Hard to define – picky, restricted, faddy? Neophobia important – refusal to try new things. Only really a problem of the developed world… Refusal to eat unhealthy foods is obviously no bad thing…

Actually not much evidence about long term consequences – such studies are hard – poor fibre intake associated with constipation, persistent fussy eating may lead to being underweight, becoming a fussy adult or possibly an eating disorder. Avon longitudinal study (where most of the data comes from) found calorie intake maintained (some studies have found higher calorie intake in fussy eaters) but lower levels of iron, zinc, fibre and vitamin A. Intake of all but Vitamin A were below recommended levels for a substantial proportion of fussy children.

Peak age seems to be around 3yrs. Twin studies suggest highly heritable (due to heritability of sensitivity to bitterness) – associated with having fussy parents too. From an evolutionary perspective, non-mobile infants are only likely to be offered safe foods by their mother; once mobile however, risk of eating poisonous plants or contaminated foods. Hence probably why preference among fussy eaters is for bland flavours and colours, and non slimy textures.

Other risk factors are older mothers, higher maternal educational attainment, lower parity and lower birthweight. More precious children??

Avon longitudinal study found maternal worry about fussy eating at 15 months predicted fussy eating at age 3 (RR=3). Fresh fruit and eating the same meal as a family protective, ready meals increased risk of fussy eating.

Early introduction of vegetables before 6 months helps but goes against WHO guidance…

Australian study showed maternal healthy (adventurous) eating helps.

Parents get very emotional about the lack of variety in their child’s diet or perceived disinterest or refusal to eat. The often “internalise the child’s food intake as a reflection of their own parenting“, whereas choices of what and how much to eat are actually an expression of the child’s emerging autonomy.

Parental pressure to eat (usually fuelled by concerns the child is underweight, which is rarely the case) is associated with fussy eating, not surprisingly, but is potentially a vicious circle. Maternal negative affectivity, internalising problems, sensitivity (ie low tolerance) predicts fussy eating; authoritative parenting style protects [Norwegian studies]. The combination of modelling health eating (which means eating the same food together and not offering alternatives) and not pressuring definitely seems best.

[Caroline Taylor and Pauline Emmet, Bristol 2018]

For extreme refusal

Things to avoid

• Do not refuse to give high-energy foods, like ice cream, cakes, biscuits and chocolate, in the hope that your child will eat ‘proper’ meals and ‘healthy’ foods.
  Reason:This is not a good way to get your child to eat new foods, and your child might lose weight if you withhold their ‘safe’ foods.
• Do not try to force your child to eat food.
  Reason:This will make your child even more anxious at mealtimes, and may cause your child to vomit the food back up.
• Leave long gaps between meals to try to make your child more hungry or hide new foods inside foods that your child already likes.
  Reason: This will make your child less hungry over time, and may lead to weight loss. Some children can very easily detect new tastes and smells, even when hidden in other foods. Your toddler may just stop eating the liked foods.

Things that help

• Encourage your child to experience different textures through ‘messy’ play every day. Your toddler may find some textures (like Play-Doh) very difficult, so start with textures that they are happy to touch. This may need to be drier consistencies initially, such as rice or lentils. Gradually progress to more messy/wet substances, allowing your toddler to gain confidence. Have plenty of fun and get messy. If you don’t like touching certain textures yourself, or don’t feel comfortable allowing your toddler to make a mess, then why not take them to a playgroup in your area?
  Reason: Many children who are extreme food refusers are very sensitive to touch on the hands and mouth, and so will not even pick up new foods. Messy play helps them to get used to new textures.
• Give small frequent meals of foods that your child accepts.
  Reason: Some children become very anxious at mealtimes and are sometimes very slow eaters. Small frequent meals will help them to take in the calories that they need.
• Remember, even children who are extremely faddy eaters usually grow and develop normally, if they are given the foods that they will accept.
  Reason:It is important to keep your child growing well, and these extreme food refusers do grow as we would expect them to if they have enough of the food that they will eat.