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1 Lincolnshire Knowledge and Resource Service Please find below the results of your literature search request. If you would like the full text of any of the abstracts included, or would like a further search completed on this topic, please let us know. Google can bring you back 100,000 answers, a librarian can bring you back the right one. Neil Gaiman Literature Search Results Search completion date: 17 th July 2013 Search completed by: Jan Badcock Enquiry Details Fussy eating in toddlerhood

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3 Guidelines Eating well for under-5s in child care Practical and nutritional guidelines Second Edition By Dr Helen Crawley The Caroline Walker Trust, 1998, BDA THE BRITISH DIETETIC ASSOCIATION Weaning During the first year, a baby grows more quickly than at any other time in his or her life. This rapid period of growth means that babies need a lot of energy and nutrients to ensure that they can grow well. Evidence Systematic review and meta-analyses of risk factors for childhood overweight identifiable during infancy Stephen Franklin Weng, Sarah A Redsell, Judy A Swift, Min Yang, Cristine P Glazebrook Arch Dis Child2012;97: Objective To determine risk factors for childhood overweight that can be identified during the first year of life to facilitate early identification and targeted intervention. Design Systematic review and meta-analysis. Eligibility criteria Prospective observational studies following up children from birth for at least 2 years. Results Thirty prospective studies were identified. Significant and strong independent associations with childhood overweight were identified for maternal pre-pregnancy overweight, high infant birth weight and rapid weight gain during the first year of life. Metaanalysis comparing breastfed with non-breastfed infants found a 15% decrease (95% CI 0.74 to 0.99; I2=73.3%; n=10) in the odds of childhood overweight. For children of mothers smoking during pregnancy there was a 47% increase (95% CI 1.26 to 1.73; I2=47.5%; n=7) in the odds of childhood overweight. There was some evidence associating early introduction of solid foods and childhood overweight. There was conflicting evidence for duration of breastfeeding, socioeconomic status at birth, parity and maternal marital status at birth. No association with childhood overweight was found for maternal age or education at birth, maternal depression or infant ethnicity. There was inconclusive evidence for delivery type, gestational weight gain, maternal postpartum weight loss and fussy infant temperament due to the limited number of studies. Conclusions Several risk factors for both overweight and obesity in childhood are identifiable during infancy. Future research needs to focus on whether it is clinically feasible for healthcare professionals to identify infants at greatest risk

4 Associations of Infant Feeding Practices and Picky Eating Behaviors of Preschool Children Jae Eun Shim, Juhee Kim, Scd; Rose Ann Mathai. J Am Diet Assoc. 2011;111: Picky eating behaviors are prevalent during childhood and are often linked to nutritional problems. However, information on the determinants of picky eating behaviors during infancy, when food acceptance patterns develop, is scarce. This study was conducted to evaluate the impact of infant feeding practices on the development of picky eating behaviors during preschool years. Baseline survey data from the Synergistic Theory and Research on Obesity and Nutrition Group Kids (STRONG Kids) program were used for this retrospective data analysis. Primary caregiver-child dyads were recruited from childcare centers in Eastern Illinois between February and July of A total of 129 self-reported responses from mothers of preschool-aged children were analyzed. Logistic regression was used to evaluate the association between infant feeding practices and picky eating behaviors. Children who were introduced to complementary foods before 6 months of age had 2.5 times higher odds of developing food neophobia and limited variety of foods (95% confidence interval [CI]: 1.01 to 5.93 and 1.06 to 5.73, respectively). Children who were breastfed exclusively for 6 months had lower odds of developing a preference for specific food-preparation methods by 78% (95% CI: 19% to 94%), food rejection by 81% (95% CI: 31% to 94%), and food neophobia by 75% (95% CI: 11% to 93%). Breastfeeding and introduction of complementary foods after 6 months of age reduced the odds of picky eating during early childhood. This study documents an association between infant-feeding practices and the development of picky eating behaviors in early childhoodhttp:// % pdf Does Picky Eating Affect Weight-for-Length Measurements in Young Children? Sivan Ekstein, David Laniado,Benjamin Glick, CLIN PEDIATR March 2010 vol. 49 no Objectives: Picky eating is a major source of parental concern, and children with picky eating habits are potentially at risk for nutritional deficits. This research aimed to determine whether picky eating is related to being underweight in young children. Methods: Participants included 34 children with picky eating behavior who were referred to the Pediatric Feeding and Nutrition Clinic for evaluation and 136 healthy controls.weight and height measurements were obtained, and weight-to-length data were calculated for each child. Results: In all, 7 of 34 children (20.6%) in the picky eaters group and 9 of 136 children (6.6%) in the control group were underweight (P =.02). Underweight was found in 15 children (14.2%) at or under 36 months and in 1 child (1.6%) older than 36 months (P =.002). Conclusions: Children with picky eating habits, especially those younger than 3 years of age, are at increased risk of being underweight. Picky eating during childhood: A longitudinal study to age 11-years Anthony J. Mascola, Susan W. Bryson, and W. Stewart Agras Eat Behav December; 11(4): Picky eating is a common disorder during childhood often causing considerable parental anxiety. This study examined the incidence, point prevalence, persistence and characteristics of picky eating in a prospective study of 120 children and their parents followed from 2 to 11 years. At any given age between 13% and 22% of the children were reported to be picky eaters. Incidence declined over time whereas point prevalence increased indicating that picky eating is often a chronic problem with 40% having a duration of more than 2-years. Those with longer duration differed from those with short duration having more strong likes and dislikes of food and not accepting new foods. Parents of picky eaters were more likely to report that their children consumed a limited variety of foods, required food prepared in specific ways, expressed stronger likes and dislikes for food, and threw tantrums when denied foods. They were also more likely to report struggles over feeding, preparing special meals, and commenting on their child s eating. Hence, picky

5 eating is a prevalent concern of parents and may remain so through childhood. It appears to be a relatively stable trait reflecting an individual eating style. However no significant effects on growth were observed. Eating Behaviour and Weight in Children L Webber,1 C Hill,1 J Saxton,1 CHM Van Jaarsveld,1 and J Wardle1 Int J Obes (Lond) January; 33(1): Objective: To test the hypothesis that quantitative variation in eating behaviour traits shows a graded association with weight in children. Design: Cross-sectional design in a community setting. Subjects: Data were from 406 families participating in the Physical Exercise and Appetite in CHildren Study (PEACHES) or the Twins Early Development Study (TEDS). Children were aged 7 to 9 years (PEACHES) and 9 to 12 years old (TEDS). Measurements: Weights and heights were measured by researchers. BMI SD-scores were used to categorise participants into healthy-weight, overweight and obese groups, with an additional division of the healthy-weight group into higher- and lower-healthy-weight at the 50th centile. Eating behaviour traits were assessed with the Child Eating Behaviour Questionnaire (CEBQ), completed by the parent on behalf of their child. Linear trend analyses compared CEBQ sub-scale scores across the five weight groups. Results: Satiety Responsiveness/Slowness in Eating and Food Fussiness showed a graded negative association with weight, while Food Responsiveness, Enjoyment of Food, Emotional Overeating and Desire to Drink were positively associated. All effects were maintained after controlling for age, sex, ethnicity, parental education and sample. There was no systematic association with weight for Emotional Undereating. Conclusion: These results support the idea that approach-related and avoidance-related appetitive traits are systematically (and oppositely) related to adiposity, and not exclusively associated with obesity. Early assessment of these traits could be used as indicators of susceptibility to weight gain. Development of food variety in children Sophie Nicklaus Appetite Feb;52(1): doi: /j.appet expose here how eating habits for a variety of foods develop in childhood, from early infancy on. Preferences for specific flavours might develop early, through milk-related flavour exposures. Breastfeeding favours the acquisition of a taste for a variety of foods. At introduction of solid foods, food preferences develop thanks to repeated exposures to a variety of foods. The persistence of these early influences is still unknown. During the third year of life, most children enter a neophobic phase during which previously liked foods are no longer accepted and introduction of new foods becomes difficult.however, habits of eating a variety of foods acquired before the neophobic phase track further on into childhood, adolescence and early adulthood. This underlines the importance of promoting the access to a variety of foods in early childhood. However, beyond the nutritional advantage of eating a varied diet, could this present any drawbacks? Providing a variety of foods generally stimulates food intake and thereby might favour obesity. More research is needed to understand the link between variety and obesity, which might be food-group dependant. Request form LKRS

6 Food neophobia and picky/fussy eating in children: A review Terence M. Doveya,Paul A. Staples, E. Leigh Gibson, Jason C.G. Halford Appetite Volume 50, Issues 2 3, March May 2008, Pages Two factors have been shown to contribute to rejection or acceptance of fruits and vegetables: food neophobia and picky/fussy eating. Food neophobia is generally regarded as the reluctance to eat, or the avoidance of, new foods. In contrast, picky/fussy eaters are usually defined as children who consume an inadequate variety of foods through rejection of a substantial amount of foods that are familiar (as well as unfamiliar) to them. Through understanding the variables which influence the development or expression of these factors (including age, personality, gender, social influences and willingness to try foods) we can further understand the similarities and differences between the two. Due to the interrelationship between picky/fussy eating and food neophobia, some factors, such as pressure to eat, personality factors, parental practices or feeding styles and social influences, will have similar effects on both magnitude and duration of expression of these behaviours. On the other hand, these constructs may be differentially affected by factors such as age, tactile defensiveness, environment and culture. The effects of these variables are discussed within this review. Behavioural interventions, focusing on early life exposure, could be developed to attenuate food neophobia and picky/fussy eating in children, so promoting the ready acceptance and independent choice of fruits and vegetables. Influence of parental attitudes in the development of children eating behaviour Silvia Scaglionia, Michela Salvionia and Cinzia Galimbertia British Journal of Nutrition / Volume 99 / Supplement S1 / February 2008, pp S22-S25 The present paper is a review of available data on effects of parental feeding attitudes and styles on child nutritional behaviour. Food preferences develop from genetically determined predispositions to like sweet and salty flavours and to dislike bitter and sour tastes. There is evidence for existence of some innate, automatic mechanism that regulate appetite. However, from birth genetic predispositions are modified by experience. There are mechanisms of taste development: mere exposure, medicine effect, flavour learning, flavour nutrient learning. Parents play a pivotal role in the development of their child's food preferences and energy intake, with research indicating that certain child feeding practices, such as exerting excessive control over what and how much children eat, may contribute to childhood overweight. Mothers are of particular interest on children's eating behaviour, as they have been shown to spend significantly more time than fathers in direct interactions with their children across several familial situations. Jae Eun Shim, Phd; Juhee Kim, Scd; Rose Ann Mathai, Picky eating behaviors are prevalent during childhood and are often linked to nutritional problems. However, information on the determinants of picky eating behaviors during infancy, when food acceptance patterns develop, is scarce. This study was conducted to evaluate the impact of infant feeding practices on the development of picky eating behaviors during preschool years. Baseline survey data from the Synergistic Theory and Research on Obesity and Nutrition Group Kids (STRONG Kids) program were used for this retrospective data analysis. Primary caregiver-child dyads were recruited from childcare centers in Eastern Illinois between February and July of A total of 129 self-reported responses from mothers of preschool-aged children were analyzed. Logistic regression was used to evaluate the association between infant feeding practices and picky eating behaviors. Children who were introduced to complementary foods before 6 months of age had 2.5 times higher odds of developing food neophobia and limited variety of foods (95% confidence interval [CI]: 1.01 to 5.93 and 1.06 to 5.73, respectively). Children who were breastfed exclusively pdf

7 Food neophobia and 'picky/fussy' eating in children: a review. Dovey TM, Staples PA, Gibson EL, Halford JC. Appetite Mar-May;50(2-3): Epub 2007 Sep 29. Two factors have been shown to contribute to rejection or acceptance of fruits and vegetables: food neophobia and 'picky/fussy' eating. Food neophobia is generally regarded as the reluctance to eat, or the avoidance of, new foods. In contrast, 'picky/fussy' eaters are usually defined as children who consume an inadequate variety of foods through rejection of a substantial amount of foods that are familiar (as well as unfamiliar) to them. Through understanding the variables which influence the development or expression of these factors (including age, personality, gender, social influences and willingness to try foods) we can further understand the similarities and differences between the two. Due to the interrelationship between 'picky/fussy' eating and food neophobia, some factors, such as pressure to eat, personality factors, parental practices or feeding styles and social influences, will have similar effects on both magnitude and duration of expression of these behaviours. On the other hand, these constructs may be differentially affected by factors such as age, tactile defensiveness, environment and culture. The effects of these variables are discussed within this review. Behavioural interventions, focusing on early life exposure, could be developed to attenuate food neophobia and 'picky/fussy' eating in children, so promoting the ready acceptance and independent choice of fruits and vegetables. Research 2006 current Is picky eating an eating disorder? Jacobi C, Schmitz G, Agras WS.Int J Eat Disord Nov;41(7): doi: /eat OBJECTIVE: To examine the prevalence of picky eating and the relationship between picky eating, previously supported correlates of picky eating, other child eating and behavioral problems and maternal eating problems in children aged 8-12 years. METHOD: In a cohort study, to 12-year-old children and their primary caretakers (91% mothers) were assessed in a small town community. Potential child eating behaviors associated with picky eating were reported by mothers using the Stanford Feeding Questionnaire. Child eating attitudes and disturbances were obtained from the McKnight Risk Factor Survey, food preferences and avoidances from a food preference list, child behavioral problems were assessed by the Child Behavior Checklist. To assess maternal eating disturbances EDIsubscales 1-3 as well as TFEQ-subscales "disinhibition" and "restraint" were used. RESULTS: Picky and nonpicky eaters differed significantly on all of the child eating behaviors found to be correlates of picky eating in a previous study with younger children. Overall, picky children were reported to avoid foods in general more often than nonpicky eaters. Picky children did not differ from nonpicky children with regard to their own and maternal eating disturbances. However, picky children displayed more problem behaviors comprising both internalizing and externalizing behaviors. CONCLUSION: The present study does not support the concept that picky eating is associated with disordered eating but rather with a range of behavioral problems.

8 Food neophobia and 'picky/fussy' eating in children: a review. Dovey TM, Staples PA, Gibson EL, Halford JC. Appetite Mar-May;50(2-3): Epub 2007 Sep 29. Two factors have been shown to contribute to rejection or acceptance of fruits and vegetables: food neophobia and 'picky/fussy' eating. Food neophobia is generally regarded as the reluctance to eat, or the avoidance of, new foods. In contrast, 'picky/fussy' eaters are usually defined as children who consume an inadequate variety of foods through rejection of a substantial amount of foods that are familiar (as well as unfamiliar) to them. Through understanding the variables which influence the development or expression of these factors (including age, personality, gender, social influences and willingness to try foods) we can further understand the similarities and differences between the two. Due to the interrelationship between 'picky/fussy' eating and food neophobia, some factors, such as pressure to eat, personality factors, parental practices or feeding styles and social influences, will have similar effects on both magnitude and duration of expression of these behaviours. On the other hand, these constructs may be differentially affected by factors such as age, tactile defensiveness, environment and culture. The effects of these variables are discussed within this review. Behavioural interventions, focusing on early life exposure, could be developed to attenuate food neophobia and 'picky/fussy' eating in children, so promoting the ready acceptance and independent choice of fruits and vegetables. The importance of exposure for healthy eating in childhood: a review. Cooke L.J Hum Nutr Diet Aug;20(4): Children's food preferences are strongly associated with their consumption patterns. Identifying the factors that influence preferences is therefore crucial to the development of effective interventions to improve children's diets. Perhaps the most important determinant of a child's liking for a particular food is the extent to which it is familiar. Put simply, children like what they know and they eat what they like. From the very earliest age, children's experiences with food influence both preferences and intake, and research suggests that the earlier and broader that experience, the healthier the child's diet. Laboratory studies of children's food acceptance have indicated that repeated opportunities to taste unfamiliar foods results in increased liking and consumption. In order to investigate whether these results can be replicated in real-world situations, a series of naturalistic studies testing the efficacy of exposure-based interventions have been carried out. In a school-based study large increases in liking and intake of raw red pepper were seen in 5- to 7-year olds and two further studies, in which mothers used exposure techniques to increase children's acceptance of vegetables, achieved similar results. If future large-scale interventions prove to be successful, training could be offered to health professionals or directly to parents themselves.

9 Prevalence of picky eaters among infants and toddlers and their caregivers' decisions about offering a new food. Carruth BR, Ziegler PJ, Gordon A, Barr SI.J Am Diet Assoc Jan;104(1 Suppl 1):s OBJECTIVES: To determine the prevalence of infants and toddlers who were considered picky eaters, the predictors of picky eater status and its association with energy and nutrient intakes, food group use, and the number of times that caregivers offered a new food before deciding their child disliked it. DESIGN: Cross-sectional survey of households with infants and toddlers (ages four to 24 months) was conducted. SUBJECTS/SETTING: National random sample of 3,022 infants and toddlers. METHODS: Data included caregiver's socioeconomic and demographic information, infants' and toddlers' food intake (24-hour recall), ethnicity, and caregivers' reports of specified times that new foods were offered before deciding the child disliked it. STATISTICAL ANALYSES: For picky and nonpicky eaters, t tests were used to determine significant mean differences in energy and nutrient intakes. Logistic regression was used to predict picky eater status, and chi(2) tests were used for differences in the specified number of times that new foods were offered. RESULTS: The percentage of children identified as picky eaters by their caregivers increased from 19% to 50% from four to 24 months. Picky eaters were reported at all ages for both sexes, all ethnicities, and all ranges of household incomes. On a day, both picky and nonpicky eaters met or exceeded current age-appropriate energy and dietary recommendations. Older children were more likely to be picky. Those in the higher weight-for-age percentiles were less likely to be picky. The highest number of times that caregivers offered a new food before deciding the child disliked it was three to five. APPLICATIONS/CONCLUSIONS: Dietetics professionals need to be aware that caregivers who perceive their child as a picky eater are evident across gender, ethnicity, and household incomes. When offering a new food, mothers need to provide many more repeated exposures (eg, eight to 15 times) to enhance acceptance of that food than they currently do.

10 Service Examples Fussy eaters Great Ormond Street It s natural to worry and assume something must be wrong when your child seems to lose interest in food. British Dietetic Association Babies/Children - vitamins - under review - alternative information source (NHS Choices). Breastfeeding - under review - alternative information source (NHS Choices). Children - diet, behaviour and learning - under review - alternative information source (NHS Choices). Children - healthy eating - under review - alternative information source (NHS Choices). Pregnancy / information sources (updated May 2013). Weaning / information sources (updated May 2013).