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Supporting families with a fussy eater.

WE ALL KNOW CHILDREN WHO ARE fussy eaters. Half of all parents report having a child who is fussy or eats a limited diet (Reau, Senturia, Lebailly & Christoffel, 1996). These fussy or difficult eating behaviours are often significant, persisting for months or years (Farrow & Blissett, 2012), and a poor diet in childhood frequently continues into adulthood and is linked to obesity and various preventable diseases, such as cancer and diabetes (Nicklas & Hayes, 2008). How this fussiness is managed early on affects whether children outgrow it or if it will continue as they get older and this is why parents and caregivers have such a vital role in helping children to develop healthy eating habits.

While information about milk feeding and weaning is abundant, practical advice about child feeding once weaning has occurred is lacking (Schwartz, Scholtens, Lalanne, Weenen & Nicklaus, 2011). Our own research confirms that parents find available resources about feeding young children and promoting healthy eating to be "too basic" and that parents often resort to searching for information independently (Mitchell, Farrow, Haycraft & Meyer, 2013).

The five most common pitfalls encountered by parents are:

* Food refusal

* Children's unhealthy food preferences

* Pressuring children to eat

* Using food as a reward

* Parental use of restriction

[ILLUSTRATION OMITTED]

A common child eating behaviour which lots of parents find worrying is food refusal. Many children go through a phase known as 'food neophobia', or fear of new foods, typically around 18-24 months, where they become wary of new foods or of foods that they previously liked (Birch & Fisher, 1998). During this phase, children often appear fussy and many parents are unsure how to respond to this. There is good evidence that a food may need to be offered up to 15 times before children trust it and are willing to taste it (Wardle, Carnell & Cooke, 2005). Once the child deems a food to be 'safe', it can take a further 15 offerings, or 'exposures, before the child develops a liking for it (Wardle et al., 2003). This means that it is vital that parents continue to offer foods that their child dislikes, as only by increasing children's familiarity with a food will it become likely to be eaten (Aldridge, Dovey & Halford, 2009).

These food exposures can be part of a meal or snack, or they can occur outside of meals when children may be more relaxed, for example, playing with food (e.g., messy play with cooked pasta or dried beans), singing songs about foods, or encouraging children to pick out and touch different foods when out shopping or at a market.

However, while the evidence suggests that repeatedly offering new foods a number of times is necessary for a food to become liked, we know that parents tend not to offer young children a disliked and refused food more than around five times (e.g., Carruth, Ziegler, Gordon & Barr, 2004) and part of this may be related to the difficulty in keeping track of exposures.

In the UK, daily consumption of five portions of fruit and vegetables is recommended. However, only around one in five children achieve this (Health and Social Care Information Centre, 2014). The Child Feeding Guide has a whole section devoted to ways that parents can increase children's fruit and vegetable intake. For example, using real fruits and vegetables in messy play, 'growing your own, or getting children involved in food preparation and cooking. By making a food more familiar, it is much more likely to be subsequently eaten (Aldridge et al., 2009).

We developed a free app for tablets and smartphones called Child Feeding Guide, which provides evidence-based information and practical support for anyone who is concerned about children's eating behaviours.

In addition to supporting parents and caregivers (henceforth referred to as 'parents'), it is also a useful resource for health professionals to use and share with families that they work with who are encountering these common feeding difficulties.

The app helps explain the science behind children's eating behaviour, allows parents to assess and monitor their own and their child's responses around food and mealtimes, and provides strategies to address fussiness in a positive way.

One unique feature of the app is that it describes the five most common feeding pitfalls that families encounter. It explains what they are, why they occur, and advises parents about what to do when they are encountered.

REFERENCES

Aldridge, V.K., Dovey, T.M., & Halford, J.C.G. (2009). The role of familiarity in dietary development. Developmental Review 29(1): 32-44.

Birch, L.L., & Fisher, J.O. (1998). Development of eating behaviours among children and adolescents. Pediatrics 101: 539-549.

Carruth, B.R., Ziegler P.J., Gordon A., & Barr S.I. (2004). Prevalence of picky eaters among infants and toddlers and their caregivers' decisions about offering a new food. Journal of the American Dietetic Association 104: 57-64.

Farrow, C. & Blissett, J. (2012). Stability and continuity of parentally reported child eating behaviours and feeding practices from 2 to 5 years of age. Appetite 58(1): 151-156.

Health and Social Care Information Centre (2014). Statistics on Obesity, Physical Activity and Diet: England 2014. www.hscic.gov.uk/catalogue/PUB13648/Obes-phys-acti-diet-eng-2014-rep.pdf

Mitchell, G., Farrow, C., Haycraft, E. & Meyer, C. (2013). Parental influences on children's eating behaviour and characteristics of successful parent-focussed interventions. Appetite 60: 85-94.

Nicklas, T.A. & Hayes, D. (2008). Position of the American Dietetic Association: Nutrition guidance for healthy children ages 2 to 11 years. Journal of the American Dietetic Association 108(6): 1038-1044.

Reau, N.R., Senturia, Y.D., Lebailly, S.A., & Christoffel, K.K. (1996). Infant and toddler feeding patterns and problems: normative data and a new direction. Pediatric Research Group. Journal of Developmental and Behavioural Pediatrics 17: 149-153.

Schwartz, C., Scholtens, P.A.M.J., Lalanne, A., Weenen, H., & Nicklaus, S. (2011). Development of healthy eating habits early in life. Review of recent evidence and selected guidelines. Appetite 57: 796-807.

Wardle, J., Carnell, S., & Cooke, L. (2005). Parental control over feeding and children's fruit and vegetable intake: How are they related? Journal of the American Dietetic Association 105: 227-232.

Wardle, J., Cooke, L.J., Gibson, E.L., Sapochnik, M., Sheiham, A., & Lawson, M. (2003). Increasing children's acceptance of vegetables: A randomised trial of parent-led exposure. Appetite 40: 155-162. Practice: CPD

DR EMMA HAYCRAFT

Senior Lecturer in Psychology, Loughborough University, UK

DR GEMMA WITCOMB

Research and Teaching Fellow, Loughborough University, UK

DR CLAIRE FARROW

Senior Lecturer in Psychology, Aston University, UK
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Title Annotation:Clinical Feature
Author:Haycraft, Emma; Witcomb, Gemma; Farrow, Claire
Publication:Community Practitioner
Geographic Code:4EUUK
Date:Apr 1, 2015
Words:1070
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