Picky eating belongs to a spectrum of paediatric feeding behaviours which have implications for both mental and physical health.
Picky eating (PE), otherwise referred to as fussy eating, is a term used to describe the rejection or restriction of familiar and/or unfamiliar foods.
This feeding behaviour is typically driven by a negative response to specific food characteristics, such as taste, texture, smell, appearance and temperature.1
Like many behavioural traits, PE belongs to a spectrum of feeding behaviours with various defining characteristics and implications for health.2 PE is considered a ‘mild’ feeding behaviour, characterised by a preference between different food types without extensive food group avoidance. On the other end of the spectrum are highly restrictive feeding behaviours, such as avoidant/restrictive food intake disorder (ARFID).1 A relatively new addition to the DSM-V diagnostic category for eating disorders, ARFID can have more serious health implications due to the avoidance of a wider range of foods and the potential for persistence into adulthood.1,3
Prevalence of PE behaviours
PE in paediatric populations has been estimated to affect as many as 1 in 25 to 1 in 2, depending on the geographic location and the study methods used.2 ARFID affects approximately 1 in every 300 Australians, however similar feeding behaviours are also associated with autistic spectrum disorder (ASD), which has a prevalence of approximately 1 in 25.4,5
Characteristics of PE behaviours
Adversity to both taste and texture has been reported, with ‘bitter’, ‘lumpy’ or ‘slimy’ food qualities more likely to instigate an adverse response.6 Fruits and vegetables are frequently avoided food groups, and are typically replaced with refined carbohydrates, including savoury snacks. The high energy density and lower nutritional density of PE diets can lead to changes in weight as well as an increased risk of certain nutrient inadequacies, most notably iron, zinc and fibre.7,2
Aetiology
While it is still poorly understood, the aetiology of PE behaviours has been attributed to a variety of genetic and environmental factors, including:
• Feeding pressures from parents and family
• High “disgust sensitivity”
• Absence of breast feeding
• Heritability in children whose mother also demonstrates restrictive food behaviours
• Negative food experiences or associations 2,6
Interestingly, research has shown food pickiness may have evolved from an instinctual food avoidance behaviour designed to prevent exposure to potentially harmful foods, thus serving as an evolutionary advantage. For instance, the crispy texture commonly associated with savoury snacks can indicate freshness, whereas a slimy texture associated with certain fruits and vegetables, can indicate spoilage.8
Health impacts
Physical adverse outcomes can include nutrient deficiencies and associated side effects, such as gastrointestinal discomfort, constipation and deviations to healthy weight and growth patterns.7
Non-physical adverse outcomes can include emotional distress, with strain on family and social relationships, and increased feelings of embarrassment. Parents often need to provide a different meal to the rest of the family, which can be problematic to the parent-child relationship. Pressure from the family to eat certain foods has also shown to be a key contributing factor, thus creating a vicious cycle.2,7
The role of the GP
GPs are frequently the first consulted health professional for restrictive eating behaviours,9 and therefore confidence in recognising the characteristics of different fussy eating behaviours and their health impacts can help lead to early detection and therefore, more favourable patient outcomes.
A multi-disciplinary approach to manage complex physical and psychological impacts of PE behaviours may be required, with treatments such as systematic des-sensitisation dietary techniques showing efficacy.10
GPs can assist with early diagnosis, monitoring nutritional and weight markers, and providing medical treatments for negative health consequences such as nutrient deficiencies.9 Oral nutritional supplementation may be of value, particularly in supporting adequate daily intake of essential nutrients such as iron and zinc, which have also found to be commonly inadequate in the diets of healthy populations of young children in Australia.11
Conclusion:
PE belongs to a spectrum of restrictive feeding behaviours that can have negative physical and mental impacts on children and their families. GPs are commonly the first consulted health professional, and therefore, confidence in early detection is key. GPs can provide support through providing access to multidisciplinary support, monitoring nutritional and weight status, addressing nutritional inadequacies and educating parents on the impact of feeding pressures on the life-cycle of PE conditions.
Sponsor/Author: Pentavite
Written by Jessica Simonis – Clinical Nutritionist (BHScNutMed). Scientific Marketing Manager at Pentavite.
References:
1. Bia?ek-Dratwa A, Szyma?ska D, Grajek M, Krupa-Kotara K, Szczepa?ska E, Kowalski O. ARFID—Strategies for Dietary Management in Children. Nutrients. 2022 Apr 22;14(9):1739.
2. Taylor CM, Wernimont SM, Northstone K, Emmett PM. Picky/fussy eating in children: Review of definitions, assessment, prevalence and dietary intakes. Appetite. 2015 Dec 1;95:349-59.
3. Dovey TM, Kumari V, Blissett J. Eating behaviour, behavioural problems and sensory profiles of children with avoidant/restrictive food intake disorder (ARFID), autistic spectrum disorders or picky eating: Same or different?. European Psychiatry. 2019 Sep;61:56-62.
4. Hay P, Mitchison D, Collado AE, González-Chica DA, Stocks N, Touyz S. Burden and health-related quality of life of eating disorders, including Avoidant/Restrictive Food Intake Disorder (ARFID), in the Australian population. Journal of eating disorders. 2017 Dec;5(1):1-0.
5. Nielsen TC, Nassar N, Boulton KA, Guastella AJ, Lain SJ. Estimating the Prevalence of Autism Spectrum Disorder in New South Wales, Australia: A Data Linkage Study of Three Routinely Collected Datasets. Journal of Autism and Developmental Disorders. 2023 Jan 18:1-9.
6. Feillet F, Bocquet A, Briend A, Chouraqui JP, Darmaun D, Frelut ML, Girardet JP, Guimber D, Hankard R, Lapillonne A, Peretti N. Nutritional risks of ARFID (avoidant restrictive food intake disorders) and related behavior. Archives de Pédiatrie. 2019 Oct 1;26(7):437-41.
7. Taylor CM, Emmett PM. Picky eating in children: Causes and consequences. Proceedings of the Nutrition Society. 2019 May;78(2):161-9.
8. Egolf A, Siegrist M, Hartmann C. How people’s food disgust sensitivity shapes their eating and food behaviour. Appetite. 2018 Aug 1;127:28-36.
9. Rowe E. Early detection of eating disorders in general practice. Australian Family Physician. 2017 Nov;46(11):833-8.
10. Thomas JJ, Lawson EA, Micali N, Misra M, Deckersbach T, Eddy KT. Avoidant/restrictive food intake disorder: a three-dimensional model of neurobiology with implications for etiology and treatment. Current psychiatry reports. 2017 Aug;19:1-9.
11. Moumin NA, Netting MJ, Golley RK, Mauch CE, Makrides M, Green TJ. Usual Nutrient Intake Distribution and Prevalence of Inadequacy among Australian Children 0–24 Months: Findings from the Australian Feeding Infants and Toddlers Study (OzFITS) 2021. Nutrients. 2022 Mar 25;14(7):1381.
