Navigating the picky eating phase in pre-school

children Claire Baseley RNutr

What’s on the menu?

How do we define fussy or picky eating?

How many kids are picky eaters?

Can parents prevent fussy eating?

Practical ways to make mealtimes less stressful and

more fun

Defining picky eating

Research in its infancy – literally!

Picky, fussy, faddy, neophobia, restrictive eating

Sliding scale of severity, longevity and clinical effects

Upper extreme is Avoidant/restrictive Food Intake Disorder

(ARFID) = new diagnostic category in DSM-5: picky eating

leading to somatic and/or psychosocial dysfunction

Broad characteristics of picky eating:

Food neophobia

Limited variety of food eaten

Low enjoyment of food

Slowness of eating

High satiety responsiveness (feeling full quickly)

Emotional undereating

Prevalence of picky eating

No gold standard for assessment

Many studies simply ask parents if their child is picky

Child Eating Behavior Questionnaire (CEBQ) ‘food fussiness’

subscale; Child Behavior Checklist (CBCL)

14% - 50% in early childhood, depending on method of

assessment

Peaks in early childhood @ 27.6%*

Declines to 13.2% aged 6y

45.5% cohort showed some pickiness throughout childhood

Most cases remit by 3y with a small number remaining

persistently picky

*Cardona Cano S, Tiemeier H, Van Hoeken D, et al. Trajectories of picky eating during childhood: a general population study. Int J Eat Disord 2015; 48:570-579.

Risk factors for picky eating

Negative maternal affect

Genetics

Lower variety of vegetables

Short duration / no breastfeeding

Late introduction of textured food

Age of weaning (earlier OR later!)

Pressure to eat, authoritarian parenting

Maternal dietary restraint

Tactile, taste sensitivity

Latest research – The Generation R

Study

De Barse et al. Appetite 114 (2017) 374-381

Experimental data supports veg first approach to weaning

Babies either weaned with 18d

veg in variety with repeat

exposure or fruit

Amount of veg eaten following

veg exposure greater than

following fruit exposure

Effect persists until at least 12

months of age

Barends et al; Appetite 81 (2014) 193-199

Why do toddlers refuse food?

Rushed or distracted mealtimes

Neophobic phase Pressured to eat

Unwell, teething

Tired Full up; grazing throughout day

Shouted at

Constipation/anaemia

Feeling sad

Top tips for parents to avoid mealtime battles – things to avoid

Rushed mealtimes

Pressuring to clean the plate

Offering an alternative meal

Using dessert as reward for eating main or vegetables

Offering snacks/drinks just before meal

Offer a snack after a refused meal to ‘top up’ tummy

Never offering a rejected food again

Feeling guilty, stressed or anxious

Eat together + role model good eating behaviour

Keep meals to 20-30 mins but don’t rush slow eaters

Calm eating environment with no distractions

Offer small portions + seconds if wanted

Offer finger food meals

Arrange for toddlers to eat together

Be positive around food

Praise toddlers when they eat well

Have a set routine for eating + snacking

Involve toddlers with shopping and food prep

Remove uneaten food without comment

Feed responsively to toddler’s appetite

Make eating and food a fun, positive experience

Try messy play and sensory engagement

Change the eating venue

Involve toddlers with cooking

Non-food rewards e.g. stickers

Repeat exposure

Offer variety + controlled choice

Practice authoritative parenting

Further information

http://www.childfeedingguide.co.uk/

http://www.infantandtoddlerforum.org/toddlers-to-preschool/fussy-eating