to the questionnaire was sent via email to all KMDs that were affiliated with the Association of Korean Medicine. The questionnaire covered items on the sociodemographic characteristics and clinical characteristics related to Korean medicine (KM), such as diagnosis, treatment, awareness, safety, and effectiveness. Of 23,910 KMDs, 384 agreed to participate and complete the questionnaire. Anorexia in children was diagnosed mainly by clinical features (36.4%) and the pattern identification (PI) theory of ‘Qi, Blood, Fluid, Humor, and Organ system diagnoses’ (32.8%). The most frequently used PIs was ‘spleen-stomach qi deficiency’ (38.6%), which was followed by ‘spleen failure in transportation’ (23.3%), ‘stomach yin deficiency’ (15.5%), and ‘liver depression’ (14.2%). Herbal medicine (38.1%) was the primary KM treatment for anorexia, and the names of the most frequently prescribed herbal decoctions were Sogunjung-tang (16.5%), Hyangsayukgunja-tang (15.9%), and Bojungikgi-tang (13.9%). This study provides information on the existing clinical practice patterns of KMDs for anorexia in children. Based on this survey, the clinical practice guidelines will be developed.
Emotional child temperament has consistently been found to be related to food fussiness. One factor that may exacerbate or reduce the risk conferred by children's emotionality is parent feeding practices during mealtimes. Specifically, the use of controlling feeding practices aimed at increasing food consumption may particularly affect children with an emotional temperament. The primary aim of this study was to investigate whether the association between child food fussiness and higher emotionality found in previous studies is moderated by maternal use of controlling feeding practices, namely verbal pressure, physical prompts and food rewards. Sixty-seven mother-child dyads were video-recorded during a meal in their home and mothers' use of controlling feeding practices during this meal were coded. Mothers completed a questionnaire assessing child temperament. Moderation analyses revealed that maternal use of verbal pressure and physical prompts moderated the relationship between higher emotionality and food fussiness, but maternal use of food rewards did not. These results indicate that the use of verbal pressure and physical prompts may have a particularly negative influence on fussy eating for children higher in emotionality.
This chapter explores infant feeding during the introduction of complementary foods and beverages and transition to solid foods. This chapter discusses how responsive feeding during this developmental stage can promote infants’ preferences for healthy foods and development of eating behaviors that support effective self-regulation of intake. In particular, novel implications of infants' increased motor skills and autonomy are examined within the context of responsive feeding, and best practices for promoting infants' preferences for healthy foods will be outlined. The concepts of the Division of Responsibility During Feeding and Baby-Led Weaning are introduced as effective conceptualizations of the principles of responsive feeding during this developmental period. This chapter concludes with recommended action items for promoting responsive feeding during the transition to solid foods.
Selective eating is a common childhood feeding problem associated with family stress and micronutrient deficiencies. While there are empirically-supported behavioral strategies for addressing selective eating, there are significant systems-level barriers to implementing them. The aim of this study was to develop and test a self-administered intervention for parents of children with selective eating. Participants were 156 parents of children with selective eating ages 18 months-6 years who were randomly assigned to either the handout + video condition (8-module video intervention and detailed handout) or handout condition (detailed handout only). Outcome measures were administered pre-intervention and 4 weeks post-intervention. . Only 23 % of participants in the handouts plus video condition played more than one video module. Both groups had significant decreases in maladaptive mealtime parenting practices, undesired child mealtime behaviors, and number of foods offered. No significant effect of study condition was found on the outcome measures. Further research is needed to determine how to encourage engagement of parents with self-administered intervention materials.
Objectives
Viewing electronic media at mealtime is a common coping strategy for feeding difficulties, but its impact on food consumption is not known. We studied the prevalence of electronic media use at mealtime, its association with food intake, and associated factors.
Methods
138 healthy 18- to 30-month-old children were classified according to the presence of feeding difficulties using the Thai language version of the Montreal Children's Hospital Feeding Scale. Electronic media use and 3-day food intake history were collected. Each child's mean energy intake and time spent eating were compared between meals consumed with and without electronic media.
Results
58% of children watched electronic media while eating. Children with feeding difficulties ingested significantly more energy per meal when they watched media (184.0 ± 104.0 vs 152.7 ± 67.0, p = 0.04). Children without feeding difficulties spent significantly more minutes per meal when watching media (29.9 ± 10.1 vs 26.2 ± 7.6, p = 0.001). Longer total daily screen time (p = < 0.001) and presence of feeding difficulties (p = 0.006) were associated with regular media use. Children who regularly used media at mealtime were significantly more likely to have a BMI-for-age z score classification as obese (16.7% VS 0.9%, p < 0.001).
Conclusion
Media use during feeding is associated with greater energy intake and longer meal duration. Thai children who regularly use media at mealtime were significantly more likely to be obese. Children with longer total daily screen times, and those with feeding difficulties are more likely to regularly use media at mealtime.
This study examined the associations between the two main kinds of food rejection, neophobia and pickiness, and executive functions in young children. Caregivers of children (n = 240) aged 3-6 years completed measures of their children's food neophobia and pickiness. A battery of tests measured children's executive functions and world knowledge. Children with higher levels of neophobia and pickiness had lower cognitive flexibility scores than children with lower levels of food rejection. Moreover, the association between food neophobia and cognitive flexibility was stronger than the association between food pickiness and cognitive flexibility. Working memory, inhibition, and world knowledge were not related to children's food rejection. These findings unraveled for the first time the negative relationship between cognitive flexibility and the main psychological barriers to dietary variety. These results contribute to a better understanding of the set of cognitive factors that are associated with food rejection in young children.
Resumen
Objetivos
La prevalencia de niños con dificultades en la alimentación (NDA) o malos comedores es alta en nuestro medio, si consideramos la opinión de los padres. Aunque en la mayoría no observamos enfermedad orgánica o repercusión nutricional, es frecuente que este problema repercuta en la dinámica familiar. Nos proponemos estimar su impacto en el estrés, la calidad de vida y el estado de salud psicológica familiar.
Métodos
Estudio de casos (NDA) y controles (controles sanos y controles con trastornos digestivos o controles enfermos). Se evaluó el estrés parental y el riesgo de afectación psicológica en estas familias, mediante escalas validadas (Parent Stress Index Short Form y General Health Questionnaire de Goldberg) y una encuesta de opinión a los padres.
Resultados
Se recogieron un total de 238 encuestas: 102 correspondientes a controles sanos, 88 con trastornos digestivos y 48 de NDA. El 45,8% de los padres de NDA se consideraban desatendidos por su pediatra y el 47,9% no estaban de acuerdo con sus recomendaciones. El 54,2% de ellos encuentra limitaciones en su vida social, el 25% problemas de pareja, el 47,9% se sienten juzgados por los demás (12,5% por sus propias parejas) sobre cómo manejan la alimentación de su hijo y un 37,5% habían solicitado o considerado ayuda psicológica. Todos estos problemas fueron significativamente más frecuentes que en los controles. Padres y madres de los NDA presentaron con mayor frecuencia riesgo de ansiedad/depresión según el General Health Questionnaire de Goldberg: un 54,2% según valores de referencia (odds ratios ajustadas frente a controles sanos 4,18; intervalo de confianza del 95% [IC95%]: 1,96 a 8,87; frente a controles enfermos odds ratio 6,25; IC95% 2,79 a 13,98) y un 33,3% según los valores de nuestros controles sanos. Asimismo, presentaron mayores puntuaciones de estrés (Parent Stress Index Short Form) que los controles sanos (diferencia de medias ajustada 21; IC95% 12,19 a 29,81) y controles enfermos (diferencia de medias ajustada 20; IC95% 9,81 a 30,19).
Conclusiones
Los padres y madres de los NDA tienen niveles elevados de estrés y riesgo de ansiedad y depresión, con repercusión a nivel social, familiar, de pareja y laboral. Además, la relación con el pediatra puede verse afectada.
How children acquire preferences for added sugar and salt was examined by investigating the effects of repeated exposure to 1 of 3 versions of a novel food (sweetened, salty, or plain tofu) on children's preference for those and other similar foods. Participants were 39 4- and 5-yr-olds assigned to taste only 1 of 3 flavored versions 15 times over several weeks. Preferences for all versions were obtained before, during, and after the exposure series. Preference increased for the exposed version only. Experience with 1 flavored version did not produce generalized liking for all 3 versions of the food. Experience with 1 version (flavored or plain) actually produced a decline in preference for the other version. This was true whether children had experience with plain or flavored versions of the food. The acquired preference was restricted to the particular food/flavor complex; through exposure, children seemed to learn whether it was appropriate to add salt or sugar to a particular food. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
It was examined whether caloric conditioning or social learning strategies dominate in taste preference acquisition in children. The caloric learning paradigm predicts that eating or drinking artificially sweetened products, which deliver virtually no energy, will not lead to a taste preference whereas the social learning paradigm predicts that seeing important others modelling the eating and drinking of these 'light' products will induce a preference for the taste of light products in the child.
In a 2 x 2 between subjects factorial design, the amount of energy and social modelling was varied.
The study was undertaken at primary schools in Maastricht, The Netherlands.
Forty-five children participated and six children dropped out. The 39 children who completed the study (14 boys and 25 girls) had a mean age of 67 months (range 51--81, s.d. 5.6).
Each subject took part in nine conditioning trials with an individually selected tasting yoghurt which was not preferred very much at the pre-test.
The children in the combined caloric and social condition showed an increase in their preference for the conditioned taste which was larger than a regression-to-the-mean effect (P=0.007), whereas children in the other groups did not.
Caloric and social learning combined, ie modelling the consumption of energy-rich foods or drinks, is the best way to establish taste preferences. Children more easily learn a preference for energy-rich food that is eaten by significant others than for food that is low in energy and eaten by significant others.
The purpose of this exploratory study is to determine the strength and direction of relationships between Moos Family Environment Variables and family food intake. The sample consisted of 42 young families with children who were mailed questionnaires following telephone interviews. Findings indicate that there is a significant negative relationship between the family's dysfunctional environment (as indicated by high conflict, control, and organization) and family dietary intake (as indicated by a high Nutritional Adequacy Reporting System score). A significant positive relationship was found between the family's cohesive and independent environments and dietary intake. On the basis of this first study, it appears that further investigation is justified in order to verify a link between dysfunctional family environments and a predisposition to eating disorders, such as anorexia nervosa. Findings from this first study are tentative but reinforce the systems view and indicate that family members do exhibit the nature of the family environment through their own eating behaviors. Further study is in process.
• To develop programs that effectively promote breast-feeding in the United States, information is needed on when mothers decide to breast-feed or formula feed and on trends in infant-feeding practices. Our surveys showed that 85% to 92% of mothers decided on a feeding method before the end of the second trimester of pregnancy, that only 5% to 7% were undecided in the third trimester, and that 96% to 97% fed their infants as previously planned. Surveys of mothers of young infants from 1976 to 1980 showed changes in infant-feeding practices to 6 months of age as follows: increase in incidence and duration of breast-feeding, decrease in newborn infants receiving formula, increase in use of formula rather than cows' milk when breast-feeding is discontinued early, and later introduction of supplementary foods for both breast-fed and formula-fed infants.
(Am J Dis Child 1983;137:719-725)
This research examined variables associated with young children's feeding problems. Mothers of 79 children ranging in age from 2 years to nearly 7 years completed extensive questionnaires with items pertaining chiefly to their children's feeding histories and past and current eating habits, their own (mothers') practices related to their children's eating habits, and the children's psychological problems. In addition, the mothers completed questionnaires supplying information about their own food likes and dislikes as well as those of their children and husbands. Children whose eating behavior was relatively problematic differed from other children in our study in several respects. They had less exposure to novel foods, and they were more likely to be prodded and rewarded to eat and punished for not eating. In addition, they had higher scores on 3 of the variables indicative of behavioral/psychological problems: aggressive behavior, toileting difficulties, and fearfulness. Finally, the problem eaters were more likely to have developed a conditioned taste aversion.
Parents frequently employ contingencies in attempts to regulate children's food intake. To investigate the effects of instrumental eating on food preferences, each of 45 preschool children was assigned to either an instrumental eating or a control condition. In the instrumental conditions (N = 31), children consumed an initially novel beverage to obtain a reward. To test predictions regarding the contributions of (1) an extension of the response deprivation theory of instrumental performance, and (2) extrinsic motivation theory in accounting for negative shifts in preference noted in a previous experiment, 4 instrumental eating conditions were generated by crossing 2 levels of relative amount consumed (baseline, baseline plus) with 2 levels of type of reward (tangible, verbal praise). To control for the effects of exposure on preference, 2 groups of children (N = 7 per group) received the same number of snack sessions, but with no contingency in effect. Preference data obtained before and after the series of snack sessions demonstrated a significant negative shift in preference for the 4 instrumental groups, while the control groups showed a slight but not significant increase in preference. The implications of the data for child feeding practices are discussed.
Information on infant feeding practices was obtained for 226 children of 90 migrant Mexican‐American mothers. Of children born during 1975–1981, 56 per cent were breastfed at birth, 38 per cent at 3 months, 21 per cent at 6 months, and 3 per cent at 12 months. Thirty percent of breastfed children were given a supplementary bottle from birth. A variety of nonmilk liquids and semisolids were also given by bottle. Breast‐feeding incidence increased from 41 to 58 per cent between 1975–78 and 1978–81 among children born in the U.S., paralleling national trends. Children born after their parents came to the U.S. were less likely to be breastfed than those born before the first move, even if they were born in Mexico on a subsequent return trip. In contrast, birthplace of the child was not related to incidence or duration of breastfeeding among children born after their parents first came to the U.S. Although maternal employment was not statistically related to decreased breastfeeding, it was a stated reason for bottle‐feeding 33 per cent of children born in the U.S. Thus, both cultural and economic pressures influence infant feeding decisions of Mexican‐American migrants.
Although all infants begin life on a milk diet, the diets of adults differ dramatically. These differences are well established by 5 or 6 years of age. This paper focuses on the contribution of early learning and experiences to the development of food acceptance patterns, some of which have been linked to individual differences in children's adiposity and eating disorders.
(C) Williams & Wilkins 1996. All Rights Reserved.
Approximately 500,000 teens become mothers every year, and 90% keep their babies. Problems are associated with adolescent parenting, including poor parenting skills and inappropriate infant/child feeding practices, which have developmental and health implications for the children. The purpose of this qualitative study was to identify the range of infant/toddler feeding practices among 20 pairs of Anglo and Mexican-American adolescent mothers and their mothers. Grandmothers were included to assess their involvement in child care. Teens often cited recommended practices but failed to follow through. Early weaning, cereal in the bottle, and providing high-fat foods and sweets were common practices. Few understood the importance of modeling appropriate eating behavior. More Anglos had conflict with their mothers, whereas Mexican Americans had more cooperative relationships. As grandmothers were sources of dietary information, conflicts were common over this issue. Including grandmothers in nutrition education efforts may benefit adolescent mothers and their children.
The purposes of this study were to document mealtime communication behaviors used by 98 Caucasian infants who were studied longitudinally from 2 to 24 months of age and to describe how these behaviors changed in the group over time. Using both closed- and open-ended questions in personal interviews, these middle and upper socioeconomic status mothers reported how their infants communicated hunger, satiety, and food likes and dislikes. Mothers also reported their own response behaviors when they believed that their infants had not eaten enough. Only a few mealtime communication behaviors were common to all infants, suggesting that infants use various behaviors to communicate similar messages. Food likes were most often communicated by mouth/eating behaviors, such as opening the mouth as food approached, eating readily, or eating a large amount of food. Food dislikes were communicated by mouth/eating behaviors, by facial expressions, and by body movements, such as turning the head or body away from food or throwing disliked food. When the mother perceived that the child had not eaten enough, most mothers offered alternative choices, either at mealtime or shortly thereafter.The results indicate that most infants are communicating via behaviors in feeding situations throughout the 2- to 24-month period.
To determine the food preferences of toddlers and the concordance with preferences of their family members, 118 children, ages 28 to 36 months, were assessed with a written questionnaire completed by their mothers. The questionnaire included 196 foods commonly eaten across the U.S. Response categories were [food] never offered, never tasted, [child] likes and eats, dislikes but eats, likes but does not eat, and dislikes and does not eat. Similar questionnaires were completed by mothers (n = 117), fathers (n = 96), and an older sibling (n = 47) of the child. Results indicated strong concordance (82.0–83.3%) of food preferences between the child and other family members. Similarity between foods never offered to the child and the mother's dislikes was significant at p = .005. On the average, children had been offered 77.8% of the 196 foods and liked 81.1% of the foods offered to them. Foods liked and eaten by over 95% of the children included French fries, pizza, potato chips, apple juice, bananas, saltine crackers, spaghetti, biscuits, rolls (white), and popcorn. No single food was disliked and not eaten by a majority of the children. Results suggest that the most limiting category related to food preferences were those foods never offered to the child.
Adults presented unfamiliar foods to 14- to 20- and 42- to 48-month-old children individually in their homes. More children put the food in their mouths when the adults also were eating than when the adults simply were offering the food. More children put food in their mouths when their mothers were the source than when the source was a friendly adult “visitor”. However, even when alone with a child, the visitor's eating elicited reliably more tasting. Analysis of requesting behavior indicated that the adults' eating aroused a desire to eat in the children. There were no consistent sex differences or interactions between sex of visitor and sex of child in children's food acceptance. There was a suggestion that younger children were more affected by repeated offerings than were older children. It is concluded that a relatively “low level” form of observational learning—“social facilitation”—can account for the data.
To determine if toddlers who were considered "picky eaters" had lower dietary scores than non-picky eaters, and if family environment and socioeconomic status were significantly related to picky eater status and dietary scores.
An incomplete block design provided two interviews at randomly assigned times (24, 28, 32, or 36 months) of Caucasian mothers from upper socioeconomic (n=74) and lower socioeconomic status (n=44). Using trained interviewers, 6 days of food intake, two administrations of a questionnaire about toddler's eating behavior, and one administration of the Family Environment Scales were collected in the home. MANOVA, discriminant function analysis, and logistic regression procedures were used to determine significant differences between picky and non-picky eater groups.
Picky eaters had lower dietary variety (p=.03) and diversity scores (p=.009) than non-picky eaters. Mothers of picky eaters compared to those of non-picky eaters used persuasion (p=.0001) and ranked their child's eating behaviors as more problematic (p=.0001).
Toddlers perceived by their mothers as picky eaters had significantly lower dietary variety and diversity scores. Parents need information and strategies to increase the number of foods acceptable to their toddlers and to develop a sound feeding plan.
This study of 198 urban breastfeeding women examined the psychosocial, demographic, and medical factors identified prenatally that may be associated with longer breastfeeding duration and may serve as suitable areas for prenatal breastfeeding promotion interventions. Of 11 psychosocial and demographic factors examined, 5 were important influences on breastfeeding duration: anticipated length of breastfeeding, normative beliefs, maternal confidence, social learning, and behavioral beliefs about breastfeeding. Methods of multivariate linear regression were used to identify prenatal factors that influenced anticipated length. Of the 10 factors entered into the regression model, parity, plans to return to work or school by six months postpartum, and maternal confidence were the most significant factors affecting anticipated length of breastfeeding. Our data suggest several factors amenable to intervention during the prenatal period that appear to influence breastfeeding duration. Prenatal promotion efforts could easily incorporate strategies that influence factors such as normative and behavioral beliefs and maternal confidence.
Factors influencing changing patterns in introducing nonmilk foods (beikost) to infants are reviewed. Currently, developmental readiness based on individual needs is favored. Caregivers may receive conflicting advice from women who cared for infants when very early introduction of beikost was widely practiced.
To determine whether the ad libitum addition of solid foods to the diet of exclusively human milk-fed infants will increase energy intake and reverse the decline in weight-for-age percentiles observed during the exclusive breast-feeding period.
Weekly or biweekly measures of growth were made longitudinally on a cohort of infants from birth to 36 weeks of age, and monthly measures of nutrient intake were made from 16 weeks of age until 10 weeks after solid foods were introduced into the diet.
Volunteer mother-infant pairs from middle and upper income groups who met entry criteria, including the intention to breast-feed exclusively for at least for 16 weeks; 58 pairs entered and 45 pairs completed the study.
Solid foods were introduced at a time determined by the mother and the pediatrician; solid foods from controlled lot numbers were provided for each infant.
After solid foods were added, daily human milk intake declined at a rate of 77 gm/mo (p less than 0.001). Milk composition did not change during the observation period. Daily total energy intake increased 29 kcal/mo, but no changes were noted in energy intake when consumption was normalized for body weight. Weight (National Center for Health Statistics percentiles) at 28 weeks was 13 percentiles lower than that at birth, and length at 28 weeks was 1 percentile lower than at week 1. Weight and length percentiles at 28 weeks, when compared with peak values at 8 weeks, had dropped 19 and 14 percentiles, respectively.
Energy intake of human milk-fed infants did not increase after solid foods were added to their diet but was maintained at approximately 20% below recommended levels. Energy intake appeared to reflect infant demands. These data suggest that the recommendations for the energy requirements of infancy should be reevaluated. The growth pattern of exclusively breast-fed infants differs from that of the National Center for Health Statistics reference population. These observations raise questions about the adaptive response of human milk-fed infants to different levels of energy intake and about the estimations of energy requirements based on the sum of basal metabolism, activity, growth, and diet-induced thermogenesis.
A nutrient database that contains current, reliable data is a prerequisite for accurate calculation of dietary intakes. Most nutrient databases are expanded from data supplied by the U.S. Department of Agriculture and may include additional foods or nutrients or data from more recent analyses, food manufacturers, or foreign food tables. Guidelines must be established for selection of reliable values from appropriate sources. A system for precise documentation of data sources provides a means for determining whether individual nutrient values were derived from chemical analyses, recipe calculations, or imputations. This article identifies data sources used by the Nutrition Coordinating Center at the University of Minnesota for its nutrient database and describes the procedures used to select and document nutrient values.
Feeding practices have been analyzed prospectively in a sample of 1,112 healthy infants selected from families using an HMO. Data were collected at well-child visits during the first year of life regarding breast-feeding, formula feeding, and use of solid foods and cow's milk. Seventy percent of all infants were breast-fed, with the mean duration of breast-feeding being almost 7 months. Factors positively associated with breast-feeding included education and marriage, whereas maternal employment outside the home and ethnicity (being Hispanic rather than Anglo-American) were related to bottle feeding. Solid foods were introduced earlier by Hispanics and, also, among less well educated and single women; maternal employment was unrelated to the introduction of solid foods. Multiple regression analysis indicated different patterns for the two ethnic groups: education and employment were related to almost all feeding practices for Anglo-Americans, whereas education and employment predicted few feeding practices for the Hispanics. These findings suggest that the effects of ethnicity are independent of those of education.
To determine the relative effectiveness of two different types of exposure on young children's preference for initially novel foods, 51 two- to five-year-old children received either "look" or "taste" exposures to seven novel fruits. Foods were exposed five, 10 or 15 times, and one food remained novel. Following the exposures, children made two judgments of each of the 21 pairs: one based on looking, the other on tasting the foods. Thurstone Case V scaling solutions were correlated with exposure frequency, and these were significant for the visual judgments of the looked at foods (r = 0.91), the visual judgments of the tasted (and looked at) foods (r = 0.97) and the taste judgments of the tasted foods (r = 0.94). The only non-significant relationship was for the taste judgments of the looked at (but never tasted) foods (r = 0.24). The results indicate that to obtain significant positive changes in preference, experience with the food must include experience in the modality that is relevant for the judgments. While visual experience produced enhanced visual preference judgments, visual experience was not sufficient to produce significantly enhanced taste preferences. This finding is consistent with a "learned safety" interpretation of the exposure effects noted in the taste judgments: experiences with novel tastes that are not followed by negative gastrointestinal consequences can produce enhanced taste preference.
Taste acceptability, determined by volume of taste substances consumed during brief presentations, was assessed in 63 black 2-year-old children who had previously been tested at birth and at 6 months of age. Intake of sucrose solutions during taste tests was related to prior dietary exposure to sugar water. Children who had been regularly fed sugar water by their mothers consumed more sucrose solutions but not more water than did children whose mothers did not feed them sugar water. However, when these children were tested with sucrose in a fruit-flavored drink base, prior exposure to sugar water was unrelated to consumption of sweetened or unsweetened fruit-flavored drink. Thus, the apparent effects of dietary exposure on sucrose acceptability were specific to the medium in which sucrose was dissolved. Studies with sucrose solutions also revealed a significant correlation between sucrose acceptability determined at 6 months and at 2 years of age. Another series of tests evaluated response to salt with soup and carrots. Individual children who ingested more salty than plain soup also tended to ingest more salty compared with plain carrots. However, measures of salt consumption and salt usage obtained from mothers were unrelated to individual differences in acceptability of salty foods.
To develop programs that effectively promote breast-feeding in the United States, information is needed on when mothers decide to breast-feed or formula feed and on trends in infant-feeding practices. Our surveys showed that 85% to 92% of mothers decided on a feeding method before the end of the second trimester of pregnancy, that only 5% to 7% were undecided in the third trimester, and that 96% to 97% fed their infants as previously planned. Surveys of mothers of young infants from 1976 to 1980 showed changes in infant-feeding practices to 6 months of age as follows: increase in incidence and duration of breast-feeding, decrease in newborn infants receiving formula, increase in use of formula rather than cows' milk when breast-feeding is discontinued early, and later introduction of supplementary foods for both breast-fed and formula-fed infants.
The relationship between frequency of exposure to foods and preference for those foods was investigated in two experiments. Participants in both studies were two-year-old children. In Experiment 1, each of six children received 20, 15, 10, 5 or 2 exposures of five initially novel cheeses during a 26-day series of familiarization trials in which one pair of foods was presented per day. In Experiment 2, eight children received 20, 15, 10, 5 and 0 exposures to five initially novel fruits, following the same familiarization procedures, for 25 days. The particular food assigned to an exposure frequency was counterbalanced over subjects. Initial novelty was ascertained through food history information. Within ten days after the familiarization trials, children were given ten choice trials, comprising all possible pairs of the five foods. Thurstone scaling solutions were obtained for the series of choices: when the resulting scale values for the five stimuli were correlated with exposure frequency, values of r = 0·95, p < 0·02; r = 0·97, p < 0·01; and r = 0·94, p < 0·02 were obtained for the data of Experiments 1, 2, and the combined sample, respectively. A second analysis, employing subjects rather than stimuli as degrees of freedom, revealed that 13 of 14 subjects chose the more familiar stimulus in the sequence of ten choice trials at greater than the level expected by chance, providing evidence for effects within subjects as well as consistency across subjects. These results indicate that preference is an increasing function of exposure frequency. The data are consistent with the mere exposure hypothesis (Zajonc, 1968) as well as with the literature on the role of neophobia in food selection of animals other than man.
Three experiments are reported on the effects of "taste" or nutrition information on willingness to try novel foods. "Taste" information improved responses to four out of the five foods examined. There was a consistent, but not statistically significant, trend for nutritional information to be effective. In experiment I, conducted with 3- to 8-year-old children in a laboratory setting, and in experiment II, conducted with 10- to 20-year-olds in a cafeteria, there were strong age effects. Older subjects responded more positively to novel foods than did younger subjects. There were no significant interactions between information and age and there were no sex differences. It is commonly assumed that novel foods are rejected because they are thought to be dangerous. However, the fact that dangerous foods are good tasting should be irrelevant to willingness to taste them. Our results are consistent with the idea that, in settings like laboratories and cafeterias, culture has already defined foods as being safe. Perhaps rejection in such settings is based on fear of a negative sensory experience.
The authors examined the breastfeeding duration and management of two groups of mothers with different exposures to services of a Certified Lactation Consultant (CLC). One group of mothers, at hospital H1 (n = 46), had access to a CLC, while mothers at hospital H2 (n = 115) did not. Results showed that: (a) mothers at H1 had significantly (t = 2.33, p < .02) longer durations of breastfeeding (M = 3.1 months, SD = 1.2) than peers at H2 (M = 2.4 months, SD = 1.2); (b) a significantly greater proportion of mothers at H1 attained their intended duration of breastfeeding compared to mothers at H2 (Mann-Whitney U, one-tailed test, Z = 1.94, p < .05); and (c) in a stepwise multiple regression analysis, intended length of breastfeeding accounted for 18% of the variance in duration of breastfeeding, mothers' age 9%, and mothers' education 3%. The results support the theory of reasoned action and the theory of patient education.
In order to construct a behavioral neophobia measure for children, we had 5-, 8- and 11-year-olds choose from ten novel and ten familiar foods which ones they were willing to taste. Meanwhile, their parents indicated their own willingness to taste each of the foods, predicted the children's willingness, estimated the number of times they and their children had eaten the foods, and completed trait measures of food neophobia for themselves and the children. The children's levels of behavioral neophobia were significantly related to both their levels of trait neophobia and their parents' predictions of their willingness to eat the foods (r = 0.38 and 0.34, respectively; p < 0.001). In addition, children's and parents' behavioral and trait neophobia scores were significantly related (both r = 0.31; p < 0.001). Finally, parents but not children were more neophobic with respect to foods of animal (vs. vegetable) origin.
The aims of the study were to investigate family members' reasons for rejection of foods served in the family, the reasons for not serving specific foods, children's reasons for liking/disliking foods and the use of parental mealtime practices to encourage child eating. Also, the relationships between child/parental neophobia and (1) the reasons for not serving specific foods and (2) the use of mealtime practices were studied. A group of randomly selected families (n = 370) with children aged 2-17 years from two Swedish towns (stratified, 185 from each) were invited and 57 participated. The results are based on an ad hoc food-frequency questionnaire, a mealtime-practices questionnaire, the Food and Neophobia Scale (Pliner & Hobden, 1992), parental ratings of child food neophobia and on a child interview. The main reason for family members rejecting the foods and the main reason for children's dislikes was "distaste". The most frequent reason for children's likings was "good taste". The most frequent reasons for not serving the specific foods were "distaste", the "food did not occur to me", "seasonal/availability" and "habit". The mothers' total Food Neophobia score was significantly correlated with "did not occur to me". Parental ratings of child food neophobia were significantly correlated with mealtime-practice factors "postpone meals" and "child decides portion".
The aims were to investigate the occurrence of food and general neophobia in Swedish families with children 2-17 years of age, parent-child correlations with respect to neophobia and the relationships between neophobia and the reported serving of specific foods in the family. A group of 370 randomly selected families from two Swedish towns (stratified, 185 from each) were invited and 57 (15%) participated. The results are based on the Food and General Neophobia Scales (Pliner & Hobden, 1992), parental ratings of child food neophobia and an ad hoc Food Frequency Questionnaire. The overall levels of neophobia were relatively low for both children and parents. There were only a few significant gender differences with respect to Food Neophobia but fathers and boys scored numerically higher than did mothers and girls on several items in the Food Neophobia Scale. The children, particularly boys, showed significantly higher Food and General Neophobia than their parents. Both Food and General Neophobia tended to decrease with increasing age among the children. Families were divided according to whether specific foods had been served or not. This classification showed virtually no relationship with the degree of food neophobia of family members. However, the higher the food neophobia in mothers and children, the fewer of the listed uncommon foods had been served in the family.
The aims were to study food and general neophobia in Swedish families, age and gender differences and familial resemblance. Also, the relationships between the level of food neophobia of individual family members and earlier experience with and the likelihood of future tasting of specific foods were investigated. A group of randomly selected families (nation-wide, stratified, N=1593) with children age 7-17 years were invited and 722 participated. The results are based on the Food and General Neophobia Scales and an ad hoc Food Frequency Questionnaire. The overall levels of food and general neophobia were low. Fathers showed significantly higher total food neophobia scores than did the mothers, and children were significantly more neophobic than their parents. The younger children had higher food and general neophobia scores than the older children. Nine-year-old boys had higher food neophobia scores than 9-year-old girls. Some evidence was found for familial resemblance with respect to both food and general neophobia. Gatekeepers' (the person who takes the greatest responsibility for food purchase and preparation) self-reported serving of the foods and mothers', fathers' and children's self-reported consumption of foods were correlated with their respective levels of food neophobia. The strongly neophobic subjects in all groups of family members were less likely to have eaten the listed foods than were the less neophobic. Thus, food neophobia seems to be related to everyday food choice.
The number of feedings needed to increase intake of a novel target food was investigated, and whether exposure effects generalized to other foods in a sample of 4 to 7-month-old infants (N=39). Other foods varied in their similarity to the target food, including the same food prepared by another manufacturer, similar foods (other fruits for infants receiving a target fruit) and a different food (e. g. vegetables for infants receiving a target fruit). Infants were fed the target food once a day for 10 days. Intake was used to indicate acceptance. Results revealed that exposure dramatically increased infants' intake of the target food, from an average of 35-72 g. Intake of the different food was unchanged. Same and similar food intake increased with target food exposure. Intake of the target, same and similar foods nearly doubled to 60 g after one exposure to the target food. These rapid increases in intake contrast the slower changes seen in young children. Results for the other foods suggest that infants may have difficulty discriminating among many foods.
Infant feeding practices are integral parts of individuals' ethnic and cultural beliefs, with culturally-based feeding beliefs influencing how individual mothers in various ethnic groups make decisions. Strongly held feeding beliefs have led to resistance against nationally and internationally established recommendations upon infant feeding practices. The context for mothers' beliefs changes for women who immigrate to another culture and geographic region where practices differ. The authors investigated whether Asian-Indian (AI) mothers who immigrate to the US change their infant feeding beliefs from those held in India, and how the infant feeding beliefs of Anglo-American (AA) mothers differ from those held by Asian-Indian-American (AIA) mothers. Survey responses from 141 AA mothers and 133 AIA mothers living in the southeastern US, and 101 AI mothers living in Coimbatore, India, are presented. The mean ages of the ethnic groups were similar, all 3 groups were relatively well educated, and the AIA mothers had lived in the US for a median of 5.9 years. The infant feeding beliefs of the AIA and AI mothers indicate that they are especially in need of services provided by dietitians and other health care providers. Otherwise, differences in beliefs were found between the 3 groups, except that all 3 groups believe that a baby should not take a bottle to bed.
E. Rozin and P. Rozin have suggested that one of the functions of "flavor principles" (the distinctive seasoning combinations which characterize many cuisines) is to facilitate the introduction of novel staple foods into a culture by adding sufficient familiarity to decrease the neophobia ordinarily produced by a new food. We tested this idea experimentally, predicting that the addition of a familiar flavor principle to a novel food would increase individuals> willingness to taste it, in comparison to their willingness to taste the same food in the absence of the flavor principle. Since people have little reluctance to approach familiar foods, addition of a familiar flavor principle to a familiar food should have little effect on willingness to taste it. In a pilot study, subjects selected from a list, a sauce which was high in familiarity and liking for them. They then rated their willingness to taste one novel and one familiar food with the sauce and one of each with no sauce. Subjects did not actually see any foods-the familiar and novel foods were simply described-and they were aware that they would not actually be tasting any foods. In the study proper, subjects rated their willingness to try each of the four food/sauce combinations described above. In this study, they actually saw the foods they were rating and were under the impression their ratings would determine what they would taste later in the study. In both studies, the addition of a familiar sauce to a novel food increased subjects> willingness to taste it (in comparison to the same food with no sauce) while the addition of a sauce to a familiar food either had no effect or decreased subjects> willingness to taste it. In the pilot study, the "flavor principle" effect intera