Moens E, Goossens L, Verbeken S, Vandeweghe L, Braet C.
Appetite. 2017 Aug 29. pii: S0195-6663(17)31274-6. doi: 10.1016/j.appet.2017.08.028. [Epub ahead of print] PMID: 28864254
Children’s eating habits are shaped in part by parental feeding practices. This study examines how parents (1) model and (2) encourage their child to taste an unknown food. Thereby, attention is paid to the distinction between encouraging what (i.e. adaptive type of encouragement) and the amount (i.e. maladaptive type of encouragement) children eat/drink. 25 families with a child with overweight and 30 families with a child of healthy weight (7–13 years) participated in a taste task. Both the child’s tasting behavior and the parents’ modeling and encouragement behavior were observed and related to the child’s age and weight status.
- As 94.3% of the children tasted the unknown food, weight status differences between tasters and non-tasters could not be investigated.
- Only 26.9% of the parents used modeling to enhance tasting behavior.
- 77.4% of the parents encouraged their children to taste (encouragement of what children eat/drink).
- 21.1% of the parents also encouraged their children to finish the juice (encouragement of amount children eat/drink).
These results evidenced that parental modeling is not often used to enhance tasting behavior in children. In contrast, parental encouragement was frequently observed, especially in parents of younger children and of healthy-weight children. Encouragement, however, seems difficult to measure and more research on adaptive parental encouragement is needed.
Cole NC, Wang AA, Donovan SM, Lee SY, Teran-Garcia M; STRONG Kids Team. J Nutrigenet Nutrigenomics. 2017 Aug 31;10(3-4):84-92. doi: 10.1159/000478857. [Epub ahead of print] PMID: 28858874
Picky eating is prevalent among preschoolers and is associated with risk of both underweight and overweight. Although differences in taste perception may be due to genetic variation, it is unclear whether these variations are related to picky eating behavior. The aim of this study was to investigate the association of 6 single nucleotide polymorphisms (SNPs) in 5 candidate genes related to chemosensory perception with picky eating behavior and adiposity in a cohort of preschool-aged children. Results indicated when controlling for child age, sex, breastfed status, and parent education level, SNPs in TAS2R38 (rs713598) and CA6 (rs2274327) were associated with picky eating behavior in children. There was no association between SNPs and BMI z-scores. Genes related to chemosensory perception may play a role in children’s picky eating behavior.
Täljemark J, Råstam M, Lichtenstein P, Anckarsäter H, Kerekes N.
J Eat Disord. 2017 Aug 21;5:25. doi: 10.1186/s40337-017-0154-2. eCollection 2017. PMID: 28835820
Restrictive eating problems are rare in children but overrepresented in those with neurodevelopmental problems. This study describes phenotypes, regarding psychiatric and gastrointestinal comorbidities, in children with restrictive eating problems. Results indicated prevalence of restrictive eating problems was 0.6% (concordant in 15% monozygotic and 3% of dizygotic twins). The presence of restrictive eating problems drastically increased odds of all psychiatric problems, especially autism spectrum disorder in both sexes, obsessive-compulsive disorder in boys and oppositional defiant disorder in girls. Comorbid gastrointestinal problems, such as lactose intolerance and constipation, were the most frequent in girls. Boy co-twins with restrictive eating problems generally had more psychiatric problems than girl co-twins. In children with restrictive eating problems odds of all coexisting psychiatric problems and gastrointestinal problems are significantly increased. The study shows the importance of considering comorbidities in clinical assessment of children with restrictive eating problems.
Goh JR, Russell CG, Liem DG. Foods. 2017 Jul 24;6(7). pii: E55. doi: 10.3390/foods6070055. PMID: 28737712
Children’s vegetable consumption is often lower than that needed to promote optimal health and development, and practical approaches for increasing vegetable consumption are needed. Sensory Specific Satiety (SSS) reduces the liking and consumption of a consumed food over the course of an eating occasion and is an important factor in meal termination. The present study aimed to investigate the development of SSS when children ate vegetables of different sizes. 72 children were recruited from Australian primary schools. Participating children consumed either whole or diced carrots for a maximum period of 10-min from a 500 g box. Cucumber was used as a control vegetable. Results suggest that, in order to increase vegetable consumption, it is better to present children whole carrots than diced carrots. These findings might aid in the development of strategies to promote children’s greater vegetable consumption.
Begen FM, Barnett J, Barber M, Payne R, Gowland MH, Lucas JS.
BMC Public Health. 2017 Jul 20;18(1):38. doi: 10.1186/s12889-017-4594-z.
For parents and caregivers of food hypersensitive (FH) children, accommodating their child’s dietary needs when eating out can be a challenging experience. This study explored caregivers’ experiences and behaviours when eating out with their FH child in order to gain insights into how they support and prepare their child in negotiating safe eating out experiences. Caregivers reported a number of issues relating to eating out with their FH child, or allowing their child to eat out without their supervision. Through themes of ‘family context’, ‘child-focused concerns’, and ‘venue issues’, caregivers described how they managed these and explained the limitations and sacrifices that FH imposed on their child, themselves, and family members. Through deeper understanding of the anxieties, negotiations and compromises experienced by caregivers of children with FH when they are eating out, clinicians can tailor their support to meet the needs of caregivers and children. Support and education provision should focus on providing caregivers of children with FH the tools and strategies to help enable safe eating out experiences.
Steinsbekk S, Bonneville-Roussy A, Fildes A, Llewellyn CH, Wichstrøm L.
Int J Behav Nutr Phys Act. 2017 Jul 6;14(1):87. doi: 10.1186/s12966-017-0542-7. PMID: 28679411
Picky eating is prevalent in childhood. Because pickiness concerns parents and is associated with nutrient deficiency and psychological problems, the antecedents of pickiness need to be identified. We propose an etiological model of picky eating involving child temperament, sensory sensitivity and parent-child interaction. Results indicated:
- at both measurement times, 26% of the children were categorized as picky eaters.
- Pickiness was moderately stable from preschool to school age, and about half of those who displayed pickiness at age 4 were also picky eaters two years later.
- While accounting for pickiness at age 4, sensory sensitivity at age 4 predicted pickiness at age 6, whereas temperamental surgency and negative affectivity did not.
- Parental structuring was found to reduce the risk of children’s picky eating two years later, whereas parental sensitivity increased the odds for pickiness.
- Although pickiness is stable from preschool to school age, children who are more sensory sensitive are at higher risk for pickiness two years later, as are children whose parents display relatively higher levels of sensitivity and lower levels of structuring.
Our findings suggest that interventions targeting children’s sensory sensitivity, as well as parental sensitivity and structuring, might reduce the risk of childhood pickiness. Health care providers should support parents of picky eaters in repeatedly offering unfamiliar and rejected foods to their children without pressure and acknowledging child autonomy.
Broilo MC, Vitolo MR, Stenzel LM, Levandowski DC.
Appetite. 2017 Sep 1;116:575-583. doi: 10.1016/j.appet.2017.05.052. Epub 2017 Jun 1. PMID: 28579333
This cross-sectional analysis aimed to analyze the strategies used by mothers of children aged 2-3 to ensure their food consumption as well as to investigate the maternal and family characteristics associated with using these strategies. Data of 463 mothers who use the public health care system in Porto Alegre, Brazil, were analyzed. Among these mothers, 58.5% used some type of strategy.
- 42.4% of mothers did not identify their behavior as a strategy to ensure their children’s food consumption.
- 69% were classified as information strategies
- 43.2% as trading strategies.
- 46.9% of the cases, some types of food were involved in the mothers’ strategies, generally ultra-processed foods.
We conclude that the use of strategies to promote children’s food consumption considered appropriate by the mothers is a fairly common practice. Health care professionals should consider mothers’ perceptions and attitudes about the subject in order to council them as to the best feeding practices for their children, as the use of these strategies can be detrimental to the formation of eating behaviors.
Cole NC, An R, Lee SY, Donovan SM. Nutr Rev. 2017 Jul 1;75(7):516-532. doi: 10.1093/nutrit/nux024. PMID: 28535257
Picky eating behavior is prevalent among toddlers and may negatively impact their growth and development. This article summarizes the correlates of picky eating and food neophobia in young children. A literature search was conducted. Inclusion criteria were English-language peer-reviewed publications that investigated correlate(s) of picky eating or food neophobia in children aged ≤30 months. Thirty-two studies were identified. The most examined correlates were characteristics related to the child (sex, weight, and dietary intake) and parent (feeding beliefs and practices). A meta-analysis estimated the prevalence of picky eating to be 22%. Each additional month of a child’s age was associated with a 0.06 U increase in the Children’s Eating Behavior Questionnaire food fussiness score. This review highlights the importance of investigating child-parent dyads and bidirectional feeding interactions and draws attention to the lack of picky eating research at the level of the cell and the community/country.
Kuschner ES, Morton HE, Maddox BB, de Marchena A, Anthony LG, Reaven J.
Clin Child Fam Psychol Rev. 2017 May 22. doi: 10.1007/s10567-017-0236-3. [Epub ahead of print] Review.
Selective eating (often referred to as “picky” eating) is common in individuals with autism spectrum disorder (ASD) across the lifespan. Behavioral interventions are widely used to treat selective eating; however, most of these programs are time intensive, have not been evaluated for use in outpatient settings, and do not typically include youth beyond early childhood. Despite the functional impact and risk for negative outcomes associated with selective eating, there are no empirically supported treatments available for older children, adolescents, or adults, either with or without ASD. To address this treatment gap, we developed BUFFET: the Building Up Food Flexibility and Exposure Treatment program. BUFFET is a 14-week, multi-family group cognitive behavioral treatment for selective eating in children (8-12 years) with ASD. In this paper, we will (1) discuss the theoretical conceptualization of BUFFET, (2) describe the treatment content and structure, (3) present feasibility data from the initial pilot trial, and (4) consider next steps in treatment development.
Zimmerman J, Fisher M. Curr Probl Pediatr Adolesc Health Care. 2017 Apr;47(4):95-103. doi: 10.1016/j.cppeds.2017.02.005. PMID: 28532967
Avoidant/restrictive food intake disorder (ARFID) is an entirely new diagnosis in the DSM-5. ARFID replaces “feeding disorder of infancy or early childhood,” which was a diagnosis in the DSM-IV restricted to children 6 years of age or younger; ARFID has no such age limitations and it is distinct from anorexia nervosa and bulimia nervosa in that there is no body image disturbance. ARFID involves a complex and heterogenous etiology, which is reviewed herein. What is known to date regarding the characteristics and medical and psychiatric comorbidities of this patient population are described and compared to other eating disorders. Evaluation and management strategies are also discussed. No data yet exist regarding ARFID׳s prognosis and prevention; however, recommendations to guide parents in establishing appropriate infant and child feeding practices are provided.
Thomas JJ, Lawson EA, Micali N, Misra M, Deckersbach T, Eddy KT.
Curr Psychiatry Rep. 2017 Aug;19(8):54. doi: 10.1007/s11920-017-0795-5. Review.
DSM-5 defined avoidant/restrictive food intake disorder (ARFID) as a failure to meet nutritional needs leading to low weight, nutritional deficiency, dependence on supplemental feedings, and/or psychosocial impairment. We summarize what is known about ARFID and introduce a three-dimensional model to inform research.
Because ARFID prevalence, risk factors, and maintaining mechanisms are not known, prevailing treatment approaches are based on clinical experience rather than data. Furthermore, most ARFID research has focused on children, rather than adolescents or adults. We hypothesize a three-dimensional model wherein neurobiological abnormalities in sensory perception, homeostatic appetite, and negative valence systems underlie the three primary ARFID presentations of sensory sensitivity, lack of interest in eating, and fear of aversive consequences, respectively. Now that ARFID has been defined, studies investigating risk factors, prevalence, and pathophysiology are needed. Our model suggests testable hypotheses about etiology and highlights cognitive-behavioral therapy as one possible treatment
Walton K, Kuczynski L, Haycraft E, Breen A, Haines J. Int J Behav Nutr Phys Act. 2017 May 5;14(1):62. doi: 10.1186/s12966-017-0520-0.
14-50% of parents identify their preschoolers as picky eaters. Dietary intake and preferences during the preschool years are characterized by slowing growth rates and children developing a sense of autonomy over their feeding and food selection. We argue that the current conceptualization of picky eating defines acts of resistance or expressions of preference (acts of autonomy) by a child as deviant behaviour. This conceptualization has guided research that uses a unidirectional, parent to child approach to understanding parent-child feeding interactions. We argue that there is a need to both re-examine the concept and parent/clinician perspectives on picky eating. Thus, the objective of this paper is two-fold: 1) We argue for a reconceptualization of picky eating whereby child agency is considered in terms of eating preferences rather than categorized as compliant or non-compliant behaviour, and 2) We advocate the use of bi-directional relational models of causality and appropriate methodology to understanding the parent-child feeding relationship. A reconceptualization of picky eating may elucidate the influence that parental feeding practices and child eating habits have on each other. This may allow health professionals to more effectively support parents in developing healthy eating habits among children, reducing both stress around mealtimes and concerns of picky eating.
Luchini V, Musaad S, Lee SY, Donovan SM. Appetite. 2017 Sep 1;116:123-131. doi: 10.1016/j.appet.2017.04.021. Epub 2017 Apr 22.
Picky eating (PE) is a common mealtime difficulty that is reported by up to 50% of caregivers. Most of the research to date on PE has focused on parents, even though millions of children also eat meals in home- or center-based childcare settings. Currently, little is known about PE behaviors manifested by the child across the home and childcare settings, or how these behaviors differ between home-based childcare (HBCC) and center-based childcare (CBCC) locations. The objectives of this study were to compare PE behaviors between the child’s home and HBCC or CBCC environments, and compare PE behaviors between HBCC and CBCC environments. Children, ages 3-5 years, were recruited from CBCC or HBCC locations. Observational results showed that children in CBCC displayed more PE behaviors when at home than at childcare, while HBCC children displayed PE behaviors more similarly between the two locations. Thus, interventions to reduce PE behaviors should be personalized for location-specific intervention programs focused on raising healthy eaters across multiple locations.
de Barse LM, Jansen PW, Edelson-Fries LR, Jaddoe VWV, Franco OH, Tiemeier H, Steenweg-de Graaff J. Appetite. 2017 Jul 1;114:374-381. doi: 10.1016/j.appet.2017.04.006. Epub 2017 Apr 8. PMID: 28400303
Fussy/picky eating – i.e. consistently avoiding certain foods – is common in childhood and can be worrisome for parents. Repeated exposure to various flavors as occurs in breastmilk and early exposure to complementary feeding may increase food acceptance and thereby decrease fussy eating. This study examines the associations between infant feeding and child fussy eating in 4779 participants of Generation R, a Dutch population-based cohort. Breastfeeding initiation and continuation, and timing of complementary feeding were assessed by questionnaires at 2, 6, and 12 months. The food fussiness scale of the Children’s Eating Behaviour Questionnaire was administered at 4 years.
- Children who were never breastfed did not differ in fussy eating frequency from children breastfed for 6 months or longer.
- However, children who were breastfed for less than 2 months had a 0.70 points higher food fussiness sum-score than children breastfed for 6 months or longer.
- An earlier introduction of vegetables was associated with less fussy eating behavior Particularly children who were introduced to vegetables between 4 and 5 months had a 0.60 point lower food fussiness score than children introduced to vegetables after 6 months.
- An early introduction to fruits or any solids was not significantly related to fussy eating, although the effect estimates were in the same direction as for introducing vegetables early.
Results suggest that breastfeeding does not predict fussy eating. However, introducing vegetables into a child’s diet before 5 months might be protective against fussy eating, although future research should account for parents’ own fussy eating.
Yee AZ, Lwin MO, Ho SS. Int J Behav Nutr Phys Act. 2017 Apr 11;14(1):47. doi: 10.1186/s12966-017-0501-3. PMID: 28399881
The family is an important social context where children learn and adopt eating behaviors. Specifically, parents play the role of health promoters, role models, and educators in the lives of children, influencing their food cognitions and choices. This study attempts to systematically review empirical studies examining the influence of parents on child food consumption behavior in two contexts: one promotive in nature (e.g., healthy food), and the other preventive in nature (e.g., unhealthy food). Results indicate
- Availability and parental modeling effects show the strongest associations with both healthy and unhealthy food consumption.
- For healthy foods, active guidance/education might be more effective.
- For unhealthy foods, restrictive guidance/rule-making might be more effective.
- For children 7 and older, restrictive guidance/rule-making could be more effective in preventing unhealthy eating.
- For children 6 and younger, rewarding with verbal praise can be more effective in promoting healthy eating and in preventing unhealthy eating.
This study illustrates that a number of parental behaviors are strong correlates of child food consumption behavior. More importantly, this study highlights 3 main areas in parental influence of child food consumption that are understudied: (1) active guidance/education, (2) psychosocial mediators, and (3) moderating influence of general parenting styles.