Picky eating: Factors affecting feeding

Many toddlers and infants go through a phase of picky eating – this won’t come a surprise to anyone, and is probably an intimately familiar story to many listeners – however, what kind of effect does picky eating at so young an age have on later health and habits? How is that affected by changing diets? And what’s the best way to encourage children to try something new?

Read more about the research from Dr Caroline Taylor and Dr Pauline Emmett here, and follow their project at the Bristol University website.

Will:

Hello, I’m well welcome to research part in this episode, many total is an infants go through a phase of picky eating. This won’t come as a surprise to anyone and it’s probably an intimately familiar story to many listeners. However, what kind of effect does picky eating it so young and age have on later health and habits? How is that affected by changing diets and what’s the best way to encourage children to try something new? Joining me to discuss every research into picky eating on a population wide level is Dr Caroline Taylor and Dr Pauline Emmett from Bristol university, Dr Pauline Emmett and Dr Caroline Taylor. Hello.

Dr Emmett:

Hi

Will:

this is something that’s been covered in our system magazine research outreach, but for the listeners at home, could you tell us a little bit about your research background?

Dr Emmett:

Well, I’m a nutritionist and dietician and I’ve been working on a longitudinal study which has looked at children’s diets for many years and this is where the research has come from.

Dr Taylor:

I’m also a nutritionist. I’m particularly interested in nutrition in pregnancy and early childhood and I’ve worked recently with Pauline on some of the studies she’s been working on with the data that she has available and we’ve been working particularly on early children’s diets.

Will:

What kind of area within nutrition and diets do you focus on in this article?

Dr Emmett:

Well, in this article we’ve looked at picky eating when very young children start to be a bit difficult about what they’re going to eat and it’s an area where parents are very worried often about how to feed their children and how to get them to eat a well balanced diet.

Will:

Now picky eating, like you say many people out there, lots of personal experience, but is there a specific definition that we’re working with when it comes to picky eating here?

Dr Taylor:

Well, that that’s part of the problem with doing research in this area. I think intuitively we recognize picky eating and children when we see it, so when we hear about it, but scientifically there isn’t one single definition that everybody working in this area accepts and this is something that makes me search in this area rather difficult because different scientists have different definitions so it’s sometimes difficult to look across studies and to try and compare them and come to some more overall conclusion.

Will:

And does it fit within something of a, a spectrum of feeding difficulty then like if some people might rate just not liking green apples is picky eating compared to more complex systems?

Dr Taylor:

Pauline will chip in on this. I’m sure most people do accept that there are some sort of aspects of picky eating that are common in most people’s definition and they would include some elements of refusing to eat foods that they haven’t come across before. We’re unfamiliar with them, but also sometimes it also would include children refusing to eat foods that they had been familiar with and perhaps there would also be elements of perhaps eating very slowly or changes in what they like and they don’t like.

Dr Emmett:

Yes. What we did was, um, we had a questionnaire to parents and we’ve looked at a specific question within that questionnaire. Well, we all asked did they have difficulty with feeding their child? Most of the child choosy about the food. So it was a parent or definition, we didn’t ask the parents exactly what they meant by that.

Will:

You’ll know it when you see it, I guess.

Dr Emmett:

Yes.

Will:

And that would be the ALSPAC trial if there’s a nice way of saying it.

Dr Taylor:

Yeah. So it’s also called the “Children of the 90s” study and it’s a study that’s been running in Bristol since the early 1990s. There was about 14 and a half thousand pregnant women recruited into the study and we’ve been using data that they provided on the children they had from those pregnancies,

Will:

some of that data has been followed up for all of that time?

Dr Taylor:

That’s right. I mean, the, the children of the mothers that recruited are still being followed to this day. And um, some of them have had their own children and they are also being included in the study.

Dr Emmett:

So then they’re in their mid twenties we’ve been looking at what was happening to them when they were very young children, but they have been followed up ever since. So we have information about their diet as teenagers as well as their diet as two year olds and three year olds.

Dr Taylor:

So what makes the children of the 90s studies so special is the longitudinal nature of the data. Many studies are cross-sectional, they just look at a particular moment in time. But the children of the the nineties study, because it’s followed children for such a long time is a uniquely rich source of data on lots of different topics.

Will:

So you can see behavior changing across age, perhaps

Dr Emmett:

Yes. So for example, with this study, we asked the parents when the children were 15 months, whether their child was choosy with food and we asked them were they worried about it? If their child was choosy with food and 56% of them felt that child was choosy at 15 months of age. And this is really quite common, but only 5% of those were greatly my read about it. More than half knew that it was quite a usual thing and look quite relaxed.

Will:

Just kids will be kids…

Dr Emmett:

Yes, yes. So some people did find it a really worrying thing. Um, what we looked at as a result of that was if the mother was very worried about it, did it make a difference? And what we found was that when we asked the question again at three years, those with the parents that were worried were really worried about it. We’re much more likely to picky eaters at that stage than the children whose parents weren’t worried. So the worry of the parents seemed to make matters worse

Will:

that is unfortunate for those parents.

Dr Taylor:

But what we have been able to show is although the diets of these children will slightly less good and the picky eating children with slightly less good than the non picky children, it wasn’t awful. We felt we’re able to reassure parents that picky eating isn’t such a bad thing and just to try and relax about it and try to feed the children in a normal way as normal a way as possible.

Will:

In terms of any health impacts, weight or nutrition, any deficiencies for mineral intake, there’s not that much cause for concern, then?

Dr Taylor:

we looked at to the diets of the children who are picky at three years over quite a few years, until they were almost 13 until though there were some differences in the diets between the picky eaters and the non picky eaters, especially in for example, vegetables. So the picky eaters ate quite a lot less vegetables. We didn’t find any difference in the way that they grew, so they were similar in their weight and Heights when they got into teenage years and we didn’t find that there were any real problems in terms of actual nutrients. So the picky eaters weren’t really going very short of important essential nutrients.

Dr Emmett:

So we were following ordinary children in everyday life. There are of course some children that do have very difficult problems and in that case, if a parent has got a child who’s really difficult, they should be consulting with their GP and then possibly being referred on because most children, it’s just a natural phase. It usually resolves itself by the parents carrying on, eating in the normal way and eating with their children, feeding them sensible foods. And it usually just resolves. But there are a few children that do have worse problems and in that case it becomes a medical problem rather than just an ordinary eating….

Will:

Eating choice, i guess? or eating phase?

Dr Taylor:

Yeah. So I think what we want to put forward is that to us, this is a normal phase of development. It’s part of the interaction, particularly between the mother and the child and parts of a way of the child’s expressing their independence and their ability to make choices for themselves. And it usually occurs around about the age of three. And if the parents, and particularly the mother can not get involved in that kind of control cycle, then it doesn’t get escalated. So that’s, that’s why we’re sending messages of reassurance that it’s almost a normal phase of behavior. And usually, as Pauline’s said, when the children get to school and they’re exposed to other foods, other ways of eating, they get a chance to express their personality and their independence at school. And then the behavior usually resolves.

Will:

And in terms of the longer followup that you’ve had for some of these data points coming up, like you say, 10 20 years on, have there been any effects in later life that you might not have foreseen that three years or 15 months?

Dr Emmett:

We’ve only been able to follow the children up to age 13 at the moment because each time we try to look at a particular aspect it takes a long time. You have to write scientific papers, which are, you know, labor intensive. Um, so at the moment we’re only up to age 13 at that age. There’s very, very little difference between the diets of the children that were picky as young children at three and the diet set for the rest of the population. So it is resolving, they are eating normally compared to other children by the age of 13 apart from one or two that might’ve, you know, had further problems. But those will have been very obvious and I expect the parents will have sorted those.

Will:

And those would be things like autism spectrum disorders or sensory processing disorders….

Dr Emmett:

Yeah. They’re slightly more likely to be picky eaters than other children and can get entrenched and that’s part of the autistic spectrum disorder rather than the picky eating as such.

Will:

A symptom of one but not a cause of the other.

Dr Taylor:

Yeah, so so there are a very few children in whom the behavior becomes embedded and they can go on to become picky eating adults, which is very socially disabling and not, you know, hidden and causes people a lot of difficulties. So if that behavior is becoming embedded, that is when parents should seek medical advice and help and intervention. But that is only a very small fraction of children.

Will:

And in terms of the long tail of this, how long will these children and now teenagers and adults of the nineties be followed up until

Dr Emmett:

the children of the 90s will be followed up… Forever? Hopefully [inaudible] funding permitting children of the 90s group are looking for funding all the time. We do have good support from the Wellcome trust and the MRC medical research council who do regularly fund the children of the nineties is a major, major study, world famous study producing amazing results all the time. So the chances of not getting funding at all are quite low. I think. You know, it is well thought of. So, um, Bristol is famous for this study

Will:

in terms of continuing this research forwards, are there any other avenues that this is opened up to you to maybe explore in different ways or different audiences, diets, any other way to branch out from this?

Dr Emmett:

Well, one of the things we are looking at is obesity development. This is the opposite end of the spectrum from picky eating I suppose. And we have done some work on that and looked at the type of diet that children are eating and it is very difficult to show that energy intake is associated with increasing obesity. But what we have been able to show is that type of diet is important. Um, lack of fruit and vegetables is one of the strongest determinants of putting on weight and becoming base. So lack of fruit and vegetables at one end and too much of the sweet treats and biscuits and cakes, low fiber bread, that sort of thing at the other end. So too much of that too little. You have the whole grains and the fruit and vegetables at the other end seem to be associated with putting on weight during your teenage years.

Will:

I can speak from personal experience, so yes, it wasn’t so much an absence of vegetables for me as replacing them with biscuits, the same volume, just the problem kind of mix.

Dr Taylor:

That’s right. And this, this is one of the major differences that comes out for picky eaters as well, that they avoid fruits and vegetables and particularly vegetables possibly because they have a bitter taste that some children really don’t like. As Pauline was saying, it’s really all children don’t teach enough fruit and vegetables. It’s just that picky eaters eat even less. So my message would be to encourage parents to help all children eat more fruits and vegetables

Dr Emmett:

and we have done some research on an EU funded project looking at introduction of fruit of vegetables into the diet and shown that the first time you give the child a vegetable, they don’t like it. They turn up their noses, say they don’t want it or spit it out if they’re very young. But if you kind of severe give the same vegetable regularly, not every day, but whenever you eating it, it’s always a good idea to be modeling eating the same foods as the children, but whenever you’re eating it, give them a very small portion of that vegetable and gradually they’ll get to like it. It’s very unusual for people to continue not to like something once they’ve tasted it several times,

Dr Taylor:

but it can take a dozen, maybe a dozen times.

Dr Emmett:

If you make an effort, you know if are eating carrots on your plate, just put one piece of carrot on this. Just carry on as normal. Don’t say anything. If they don’t eat it, don’t worry about it. If they do eat it the next time, put two pieces of carrot and so on, and it just becomes a normal thing for them to eat.

Dr Taylor:

The other thing that’s really important as well is I’m having family meal times, trying to not get drawn into cooking lots of different items for different family members. So perhaps have family meal times just cook one meal and the children eat that. No offer of extra things if the main meals refused

Will:

Slowly kind of bring people back towards social eating.

Dr Emmett:

Yeah, and I think, you know we found when we were doing the children of the nineties food records, children do seem to like roast dinners. So if you can build on that and you know, have a, have a roast dinner once a week, build on that sort of thing. They do actually enjoy sitting and eating with parents in a social gathering. And if you can’t do it every day, do it as often as possible. Yknow, three or four times a week minimum really. And it just helps the children, they see how to eat, how to sit at a table, how to behave. They get a chance to talk among themselves, don’t have the television on the radio, sit and talk to children and eat as a family. And it does make a difference.

Will:

Sounds like a down home traditional evening.

Dr Emmett:

Yeah, absolutely. Yeah, absolutely, and go away off to that and you know, do other things. But if you can have half an hour sitting around a table each evening, that’s, that’s really good because just eating with the television on, you’re not really concentrating on the food that you’re eating. It’s really important to try and engage with the food and with your family.

Will:

I suppose that ties into wider concerns about engaging with your diet from farm to table.

Dr Emmett:

Yeah. And children actually learn a lot about that sort of stuff at school. So you can tap into what they’re doing at school with family meals,

Dr Taylor:

but you didn’t have to go to a lot of expense buying sort of locally sourced vegetables or you know, expensive items. You can just use vegetables, you know, that are widely available and foods that are easy to get, and you don’t have to spend a lot of money feeding children.

Will:

Doesn’t have to be the full M&S shop.

Dr Emmett:

No. Oh, no, definitely. No, I mean the frozen vegetables from my slender, very good. Especially when other vegetables are out of season. You know, some, sometimes of the year it’s quite difficult to get a whole range. So, frozen veg, as part of a balanced diet are excellent.

Will:

So it doesn’t have to be a full economic and lifestyle change. Just the attitudes and the period of time spent eating.

Dr Emmett:

Yeah. A meal should have some vegetables and or fruit, not just carbohydrate

Will:

Three forms of potato doesn’t quite a meal make.

Dr Taylor:

No, no.

Will:

Despite my best efforts.

Dr Taylor:

potatoes don’t count as your five a day

Dr Emmett:

potatoes are fine. But when we’re, when we mean vegetables, we mean all the other ones, not just the potatoes.

Dr Taylor:

Eat a rainbow.

Dr Emmett:

A rainbow is a very, very good way of doing it. Yes. And that’s the sort of thing you can talk to children about. That’s a really basic thing that they understand really, really well.

Dr Taylor:

The other thing, it’s nice to deal with children as well as um, get them involved in cooking because most children absolutely love doing things in the kitchen with the family. And if children have a stake in designing meals and then making them, there’ll be encouraged to eat them as well. So your cooking sessions don’t always have to be cakes and biscuits with children, you can get them helping to make main meals as well.

Will:

So some of that you’ve seen with picky eaters that as well as just being offered the food enough times. If they’ve made the food they are less distant from it

Dr Emmett:

Oh I think so. That works with all children and also touching it, feeling it, seeing what happens when it’s cooked, you know, just being involved altogether. It’s sometimes that children have got, just all of us have got detached from food, you know, we just go to the supermarket, buy a packet of something. You don’t actually have to handle it in any way. Whereas when you handling and feeling food and, and cutting it up and you know, preparing it, it makes a lot of difference to the way you feel about it.

Dr Taylor:

And it probably helps children to become familiar with different types of fruits and vegetables as well and breaks down that sort of barrier of suspicion. And you know the unknowingness

Dr Emmett:

well with a, with a picky child you, you could start by getting them just to feel the food play with it. Not necessarily eating if that’s a problem. But you know once they are a lot more familiar with the foods they’re going to be much more likely to want to try it

Will:

and normal and placed fully in the context of it’s been bought, it’s been prepared and now we eat it and we share in that experience.

Dr Emmett:

Yes, that’s right. So that’s the way forward on the picky eaters, not making a thing about it, not standing over them and making them eat something.

Dr Taylor:

you want to get away from that power struggle.

Dr Emmett:

Absolutely. It’s difficult.

Dr Taylor:

It’s difficult to do when you’re in the midst of it to try and step back…

Dr Emmett:

And children soon learn how to wind you up.

Will:

I learned how to wind up my parents from my older brother…

Well if people do want to stay in touch with your research or keep track of it. What would be the best way for them to follow along?

Dr Taylor:

Look at our staff pages cause they always updated with our publications.

Dr Emmett:

the children of the nineties ALSPAC study have a very good webpage. Searching on our names actually works quite well.

Will:

Thank you both very much for your time.

Dr Emmett:

It’s a pleasure. Thank you.

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