The Picky Eating Child’s Growth & Development: At Peace or at War?

Greet Your Picky Eater with a Variety of Foods, Don’t Retreat from Any of it

Some Picky Eaters Eliminate an Entire Food Group

Chocolates, ice creams, pastries, potatoes and juices aren’t exclusively for our little heroes! But, they do choose to eat them over any others. A fluffy paratha or a rainbow-colored sabji doesn’t delight their eyes and all they constantly have an eye on are the crunchy potato wafers, sugary jam and bread or the thick chocolate smoothie. We introduce all types of foods and ingredients right from our child’s early age irrespective of his/her likes/desires. We ensure to make sure that no offensive comments are passed upon certain foods in front of our children and most of all, though we don’t like something we eat it up just because we are our kid’s first role model. Despite their hearty attempts, we fail miserably in our endeavor to nurture a kid whose choices are varied and wide. Welcome to the world of picky eaters!
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Picky eating is defined as an unwillingness to eat familiar foods or try new foods so strongly that it disrupts daily routine and impairs parent-child relationship apart from creating enough troubles for the parent and the child individually. This is extremely common in preschool-aged children with almost 14-50% of parents reporting their child to be a picky eater. Rejecting new foods does irritate parents but they are even more devastated when the child shows outright rejection towards familiar foods such as fruits and veggies despising their taste. Such elimination of certain foods does lay the path for restricted dietary choices that have a direct impact on the child’s growth and development which happen at a rapid pace during the child’s early years. Weight gain increases drastically by age 2 and slows down between 2 and 5 years, the period during which the child’s appetite also diminishes. It’s the age during which the kid starts to pick and choose foods, rejects new foods (neophobic), experiences food jags (short term periods of restricted intake) and looks forward to eating specific foods all the time. Such characteristics of neophobia and food jags often are defined by one single term for the kid-picky eater.

Nurture Issues Due to Nutrient Underplay
In children, picky eating is a normal phase in their development process but the same phase becomes worrisome in some of them. The quality of a child’s diet is the sum total of the complementary foods introduced and the child’s eating behavior. A picky eater is always at a high risk of being underweight or overweight as his/her nutrients are commonly compromised. Though parents constantly keep complaining, take extra precautions to ensure that their children don’t grow out to be less healthy than their peers there are not quite many studies that measure growth in children who are picky eaters. One study shows that girls who were picky eaters between 5 and 15 years of age were within recommended weight ranges and unlikely to be overweight or underweight compared to non-picky eaters. This makes us wonder whether picky eating is a safety vest against erratic weight changes leading to obesity or underweight issues, two of the most common conditions attacking children worldwide, but at the expense of compromised nutrition and health?
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ALSPAC Study
More than 13,000 children were selected for the study and the parents were sent questionnaires, through post. A single question on picky eating was asked at 38 months and this included “Does your child have definite likes and dislikes as far as food is concerned?” and the suitable responses including Yes/No, quite choosy/Yes, very choosy were also provided. The scores were 0,1 or 2 depending on the response given as not picky, somewhat picky or very picky. Growth data (height, weight, total body fat mass and total body lean mass) was collected every year between the age of 7 and 17 (except at the kid’s 14th and 16th year).

Kids were classified into BMI groups (thin/normal weight/overweight) within the three groups of picky eaters. Datasets were prepared and the height, weight and BMI for both boys and girls tracked along the centile lines when plotted on the growth chart. Results showed that:

1. Body fat percentage was lower for boys and girls who were ‘very picky’ compared to ‘not picky’ and the results were similar for fat mass index as well.
2. Lean mass index were lower for very picky eaters from the age of 11 in both boys and girls
3. Male and female ‘very picky’ eaters were about 1.5-2 cm and 1.0-1.5 cm shorter respectively until the age of 12 after which girls showed very meagre differences.
4. Male and female ‘very picky’ children were 1.5-2.5 kg and 1.0-1.5 kg lighter than ‘not picky’ children at any age
5. While the % of thinness was more in the ‘somewhat picky’ and ‘very picky’ children for every age, the % of obesity/overweight was less in these two groups.
6. While ‘very picky’ children had greater chances of being thin and were thin at more age junctions than not picky children, results showed that 70% were never thin at any point during their life.
7. While evidences for differences in growth and body composition from age 7 to 17 were identified in the ‘very picky’ group identified at age 3, the mean height, weight and BMI were consistently above the 50th centile showing that there was not much to be worried about.
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Of the total lot of eaters identified at 3 years, 47% continued being picky at 4.5 years and 40% at 5.4 years. The picky eaters in this study were greatly associated with an increased likelihood of being thin and there was nothing much to worry about our picky eater in general.

High-energy Low-Nutrient Foods
Fussy eaters compensate for their lack of vegetable and fruits intake by consuming other high-energy foods and one study proved that fussy eaters between age 8 and 12 faced higher risk of suffering from overweight as they were keen on eating fast food items comparatively. Such increase in weight puts the child at a risk of cardiovascular problems and emotional problems too. There are several studies that show that fussy eaters have a lower BMI, lower body fat percentage and underweight but quite a few studies could not find any association between fussy eaters and weight changes.
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Another study looked into the details of fussy eaters at age 4 and their body mass at age 6. 4191 children participated in the study and each of them were assessed with a Children’s Eating Behavior Questionnaire (CEBQ). Picky eaters scored low on food responsiveness and enjoyment while scoring high on satiety responsiveness, food fussiness and slowness in eating. The same children came over to the research center when they were 6 years old during which height and weight measurements were taken. Each child was put into one of the four categories-underweight, normal weight, overweight or obese according to the measurements. Results of the study showed that:

1. Kids classified as fussy had a 0.37 lower BMI score at age 6 compared to other children   
2. Fussy eaters were shorter than non-fussy eaters but the difference diminished as the child approached his/her 4th birthday indicating that the chances of a decreased height growth up to the age of 6 was doubtful
3. Fussy eaters were at a greater risk of being underweight than non-fussy and were not at a risk of suffering from obesity/overweight
4. Fussy eaters had a low BMI at 4 years which brings us to the point that the kid’s weight during the previous years could have influenced their eating behavior.
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Fussy eating might be a short phase in the child’s development but it has the potential to bring in disastrous side effects due to the possible risks of underweight issues and low fat-free mass.

Perception of Nutrient Intake Among Parents of Picky Eaters
Some studies do show that picky eaters eat less of food rich in nutrients such as riboflavin, niacin, vitamin C, thiamin and dietary fiber these nutrients were not present in inadequate levels in these children. Picky eaters reside everywhere around the world but unlike in most countries, those picky eaters in China eat less of grains too alongside fruits and vegetables. A Chinese study on picky eaters tried to analyze three things:
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1. Compare nutrient intake between picky eaters and non-picky infants
2. Perceived food group rejection will be compared to actual food group intake
3. Perceived weight status will be compared to actual weight status for picky and non-picky eaters
   
   

8 cities were chosen for the study and infants and toddlers from birth to 35 months old were involved in the study from two maternal and childcare centers totaling to 1414 kids. A general questionnaire involving the child’s age, weight, height, eating practices etc. was filled.

Parents were asked the question ‘Do you consider your child to be a picky eater’ and if the answer was ‘yes’ another question followed it ‘Which food category does your child avoid eating?’ The final question ‘Do you think your child is overweight, normal or underweight’ was answered by all parents. Almost 28% parents considered their children to be picky eaters and the numbers increased as the kid’s age increased. Nutrition-wise the researchers found no significant difference between picky and non-picky eaters. In 6-11-month-old-infants picky eaters had lower levels of vitamin A, thiamin, riboflavin, vitamin B6 and vitamin C compared to non-picky eaters. Picky toddlers between 24 and 35 months of age consumed greater amounts of fat compared to non-picky eaters.
Results showed that the main food categories avoided by 6-11 month-old picky eaters were milk and dairy products (28%), desserts (20%), bean and bean products (16.7%) and meat (16.7%). Toddlers between 12 and 23 months avoided eating vegetables (33%), grains and grain products (17%) and eggs (15%). Toddlers aged 24-35 months avoided vegetables (50.8%), meat (23.2%) and grains and grain products (10.7%).

Mean intake of eggs and fruits were lower in children reported to avoid these food groups than in non-picky children whereas mean intake of meat was higher in picky eating children whose parents reported that they avoided this food group compared to non-picky eating children. Though picky and non-picky eaters had similar weight status distributions parents were usually likelier to underestimate than overestimate their children’s body weight. And, parents find picky eating to be a problem of first-degree concern despite the fact that nutrient and calorie intake between both the groups did not differ. Such concerned parents generally overfeed their children with energy-dense foods that are calorie-rich resulting in unhealthy feeding practices and weight issues.

Stick with Basics
We don’t have research or long-term studies helping us with techniques to overcome fussy eating practices in kids. Repeatedly exposing the child to different foods without compelling them to eat is one of the critical steps in helping the child accept different foods with an open heart. Parents can involve their children while cooking and also ensure to eat at least a few meals together every week. A parent is a child’s first role model and when the kid sees the parent eating all varieties of food without inhibition the child also becomes tempted to do the same. This helps the child overcome any food-based bias and enjoy a well-balanced meal.
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References
Growth & Body Composition in Children who are Picky Eaters: A Longitudinal View: https://www.nature.com/articles/s41430-018-0250-7

Longitudinal Association between preschool fussy eating and body composition at 6 years of age: https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-015-0313-2
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Perception of Food Intake & Weight Status Among Parents of Picky Eating Infants & toddlers in China: https://www.sciencedirect.com/science/article/pii/S019566631630704

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