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

Abstract

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

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

“…Definitions of fussy eating vary widely, due to measurement methodologies and the ages at which assessments are made (8) . Parent-reported assessments of fussy eating often refer to a child's low quantity or variety of foods consumed, or strong food preferences (6,9) .…”

“…Although questionnaires are convenient tools to measure fussy eating at a population level (8) , predetermined questions limit the characterisation of children's fussy eating to behaviour. Conversely, qualitative studies provide a contextual, first-hand account of how parents describe specific feeding concerns that can capture emotional content (14) .…”

The Influence of Parental Feeding Strategy on Child Eating Behavior—The Mediating Role of Pressure to Eat

“…随着物质资源不断丰富，可选择的食物种类越来越多，儿童对于食物的挑剔程度也随之增长。近期 研究调查了北京、广州、苏州等九个地区城市儿童，结果显示：有六成的儿童存在挑食行为 (Volger, Sheng, Tong, Zhao, Fan, Zhang et al, 2013)。挑食具体表现为：不愿意尝试新食物，对于食物有强烈的偏好 (Taylor, Wernimont, Northstone, & Emmett, 2015;Wardle, Guthrie, Sanderson, & Rapoport, 2001)。研究表明，挑食可 能导致微量元素和蛋白质缺乏等营养问题，还会造成体重偏低 (Volger et al, 2013;Xue, Zhao, Cai, Yang, Szeto, Ma et al, 2014;Yong, Lee, Ke, Zheng, Ma, Gao et al, 2015)。 父母可以通过自身的行为示范，或者通过控制孩子的饮食环境，来影响下一代的饮食行为和习惯， 从而改善其体重和其他营养状况 (Savage, Fisher, & Birch, 2007;Vollmer & Mobley, 2013)。有研究发现，父 母自身规律的进食蔬果行为，及其提供蔬果的丰富程度，都会促进儿童进食蔬菜水果 (Kaiser, Aguilera, Horowitz, Lamp, Johns, Gomez-Camacho et al, 2015;Wyse, Wolfenden, & Bisquera, 2015)；反之，孩子则会 较少进食蔬菜水果，较多进食零食 (Jackson, Smit, Manore, John, & Gunter, 2015;Schrempft, Jaarsveld, Fisher, & Wardle, 2015 Table 3. The mediation effect of parental feeding pressure between parental feeding strategy and child's behavior (N = 424) …”

The impact of front-of-pack marketing attributes versus nutrition and health information on parents' food choices

“…Food fussiness is characterized by an unwillingness to eat both familiar and unfamiliar foods, and, therefore, a poorer dietary intake (Carruth, Ziegler, Gordon, & Barr, 2004;Dovey et al, 2008;Taylor, Wernimont, Northstone, & Emmett, 2015;Wardle, Guthrie, Sanderson, & Rapoport, 2001). Parents of fussy children have higher motivations to select foods that their…”