Research & Education

Picky Eating in Childhood

Parents dealing with children who display limited and strong food preferences as well as an unwillingness to try new foods are not strangers to the frustration and anxiety picky eating can provoke. Picky eating is a relatively common problem among children affecting up to 50 percent of all 2 year olds. Concerns regarding restrictive diets nutrient deficiencies the development of eating disorders and adverse health outcomes are legitimate and although some children do seem to outgrow this trend its growing prevalence and potential consequences make it a topic worthy of consideration. Children classified as picky eaters generally have a strong preference for a limited variety of low nutrient dense foods such as sugary or salty snacks and refined grains while avoiding fruits and vegetables fiber-rich foods and a variety of protein sources. Additionally picky eaters tend to have special preferences for food texture color and combinations. A chronic avoidance of nutrient rich foods can potentially lead to poor growth rates the development of eating disorders micro-nutrient deficiencies sleep disruptions gastrointestinal issues (ie. constipation) hormonal imbalances reduced immunity and poor cognitive or behavioral development. Exclusive intake of high-energy foods can potentially lead to childhood obesity and its comorbid conditions. Picky eaters also bring notable stress upon caregivers and family relationships. 

Factors contributing to the development of picky eating in children are numerous but give insight into possible behavioral changes that could curb this trend. Several studies have agreed that early feeding practices seem to influence the incidence of pickiness in childhood substantially. Early cessation of exclusive breastfeeding and subsequent weaning has been related to pickiness in children while waiting to wean until after 6 months has been found to reduce the odds of picky eating in early childhood. Formula feeding versus breast-feeding may play a role as well. Breast milk has the innate ability to take on the flavor of a mother’s diet. Therefore infants who are breastfed have a greater exposure to various flavors and are found to be less picky and more willing to try new foods. Consequently it is equally important for mothers who are breastfeeding to consume a diet with varied flavors and types of foods in order to avoid preferences for a limited number of food groups.

As the weaning process begins there are some critical actions that can be taken to avoid future pickiness and promote good food acceptance in children. Repeated exposure to various food flavors and textures is necessary for developing a wide range of food acceptance. Children may need to be exposed to a new food or texture up to 8-15 times before accepting it. Many parents incorrectly assume that a child’s rejection of new food indicates dislike. However neophobia (avoidance of new food) is a naturally occurring protective mechanism which all children possess in order to avoid dangerous compounds. Therefore repeated exposure is necessary to overcome this natural propensity to reject new food. As a new food is introduced it does not need to constitute an entire meal; but rather just a bite or two will be sufficient to build a tolerance to that food and eventually a positive acceptance of it. 

Finally studies support the idea that children’s food preferences and behaviors do indeed mirror that of their parents or caregivers. Children are more willing to accept food that those around them are eating. If parents and caregivers display pleasure in consuming nutrient rich foods such as fruits and vegetables children will be more likely to assume a positive attitude toward these same foods. 

As parents and caregivers work through the process of transitioning a child from being a picky eater to accepting a greater variety of foods it may be important to address nutrient deficiencies that may be common among picky eaters. Deficiencies are dependent on the types and amounts of foods consumed regularly and therefore may not be reflected in all picky eaters. Inadequate energy intake from protein and fat has been shown to be a concern among picky children if their finicky eating habits began early in life. This would apply particularly to those children whose preference is for sugary foods and refined carbohydrates while avoiding most meat and protein sources. Making shakes with bananas (a commonly accepted food among picky eaters) and an added protein powder may be beneficial. Inadequate fiber intake is a significant issue among picky eaters often leading to chronic constipation. Reduced or absent intake of fibrous vegetables beans legumes and whole grains is clearly responsible for this dilemma. Exchanging refined grains for whole grains may be an easier transition than forcing a picky eater to eat vegetables and beans; however hiding natural fiber such as chia seeds or flax in shakes or nut butter may help to increase fiber intake initially. In a study evaluating micronutrient intakes of picky and non-picky children it was found that picky eaters had significantly lower intakes of vitamin E and folate compared to non-picky eaters although both groups fell below recommended US intakes. Other studies found picky eaters to be deficient in calcium iron zinc vitamins A C and D thiamin and niacin. Adequate micronutrients are critical for physical and cognitive development and therefore it is essential that children who are not consuming a variety of nutrient rich foods are provided with an age-appropriate multivitamin. 

In light of the rapidly declining health of Americans it is imperative that we consider all aspects of early intervention in wellness and disease prevention. Picky eating in toddlerhood and childhood may easily be an overlooked factor in this health dilemma. Educating parents and caregivers in tangible ways to prevent and overcome pickiness as well as being aware of the immediate and long-term health challenges associated with inadequate nutrient consumption could have great benefit on the future health of the next generation.