Story
Picky Eating in Children
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In one pass A child of two or three who starts pushing away new dishes, and even some familiar ones, is usually not spoiled.
Educational content, not medical advice — consult a clinician.
Story path
Chapter 1
Fear of new food is a stage
A child of two or three who starts pushing away new dishes, and even some familiar ones, is usually not spoiled. This is a common stage of development, and most children grow out of it.
Reluctance to eat unfamiliar food is called food neophobia, and it is usually strongest between ages 2 and 6. Researchers see it as a protection that made sense in evolution: being wary of strange food first means swallowing fewer things that might be harmful. Food is much safer today, but the caution is still there in children.
Picky eating is broader: the child turns down not only new dishes but a good number of familiar foods too, and eats a narrow range. In a Dutch study of 4018 children, mothers described 27.6% as picky at age 3, falling to 13.2% at age 6; almost two thirds of early picky eaters stopped being picky within 3 years.
If a child chokes while eating and cannot cough or breathe in, get someone to call emergency services and start back blows at once; When it is more than picky eating shows how. Frequent coughing or choking at meals, trouble swallowing, or weight going down is more than picky eating; the chapter When it is more than picky eating lists the situations that need a doctor.
Reluctance to eat unfamiliar food is called food neophobia, and it is usually strongest between ages 2 and 6. Researchers see it as a protection that made sense in evolution: being wary of strange food first means swallowing fewer things that might be harmful. Food is much safer today, but the caution is still there in children.
Picky eating is broader: the child turns down not only new dishes but a good number of familiar foods too, and eats a narrow range. In a Dutch study of 4018 children, mothers described 27.6% as picky at age 3, falling to 13.2% at age 6; almost two thirds of early picky eaters stopped being picky within 3 years.
If a child chokes while eating and cannot cough or breathe in, get someone to call emergency services and start back blows at once; When it is more than picky eating shows how. Frequent coughing or choking at meals, trouble swallowing, or weight going down is more than picky eating; the chapter When it is more than picky eating lists the situations that need a doctor.
Evidence · How much food fear is inborn
A UK study asked the parents of 5390 pairs of twins aged 8 to 11 to fill in questionnaires on how much their children feared new food. Comparing identical and non-identical twins, it estimated that genes explained about 78% of the differences; the other 22% came from experiences unique to each child, and the environment a family shares explained almost none (Cooke 2007).Two things follow. First, how wary a child is of new food is largely inborn; it is not that the parents fed them wrong, so there is no need for guilt. Second, inborn does not mean fixed: heritability describes why a group of children differ from one another, not how much one child can change. The trials in the chapter Liking grows with repeated tastes work on exactly that: each child's own experience.
Know the limits: this is a tendency measured by parent questionnaires, not observed at the table, and the children were twins in the UK.
cooke-2007-neophobia-heritability
Chapter 2
Bitter tastes stronger to children
Much of the reason children dislike leafy greens is on the tongue: the same mouthful tastes more bitter to a child than to an adult.
The tongue carries bitter taste receptors (TAS2R), whose job is to raise an alarm: bitterness often signals poison, and spitting out what tastes bitter means swallowing fewer toxins. Sweetness works the other way. Children are born liking sweet, and sweetness draws a newborn to breast milk.
Both leanings are stronger in children than in adults. Children prefer a higher level of sweetness than adults do, and only around middle to late adolescence, about when the body stops growing taller, does that preference fall to adult levels. For bitterness, children with the same genotype are more sensitive than adults, and the difference fades only in mid-adolescence. What children reject first is exactly the bitterness of green vegetables and liquid medicines (Mennella review).
So a child who calls vegetables bitter is using a sense of taste that has not finished growing; it is not an act, and it is not a bad habit. It changes with age, and the approach in the chapter Liking grows with repeated tastes can help a child come to accept it.
The tongue carries bitter taste receptors (TAS2R), whose job is to raise an alarm: bitterness often signals poison, and spitting out what tastes bitter means swallowing fewer toxins. Sweetness works the other way. Children are born liking sweet, and sweetness draws a newborn to breast milk.
Both leanings are stronger in children than in adults. Children prefer a higher level of sweetness than adults do, and only around middle to late adolescence, about when the body stops growing taller, does that preference fall to adult levels. For bitterness, children with the same genotype are more sensitive than adults, and the difference fades only in mid-adolescence. What children reject first is exactly the bitterness of green vegetables and liquid medicines (Mennella review).
So a child who calls vegetables bitter is using a sense of taste that has not finished growing; it is not an act, and it is not a bad habit. It changes with age, and the approach in the chapter Liking grows with repeated tastes can help a child come to accept it.
Evidence · Genes make some children more sensitive
The bitter receptor gene TAS2R38 comes in several common versions: some people are very sensitive to a bitter compound called PROP, and others can barely taste it. A US study genotyped 143 children and their mothers and used games to measure bitter sensitivity and sweet preference (Mennella 2005).Among people carrying one sensitive and one insensitive copy, 64% of children could taste the faintest level of bitterness, compared with 43% of mothers: the same genes, but more sensitive in children.Children carrying a sensitive copy preferred sweeter sugar water and sweeter cereals and drinks; in the mothers this link did not appear, and race, ethnicity and culture mattered more.
This is a one-time cross-sectional study. It shows that genes and taste preferences are linked; it cannot say that any one child is picky because of genes. But it is a reminder for adults: a vegetable that does not taste bitter to you may taste quite different to your child.
Chapter 3
Appetite swings from meal to meal
When a child's appetite drops after age one or two, growth is often part of the reason: babies grow very fast in the first year, and after that the pace slows clearly, so appetite is no longer as fierce. A pediatric review also notes that many young children whose parents think they eat too little are only mildly affected, and some are within the normal range and simply misperceived (Kerzner 2015).
A child's body also adjusts on its own: a big meal is followed by a smaller one. A US study weighed everything 15 children aged 2 to 5 ate over 6 days. Meal by meal, intake swung widely, with an average variation of about 33.6%; over a whole day, the variation was only about 10.4% (Birch 1991). Children balance the books over the day, not meal by meal.
That is why the NHS advises looking at what a child eats over a week rather than a day; a child who is active, gaining weight and seems well is getting enough.
What most easily throws this balance off is snacks and drinks between meals: a glass of milk or a carton of juice can take up the appetite for the next meal. The NHS says 2 healthy snacks a day is plenty, and the European pediatric society advises that toddlers over 1 have less than 500 mL of cow's milk a day; drinking too much is also a risk factor for iron deficiency.
A child's body also adjusts on its own: a big meal is followed by a smaller one. A US study weighed everything 15 children aged 2 to 5 ate over 6 days. Meal by meal, intake swung widely, with an average variation of about 33.6%; over a whole day, the variation was only about 10.4% (Birch 1991). Children balance the books over the day, not meal by meal.
That is why the NHS advises looking at what a child eats over a week rather than a day; a child who is active, gaining weight and seems well is getting enough.
What most easily throws this balance off is snacks and drinks between meals: a glass of milk or a carton of juice can take up the appetite for the next meal. The NHS says 2 healthy snacks a day is plenty, and the European pediatric society advises that toddlers over 1 have less than 500 mL of cow's milk a day; drinking too much is also a risk factor for iron deficiency.
Evidence · Tighter control, weaker self-regulation
Can adults override this self-adjusting appetite? One study gave 77 children aged 3 to 5 two-part meals: the energy density of the first part was set higher or lower, and researchers watched whether the children ate less or more in the second part to match (Johnson 1994).Children with more body fat were less able to adjust later intake to the energy they had already eaten.The best predictor of this ability was how tightly the mother controlled feeding: the tighter the control, the poorer the child's adjustment, with a correlation of -0.67.
This is a correlational study. It cannot show that tight control causes the problem; it may be that children who adjust poorly lead their mothers to control more. The authors concluded that the environment most likely to help a child learn to manage how much they eat is one where adults provide healthy choices and leave the amount to the child.
Chapter 4
Liking grows with repeated tastes
The best-supported way to help a child accept a food is plain: offer small tastes, again and again, without asking them to finish.
The protective mechanism behind fear of new food predicts that a food tasted several times with nothing bad happening moves from strange to familiar, and the wariness eases; that step has not been measured directly, but trials find results in that direction. In a UK randomized trial, 156 parents of children aged 2 to 6 first picked a vegetable their child disliked, and one group gave the child a taste of it every day for 14 days. In that group, liking for the vegetable and the amount eaten rose more than in the groups that got only nutrition information or nothing at all (Wardle 2003).
A systematic review pooling 43 articles also found that repeated tasting of one vegetable made children like it more and eat more of it, and that tasting a variety of vegetables made a new vegetable easier to accept. But the effects were small, and there is little evidence on long-term benefit (Appleton 2018).
So be patient. One review suggests that 10 to 15 positive experiences may be needed; the NHS also says children's tastes change, and something hated this month may be loved a month later.
The protective mechanism behind fear of new food predicts that a food tasted several times with nothing bad happening moves from strange to familiar, and the wariness eases; that step has not been measured directly, but trials find results in that direction. In a UK randomized trial, 156 parents of children aged 2 to 6 first picked a vegetable their child disliked, and one group gave the child a taste of it every day for 14 days. In that group, liking for the vegetable and the amount eaten rose more than in the groups that got only nutrition information or nothing at all (Wardle 2003).
A systematic review pooling 43 articles also found that repeated tasting of one vegetable made children like it more and eat more of it, and that tasting a variety of vegetables made a new vegetable easier to accept. But the effects were small, and there is little evidence on long-term benefit (Appleton 2018).
So be patient. One review suggests that 10 to 15 positive experiences may be needed; the NHS also says children's tastes change, and something hated this month may be loved a month later.
In practice · How to offer a daily taste
Putting the trial methods together with NHS advice gives roughly this:One small taste at a time: make clear that a taste is enough and leave the amount to the child. Both trials used one taste a day, one for 8 days and one for 14 days (Wardle 2003).Eat together: children learn to eat new foods best by copying adults, so eat with them as often as you can, and eat the same food.Change how it is served: a child who refuses cooked carrots may eat raw grated carrot.If it is refused, take it away: say nothing, stay as calm as you can, and bring it back another day.Do not wait until they are too hungry or tired: start meals before your child is overhungry or worn out, and let a slow eater take their time.
All of this gives a child many tries with no pressure. A bite swallowed under pressure does not count as a positive experience; the chapter Why pressure to eat backfires explains why.
Chapter 5
Why pressure to eat backfires
Pushing a child to eat often makes them eat less and like the food less.
In a US experiment, 27 children aged 3 to 5 were served two soups repeatedly; for each child, one soup chosen at random always came with requests to finish it, and the other came with none. The children ate clearly more when they were not pressured, and made far more negative comments about the soup they were pressured to finish (Galloway 2006). The mechanism predicts that a food repeatedly paired with tension and unpleasantness leaves the child remembering the unpleasantness; this step has not been measured directly.
The evidence on rewards is mixed. In a trial in which 49 primary school children tasted red pepper, the group that earned a sticker for eating a piece landed between daily tasting alone and doing nothing, and did not differ clearly from either (Wardle 2003); a systematic review, on the other hand, found that rewards helped children eat a bit more (Appleton 2018). What the NHS clearly advises against is using food as a reward: children may come to think of sweets as nice and vegetables as nasty. If you want to reward, offer a trip to the park or a game together.
A simple split of roles: adults decide what is served, and the child decides how much to eat. That is the conclusion the authors of the Johnson 1994 study drew.
In a US experiment, 27 children aged 3 to 5 were served two soups repeatedly; for each child, one soup chosen at random always came with requests to finish it, and the other came with none. The children ate clearly more when they were not pressured, and made far more negative comments about the soup they were pressured to finish (Galloway 2006). The mechanism predicts that a food repeatedly paired with tension and unpleasantness leaves the child remembering the unpleasantness; this step has not been measured directly.
The evidence on rewards is mixed. In a trial in which 49 primary school children tasted red pepper, the group that earned a sticker for eating a piece landed between daily tasting alone and doing nothing, and did not differ clearly from either (Wardle 2003); a systematic review, on the other hand, found that rewards helped children eat a bit more (Appleton 2018). What the NHS clearly advises against is using food as a reward: children may come to think of sweets as nice and vegetables as nasty. If you want to reward, offer a trip to the park or a game together.
A simple split of roles: adults decide what is served, and the child decides how much to eat. That is the conclusion the authors of the Johnson 1994 study drew.
In practice · What to do at the table
NHS advice for parents of fussy eaters comes down to these steps at the table:Give your child the same food as the rest of the family, just without added salt in their portion.Serve small portions, and praise your child for eating, even if they eat only a little.If they refuse, do not force them; take the food away without saying anything, and try again another day.Talk about other things at meals, so the table is not only about eating.Ask an adult your child likes to eat with you; sometimes a child will eat more for a grandparent. You can also invite children of the same age who eat well, but do not keep comparing your child with them.
On the other side, insisting the plate is cleared, chasing the child with spoonfuls, and trading snacks for vegetables all add pressure to eating.
Some picky eating also traces back to early feeding: one review lists early feeding difficulties, lumpy foods introduced late in weaning, and pressure to eat among the causes. How babies practice tastes and chewing is covered in Starting solids.
Chapter 6
What picky eaters may run short of
Most picky eaters grow fine. What deserves attention is a few nutrients that are easy to fall short on: iron, zinc and dietary fiber.
In a long-running UK birth cohort (ALSPAC), picky eating had no consistent effect on growth. The problem is a narrow diet: eating little meat makes it easy to run short of iron and zinc, and eating few vegetables and fruits means little fiber (Taylor review).
Iron: toddlers grow fast and need plenty of iron. Meat and iron-fortified foods are good sources; after age 1, keep cow's milk under 500 mL a day, because drinking too much is a risk factor for iron deficiency.Fiber: in the same cohort, picky eaters around age 3 ate about 1.4 g less fiber a day and more often had hard stools; once fiber intake was added to the analysis, the link weakened and was no longer clear, which suggests it runs through low fiber (an observational study; Taylor 2016).Vitamins: the UK government recommends that all children from 6 months to 5 years, picky or not, have vitamin drops containing vitamins A, C and D every day (except babies having more than 500 mL of infant formula a day); do not give two supplements at once, such as cod liver oil plus drops. This is UK practice; elsewhere, follow your local child health doctor.
Do not decide on your own to add iron or zinc. Only a blood test can show whether a child is short of iron, so leave it to a pediatrician.
In a long-running UK birth cohort (ALSPAC), picky eating had no consistent effect on growth. The problem is a narrow diet: eating little meat makes it easy to run short of iron and zinc, and eating few vegetables and fruits means little fiber (Taylor review).
Iron: toddlers grow fast and need plenty of iron. Meat and iron-fortified foods are good sources; after age 1, keep cow's milk under 500 mL a day, because drinking too much is a risk factor for iron deficiency.Fiber: in the same cohort, picky eaters around age 3 ate about 1.4 g less fiber a day and more often had hard stools; once fiber intake was added to the analysis, the link weakened and was no longer clear, which suggests it runs through low fiber (an observational study; Taylor 2016).Vitamins: the UK government recommends that all children from 6 months to 5 years, picky or not, have vitamin drops containing vitamins A, C and D every day (except babies having more than 500 mL of infant formula a day); do not give two supplements at once, such as cod liver oil plus drops. This is UK practice; elsewhere, follow your local child health doctor.
Do not decide on your own to add iron or zinc. Only a blood test can show whether a child is short of iron, so leave it to a pediatrician.
Numbers · What persistent picky eaters miss
Pooling ALSPAC data, the Taylor review compares children who were picky throughout with children who were never picky:Energy intake did not differ; protein was about 8% lower on average, but no child was short of protein.Carotene, vitamin D, iron, zinc and selenium were all somewhat lower, by about 3% to 16%; a substantial share of children were below the lower reference intake for retinol and zinc.They ate about 40% less carcass meat, about 48% fewer vegetables and about 33% less fruit.
For growth, picky eaters' average weight, height and body mass index (, weight relative to height) stayed above the 50th centile, the middle of children their age, though a little below non-picky children, with slightly more thinness. The review also cautions that the non-picky children in this cohort grew well above average, so results could differ in another population, and that a small group who stay picky into adolescence may be more likely to be thin or to develop an eating disorder, and should be spotted early so parents get support.
In children around age 3, vegetables supplied only 8.9% of picky eaters' fiber, against 15.7% in non-picky children (Taylor 2016).
Chapter 7
When it is more than picky eating
Most picky eating improves with age and needs no medical care. These situations are more than picky eating.
Call emergency services now if a child chokes while eating and cannot cough or breathe in: shout for help, get someone to call emergency services, and start first aid at once: for a child over 1, lean them forward and give up to 5 back blows between the shoulder blades, then up to 5 abdominal thrusts, and keep alternating until help arrives; for babies under 1, see Starting solids.
Get an urgent appointment (the NHS lists these as needing urgent care): a child who often coughs or chokes when eating or drinking; food or milk coming back up, sometimes through the nose; a feeling that something is stuck in the throat; crying a lot or arching the back when feeding; a wet, gurgly voice after eating or drinking; shortness of breath after eating; or repeated chest infections. These can be signs of a swallowing problem.
See a pediatrician if:
Weight is going down, or the height and weight curves keep sliding.The child eats so little that they rely on nutritional supplements to get by, or tests find a nutritional deficiency such as iron deficiency anemia.After choking or vomiting once, the child is suddenly afraid to eat, or their aversion to smells or textures makes school or eating with others hard. This may be avoidant/restrictive food intake disorder (ARFID), which has nothing to do with fear of weight gain and has specific treatment.The child is still very picky after the preschool years.
This story is education and does not replace a diagnosis.
Call emergency services now if a child chokes while eating and cannot cough or breathe in: shout for help, get someone to call emergency services, and start first aid at once: for a child over 1, lean them forward and give up to 5 back blows between the shoulder blades, then up to 5 abdominal thrusts, and keep alternating until help arrives; for babies under 1, see Starting solids.
Get an urgent appointment (the NHS lists these as needing urgent care): a child who often coughs or chokes when eating or drinking; food or milk coming back up, sometimes through the nose; a feeling that something is stuck in the throat; crying a lot or arching the back when feeding; a wet, gurgly voice after eating or drinking; shortness of breath after eating; or repeated chest infections. These can be signs of a swallowing problem.
See a pediatrician if:
Weight is going down, or the height and weight curves keep sliding.The child eats so little that they rely on nutritional supplements to get by, or tests find a nutritional deficiency such as iron deficiency anemia.After choking or vomiting once, the child is suddenly afraid to eat, or their aversion to smells or textures makes school or eating with others hard. This may be avoidant/restrictive food intake disorder (ARFID), which has nothing to do with fear of weight gain and has specific treatment.The child is still very picky after the preschool years.
This story is education and does not replace a diagnosis.
References · 20
- Norris, M. L., Spettigue, W. J., & Katzman, D. K. (2016). Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatric Disease and Treatment, 12, 213-218. Review. ARFID (DSM-5) covers restrictive or avoidant eating that results in significant weight loss, growth compromise, reliance on nutritional supplements to meet energy needs, nutritional deficiency (such as iron deficiency anemia) or marked interference with psychosocial functioning, without fear of weight gain or body-shape concerns. It was meant to capture only clinically significant restriction, not the many children labelled picky or fussy eaters. Picky eating is generally defined in normal-weight children who eat an inadequate variety by rejecting familiar or unfamiliar foods; food neophobia generally peaks between the 2nd and 6th year of life and gradually declines (full text PMC4725687). 10.2147/NDT.S82538
- Białek-Dratwa, A., Szczepańska, E., Szymańska, D., Grajek, M., Krupa-Kotara, K., & Kowalski, O. (2022). Neophobia—a natural developmental stage or feeding difficulties for children? Nutrients, 14(7), 1521. Narrative review. Food neophobia, the reluctance to try new and unfamiliar foods, falls in early childhood and can shape taste preferences and diet quality. It has an evolutionary significance because it protects the individual from ingesting potentially dangerous substances, but it also fosters avoidance of beneficial foods; with today's emphasis on food safety it may be less adaptive, yet a conservative attitude toward new foods still prevails. Neophobia is strongly associated with diet diversity and with previous exposure to different foods; the review separates it from other feeding difficulties that need differentiating. 10.3390/nu14071521
- Cardona Cano, S., Tiemeier, H., Van Hoeken, D., Tharner, A., Jaddoe, V. W., Hofman, A., Verhulst, F. C., & Hoek, H. W. (2015). Trajectories of picky eating during childhood: a general population study. International Journal of Eating Disorders, 48(6), 570-579. Generation R cohort, 4018 children in the Netherlands, maternal report at 1.5, 3 and 6 years. Picky eating prevalence was 26.5% at 1.5 years, 27.6% at 3 and 13.2% at 6. Trajectories: never picky 55%, remitting 32%, late-onset 4%, persistent 4%; almost two thirds of early picky eaters remitted within 3 years. Picky eating is usually transient and part of normal development, but a group of persistent picky eaters, often from socially disadvantaged backgrounds, continues to have problems beyond preschool age. 10.1002/eat.22384
- Taylor, C. M., & Emmett, P. M. (2019). Picky eating in children: causes and consequences. Proceedings of the Nutrition Society, 78(2), 161-169. Narrative review centred on the UK ALSPAC cohort. Picky eating is common in early childhood, peaks at about age 3, and has no agreed definition. Causes include early feeding difficulties, late introduction of lumpy foods, pressure to eat and early choosiness; protective factors include fresh foods and eating the same meal as the child. Consequences: poor variety, low iron and zinc intakes (with low meat, fruit and vegetables) and low fibre linked to constipation. In ALSPAC persistent picky eaters had similar energy intake, 8% lower protein (none inadequate), 3-16% lower carotene, vitamin D, iron, zinc and selenium, and ate 40% less carcass meat, 48% less vegetables and 33% less fruit than never-picky children. Mean weight, height and BMI of picky eaters stayed above the 50th centile though below non-picky children, with slightly more thinness; non-picky ALSPAC children grew well above the 50th centile, so other populations may differ. Little evidence of a consistent effect on growth, but a small persistent subgroup may risk thinness in adolescence or an eating disorder. Strategies: repeated graded exposure (10-15 positive experiences may be needed), non-food rewards, avoiding pressure, parental modelling, limiting snacks and milk, juice or soft drinks between meals, family meals. 10.1017/S0029665118002586
- NHS. (2024). How to stop a child from choking. If the child is coughing loudly, encourage coughing and stay; if the cough is silent or they cannot breathe in properly, shout for help; while conscious, for babies under 1 give up to 5 back blows (face down along your thigh or forearm, head supported, heel of the hand between the shoulder blades) then up to 5 chest thrusts (face up, head lower, 2 fingers just below the nipple line), checking between each; for children over 1, give up to 5 back blows in a forward-leaning position, then up to 5 abdominal thrusts, checking between each; call 999 if the blockage does not come out and keep repeating until help arrives; get medical help even if the object comes out; don't poke blindly with fingers; if the child becomes unconscious, call 999 and start CPR (page last reviewed 28 October 2024). www.nhs.uk/baby/first-aid-and-safety/first-aid/how-to-stop-a-child-from-choking
- NHS. (2023). Dysphagia (swallowing problems). Signs include coughing or choking when eating or drinking, bringing food back up sometimes through the nose, a feeling that food is stuck, and a gurgly, wet-sounding voice when eating or drinking; over time it can cause weight loss, dehydration and repeated chest infections. Ask for an urgent GP appointment or get help from NHS 111 if you or your child has difficulty swallowing, coughs or chokes while eating or drinking, feels something is stuck in the throat after eating, keeps bringing food or milk back up sometimes through the nose, cries a lot or arches their back when feeding, has a wet, gurgly voice after eating or drinking, is short of breath after eating or drinking, or gets lots of chest infections (page last reviewed 2 May 2023). www.nhs.uk/symptoms/swallowing-problems-dysphagia
- Mennella, J. A., & Bobowski, N. K. (2015). The sweetness and bitterness of childhood: insights from basic research on taste preferences. Physiology & Behavior, 152(Pt B), 502-507. Review of experimental research: children are born preferring sweet tastes, prefer higher levels of sweet than adults, and their preference declines to adult levels during middle to late adolescence, coinciding with the end of physical growth. Children dislike and reject bitter taste, which protects them from ingesting poisons; children of the same TAS2R38 genotype are more bitter-sensitive than adults, with the changeover in mid-adolescence, and this shows in the green vegetables and liquid medicines they reject. Sugars and salts can partly mask bitterness, depending on the compound and the person's age. The heightened sweet preference and bitter dislike reflect basic biology, though often detrimental in the modern food environment. 10.1016/j.physbeh.2015.05.015
- Mennella, J. A., Pepino, M. Y., & Reed, D. R. (2005). Genetic and environmental determinants of bitter perception and sweet preferences. Pediatrics, 115(2), e216-e222. Cross-sectional study of 143 children and their mothers genotyped for the TAS2R38 bitter receptor gene (A49P). Genotype influenced bitter perception of PROP in children and adults, but the relation was modified by age: 64% of heterozygous children versus 43% of heterozygous mothers detected the lowest PROP concentration. Children with one or two bitter-sensitive alleles preferred higher sucrose concentrations and sweeter cereals and beverages; in adults genotype was not related to sweet preference, and race/ethnicity (culture and experience) was the strongest determinant. An association study: it links genotype to taste in children, not to picky eating as such. 10.1542/peds.2004-1582
- Kerzner, B., Milano, K., MacLean, W. C., Jr., Berall, G., Stuart, S., & Chatoor, I. (2015). A practical approach to classifying and managing feeding difficulties. Pediatrics, 135(2), 344-353. Many young children are thought by their parents to eat poorly; most are mildly affected, but a small percentage have a serious feeding disorder, and even mildly affected children whose anxious parents adopt inappropriate feeding practices may experience consequences, so pediatricians should take all parental concerns seriously. Children are categorized by limited appetite, selective intake and fear of feeding, each ranging from normal (misperceived) to severe (behavioral and organic), with caregiver feeding styles (responsive, controlling, indulgent, neglectful) included (abstract, PMID 25560449). 10.1542/peds.2014-1630
- Birch, L. L., Johnson, S. L., Andresen, G., Peters, J. C., & Schulte, M. C. (1991). The variability of young children's energy intake. New England Journal of Medicine, 324(4), 232-235. 24-hour food intake was measured for 15 children aged 2 to 5 years on six days. Intake at individual meals was highly variable (mean coefficient of variation 33.6%), but total daily energy intake was relatively constant (10.4%); in most cases high intake at one meal was followed by low intake at the next, or vice versa. Conclusion: although consumption varies from meal to meal, daily energy intake is relatively constant because children adjust intake at successive meals. Small observational study. 10.1056/NEJM199101243240405
- NHS. (2023). Fussy eaters. It is normal for toddlers to refuse to eat or taste new foods; think about what a child eats over a week rather than a day; a child who is active, gaining weight and seems well is getting enough. Keep offering a variety of foods and going back to rejected ones, since tastes change and it may take lots of attempts. Tips: give the same food as the family without added salt; children learn by copying, so eat together; small portions and praise; if food is rejected do not force, take it away calmly and try another time; do not leave meals until the child is too hungry or tired; be patient with slow eaters; 2 healthy snacks a day is plenty; do not use food as a reward, because the child may think of sweets as nice and vegetables as nasty, and use a trip to the park or a game instead; make mealtimes enjoyable; eat with other children or a liked adult; change how a food is served, for example raw grated carrot instead of cooked (page last reviewed 13 November 2023). www.nhs.uk/baby/weaning-and-feeding/fussy-eaters
- Domellöf, M., Braegger, C., Campoy, C., Colomb, V., Decsi, T., Fewtrell, M., et al. (2014). Iron requirements of infants and toddlers. Journal of Pediatric Gastroenterology and Nutrition, 58(1), 119–129. ESPGHAN position paper: rapid growth gives young children high iron requirements; risk factors for iron-deficiency anaemia include low birth weight, high cow's-milk intake and low intake of iron-rich complementary foods; no evidence that iron supplementation of pregnant women improves their offspring's iron status in a European setting; delayed cord clamping reduces the risk of iron deficiency; insufficient evidence for general iron supplementation of healthy normal-birth-weight European infants; marginally low-birth-weight infants (2000-2500 g) should receive iron supplements of 1-2 mg/kg/day; formula-fed infants up to 6 months should get iron-fortified formula; from 6 months all infants and toddlers should receive iron-rich foods including meat products and/or iron-fortified foods; unmodified cow's milk should not be the main milk drink before 12 months, and toddlers should have under 500 mL a day (abstract, PMID 24135983). 10.1097/MPG.0000000000000206
- Wardle, J., Cooke, L. J., Gibson, E. L., Sapochnik, M., Sheiham, A., & Lawson, M. (2003). Increasing children's acceptance of vegetables; a randomized trial of parent-led exposure. Appetite, 40(2), 155-162. 156 parents of 2-6 year old children were randomized to Exposure, Information or Control after a taste test that selected a previously disliked target vegetable. Exposure parents gave the child a taste of it daily for 14 days. Liking, ranking and consumption of the target vegetable rose more in the Exposure group than in either other group, and only the Exposure group improved significantly on all three. A short-term trial of one vegetable per child; the authors call daily tasting promising. 10.1016/S0195-6663(02)00135-6
- Appleton, K. M., Hemingway, A., Rajska, J., & Hartwell, H. (2018). Repeated exposure and conditioning strategies for increasing vegetable liking and intake: systematic review and meta-analyses of the published literature. The American Journal of Clinical Nutrition, 108(4), 842-856. Systematic review and meta-analyses of 43 articles (117 comparisons). Repeated exposure increased liking and intake of the exposed vegetable compared with no exposure; conditioning increased liking more than exposure alone, rewards increased intake, and flavor-nutrient conditioning may have decreased intake; exposure to a variety of vegetables increased liking and intake of a novel vegetable. But effect sizes are small, there is limited evidence of long-term benefit, and the analyses are limited by study design, compliance and reporting; larger realistic studies are needed. 10.1093/ajcn/nqy143
- Galloway, A. T., Fiorito, L. M., Francis, L. A., & Birch, L. L. (2006). 'Finish your soup': counterproductive effects of pressuring children to eat on intake and affect. Appetite, 46(3), 318-323. Repeated-measures experiment in 27 preschool children aged 3 to 5 years: each child was randomly assigned to have one of two soups consistently paired with pressure to eat (requests to finish it) and the other served without pressure. Children consumed significantly more when not pressured and made overwhelmingly fewer negative comments. Children pressured to eat at home had lower BMI percentiles and were less affected by the pressure in the lab. Small within-child experiment; supports earlier correlational work that pressure can harm children's affective responses to and intake of healthy foods. 10.1016/j.appet.2006.01.019
- Wardle, J., Herrera, M. L., Cooke, L., & Gibson, E. L. (2003). Modifying children's food preferences: the effects of exposure and reward on acceptance of an unfamiliar vegetable. European Journal of Clinical Nutrition, 57(2), 341-348. 49 children in three London primary schools were randomized to exposure, reward or no-treatment control for 2 weeks: eight daily sessions in which the exposure group was offered a taste of sweet red pepper and could eat as much as they liked, while the reward group could choose a cartoon sticker on condition of eating at least one piece. Exposure significantly increased liking and consumption compared with control; the reward group was intermediate and did not differ significantly from either exposure or control. Small trial. 10.1038/sj.ejcn.1601541
- Johnson, S. L., & Birch, L. L. (1994). Parents' and children's adiposity and eating style. Pediatrics, 94(5), 653-661. 77 children aged 3 to 5 years ate controlled two-part meals that tested whether they adjusted intake to changes in the caloric density of the diet. Children with greater body fat stores were less able to regulate energy intake accurately. The best predictor of children's ability to regulate was parental control in the feeding situation: mothers who were more controlling had children who showed less ability to self-regulate (r = -0.67). The authors suggest the optimal environment is one in which parents provide healthy food choices but let children control how much they eat. Correlational: it cannot show which way the relation runs. pubmed.ncbi.nlm.nih.gov/7936891
- Taylor, C. M., Northstone, K., Wernimont, S. M., & Emmett, P. M. (2016). Picky eating in preschool children: associations with dietary fibre intakes and stool hardness. Appetite, 100, 263-271. ALSPAC: dietary fibre intake at 38 months was lower in picky than non-picky eaters (mean difference -1.4 g/day), and picky eaters got a lower share of fibre from vegetables (8.9% vs 15.7%). Picky eating was associated with usually having hard stools at 42 months (OR 1.31, 95% CI 1.07-1.61), and this was attenuated when fibre was added to the model, suggesting fibre intake mediated the association. Observational, questionnaire-based. 10.1016/j.appet.2016.02.021
- NHS. (2024). Vitamins for children. The UK government recommends that all children aged 6 months to 5 years are given vitamin supplements containing vitamins A, C and D every day (babies having more than 500 mL of infant formula a day should not, because formula is fortified). Having too much of some vitamins can be harmful: keep to the dose on the label and do not give two supplements at the same time, for example cod liver oil and vitamin drops. A pharmacist can advise which supplement suits the child (page last reviewed 30 May 2024). www.nhs.uk/baby/weaning-and-feeding/vitamins-for-children
- NHS. (2024). Eating disorders: overview. Avoidant/restrictive food intake disorder (ARFID) is when someone avoids certain foods, limits how much they eat or both; beliefs about weight or body shape are not the reasons. Possible reasons include negative feelings over the smell, taste or texture of certain foods, a response to an upsetting past experience with food such as choking or being sick after eating, and not feeling hungry or a lack of interest in eating. Warning signs include dramatic weight loss and avoiding eating with others; see a GP as soon as possible, who may refer to an eating disorder specialist; with treatment most people recover (page last reviewed 23 January 2024). www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/eating-disorders/overview