Video Abstract
Picky eating is common, yet little is known about trajectories of picky eating in childhood. Our objectives were to examine trajectories of child picky eating in low-income US children from ages 4 to 9 years and associations of those trajectories with participant characteristics, including child BMI z score (BMIz) and maternal feeding-behavior trajectories.
Mother-child dyads (N = 317) provided anthropometry and reported on picky eating and maternal feeding behaviors via questionnaires at child ages 4, 5, 6, 8, and 9 years. At baseline, mothers reported on demographics and child emotional regulation. Trajectories of picky eating and maternal feeding behaviors were identified by using latent class analysis. Bivariate analyses examined associations of picky-eating trajectory membership with baseline characteristics and maternal feeding-behavior trajectory memberships. A linear mixed model was used to examine the association of BMIz with picky-eating trajectories.
Three trajectories of picky eating emerged: persistently low (n = 92; 29%), persistently medium (n = 181; 57%), and persistently high (n = 44; 14%). Membership in the high picky-eating trajectory was associated with higher child emotional lability and lower child emotional regulation. Picky eating was associated with restriction (P = .01) and demandingness (P < .001) trajectory memberships, such that low picky eating was associated with low restriction and high picky eating was associated with high demandingness. Medium and high picky-eating trajectories were associated with lower BMIz.
Picky eating appears to be traitlike in childhood and may be protective against higher BMIz.
Comments
RE: Trajectories of picky eating in low-income US children.
The June 2020 study published by Fernandez et al. has contributed to the knowledge base on the trajectories of picky eating behaviors in children as well as parental feeding behaviors. This study wisely recommends early interventions for children identified as picky eaters. We agree fully with the authors that it is important for healthcare professionals to be aware that parents need appropriate and prompt support. Struggles over picky eating in childhood creates ongoing family misery and strife and has been correlated with eating disorders later in life(1).
We found interesting that the children’s behaviors that are described as picky in the Child Eating Behavior Questionnaire (CEBQ)(2) are, in fact, a part of normal eating behavior in toddlers and school age children. Children are commonly skeptical of new food and uninterested in eating or even tasting it(3). The ideal early intervention then would help parents understand that these are normal child eating behaviors that demonstrate the child’s caution in approaching new food. This does not mean that the child will be picky for life nor imply that picky eating at its extreme is normal. Given time and repeated neutral exposure, new foods become familiar food, and children gradually learn to eat the food their parents eat(3).
We add a warning to the authors’ suggestion that child picky eating may be protective of overweight and obesity. Lower child BMI is as likely to be a cause as an effect of picky eating. Evidence shows that parents of children who are naturally smaller tend to exert more pressure and control in feeding. These feeding behaviors, in turn, make their children pickier(4,5). We find it important to make this distinction for healthcare personnel who may Ignore reported picky eating behaviors in children who are perceived as large thinking that child’s picky eating may be protective against obesity. This has the potential to cause harm and not allow a child to develop eating skills that are needed for ideal health and wellbeing as they grow. It is important for healthcare professionals to be aware that parents of children at all BMI levels need appropriate and prompt support.
The authors conclude with a recommendation that future work examine effects of picky-eating interventions on children’s weight gain and maternal feeding-behavior trajectories. We remind the authors that for future interventions there is already a recognized AAP best practice feeding model widely used and depended upon by primary care providers and parents that applies the research on repeated neutral exposure: the Satter Division of Responsibility in Feeding (sDOR). A questionnaire for examining parent adherence to sDOR, sDOR.2-6yTM, has been validated and will soon be published.
1.Herle M, De Stavola B, Hübel C et al. A longitudinal study of eating behaviors in childhood and later eating disorder behaviors and diagnoses. The British Journal of Psychiatry. 2020; 216(2):113-119.
2.Wardle JC, Guthrie A, Sanderson S Rapoport L. Development of the Children's Eating Behaviour Questionnaire. J Child Psychol Psychiatry. 2001; 42: 963-970.
3.Birch LL, Marlin DW. I don't like it; I never tried it: Effects of exposure on two-year-old children's food preferences. Appetite. 1982;3: 353-360.
4.Satter EM. The feeding relationship: problems and interventions. J Pediatr. 1990; 117: S181-S189.
5.Webber L, Cooke L, Hill C, and Wardle J. Child adiposity and maternal feeding practices: a longitudinal analysis. Am J Clin Nutr. 2010; 92(6): 1423-1428.