孩子挑食 · 为什么怕新菜、嫌菜苦

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1. 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
2. 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
3. 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
4. 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
5. 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
6. 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
7. 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
8. 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
9. 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
10. 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
11. 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
12. 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
13. 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
14. 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
15. 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
16. 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
17. 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
18. 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
19. 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
20. 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