Is your child a “fussy eater”? Or do you know any children who are? I see a lot of parents of fussy eaters in my private practice, and often see parents posting online asking for “toddler-friendly” or “child-friendly” recipes or tips on how to “get food in” to their child. Unfortunately, these are not actually the questions that need answers! The solution to fussy eating doesn’t lie in special recipes, and it isn’t actually a parent’s job to “get food in” to their child. In fact, creating special recipes and devising ways to “get food in” to a child can actually make the fussy eating worse! Read on to find out more or skip straight to the Free Downloads page to gain access to my Preventing Fussy Eating download.
What is fussy eating?
There isn’t a universally-agreed definition of fussy eating (also known as “picky eating”) , but one definition from a review of fussy eating is: “the consumption of an inadequate variety or quantity of foods through the rejection of a substantial amount of both familiar and unfamiliar foods”.
The term “inadequate variety” is of course subjective, so I find it useful to think it terms of the number and types of nutritious (“core”) foods that a child will happily eat, plus their eating behaviour at meal times. i.e.: (a) will they eat a variety of foods from each and every one of the following food groups? (i) green vegetables (ii) red/orange/yellow vegetables (iii) grain-based foods, such as rice, pasta, oats, bread (iv) protein/iron rich foods, such as lentils, beans, chick peas, tofu, tempeh (or animal products if the child is not on a fully plant-based diet) (v) fresh fruit (vi) nuts/seeds (or their pastes for young children) and (b) do they happily eat at least 20-30 different foods? And (c) do they happily eat the family meal, at least most of what is offered, most of the time? If the answer is “no” to any of these questions, fussy eating could be a problem requiring further investigation.
A subset of fussy eating is called “food neophobia”, which is the unwillingness to try new foods. This is fairly common in children at around the age of two years, and I encourage parents to take steps to prevent this problem rather than simply waiting for it to happen. (More on this in my free download on preventing fussy eating.)
Why is fussy eating a problem?
Fussy eating not only causes problems for family mealtime harmony and parental stress levels, but also can result in nutrient deficiencies and growth failure in children. For example, in a 2021 Canadian study, the 155 children classified as picky eaters had a lower intake of protein, folate, magnesium, potassium, zinc, and vitamins B1, B2, B3, B6, D, and E than the 166 children that were not fussy eaters. In my dietetics practice I have observed many cases of poor nutrient intake caused by fussy eating, plus a few cases of growth failure. Fussy eaters tend to prefer bland comfort foods, highly processed foods or sweet foods (such as fruit) and tend to avoid important more nutritious foods such as vegetables.
Isn’t it just a phase my child will grow out of?
While fussy eating can appear as part of a developmental phase, it doesn’t always resolve itself on its own. In some cases, it can become entrenched behaviour and can also have long-term negative consequences for a child’s health, even if the child does eventually grow out of it. Inadequate nutrient intake in infancy and childhood can lead to long-term negative health impacts even after the deficiency has been corrected (such as in the case of iron and iodine deficiency), affecting a child’s intellectual capacity, motor skills, memory, attention span and behaviour as adults. In other words, fussy eating in a toddler could lead to poorer performance later at school and in adult life. However, anxiety about fussy eating can actually make it worse, so worrying about it isn’t the answer. Calmly introducing and consistently adhering to feeding behaviours and practices that have been found to help prevent or alleviate fussy eating is the best way to deal with the issue. The feeding behaviours to put into practice to help prevent fussy eating are listed in my free download on preventing fussy eating.
What causes fussy eating?
There can be a range of causes of fussy eating, and it’s important to identify the cause/s in order to formulate the best approach to overcome the problem. Sometimes fussy eating is caused by an underlying physical or medical condition, and it this is the case, this needs to be addressed first. Early food/eating-related problems such as reflux, eosinophilic oesophagitis, food allergies, persistent vomiting, choking, late introduction of solids etc can cause an aversion to eating some or all foods which can persist after the initial caused has been overcome. Deficiency in some nutrients (including iron, zinc and vitamin B12) can affect appetite and feeding behaviour, resulting in fussiness with food. Sensory issues (such as those commonly seen in children with autism) can affect the textures and types of foods favoured by a child, and typically extend to other areas besides food, requiring input from not only a dietitian but also other health professionals.
Most cases of fussy eating occur as part of a normal developmental stage, with levels highest in children between the ages of 18 months and three years. In my experience, fussy eating in children aged under about 15 months of age is more commonly due to underlying medical conditions, whereas in children older than this most fussy eating is of behavioural rather than of medical or physical origin. Typically, at around the age of two years, toddlers strive to gain more independence and make more decisions for themselves, and this commonly extends to the dinner table. Fussy eating at this stage is not really about the food, which is why the solution to fussy eating is not about finding recipes or foods that your child will eat. In fact, doing that can actually make the problem worse! The good news is that parental behaviour is a major influence on child feeding behaviour, so fussy eating is in most cases able to be overcome if parents and caregivers take appropriate action. In many cases, well-meaning parents can actually cause fussy eating, or can inadvertently make it worse.
If after reading this you can see how you might have contributed to your child’s fussy eating, don’t worry! It’s never too late to set in place the behaviours that will help overcome fussy eating.
Can fussy eating be prevented?
In many cases, yes! There are many factors in parents’ control which have been found to reduce the likelihood of fussy eating in children. The most important times to take action to prevent fussy eating are (i) during pregnancy and when breastfeeding/ before solids are introduced (ii) when weaning and into the first year and (iii) in the child’s second year of life. Laying the foundations to help minimise the chance of fussy eating in your child starts well before the time that fussy eating typically occurs. My clients who do this often tell me proudly (and sometimes a little smugly) that their child is such a good eater compared to other children their age, with virtually no signs of fussiness and well-established good eating habits. Access my free download if you’d like a simple list of actions you can take to help prevent fussy eating in your child. Or read on for the background information and research behind the recommendations.
During pregnancy and breastfeeding / before solids are introduced
A woman’s diet during pregnancy can affect not only their baby’s health, but also their food preferences. The flavour of the amniotic fluid is affected by the mother’s diet, and babies taste this when in the womb. For example, it has been found that babies are more likely to like garlic or particular vegetables if their mother ate them frequently during pregnancy.
As with pregnancy, foods that a breastfeeding mother eats appear to be more readily accepted by their infants upon weaning. But whether breastfed or not, the eating behaviour and food preferences of infants are influenced by their mother’s food choices and eating behaviour. Babies’ total intake of vegetables is higher in women who eat more vegetables both pre- and post-natally. Part of the process of learning to eat involves becoming familiar with a wide variety of foods, which is why exposure to different foods can increase a baby’s likelihood of eating them. Infants are influenced by the food choices of their parents and caregivers, and when ready to eat will likely be more inclined to eat those foods, whether they are appropriate or not.
When solids are introduced
The types of food offered as first foods is important. While at this age babies have a preference for sweet foods, I recommend that parents offer vegetables as first foods rather than fruit, as research has shown that this will increase a child’s vegetable consumption, which is a major challenge for most parents of fussy eaters. Delaying introduction of vegetables has been found to be associated with increased likelihood of poor vegetable consumption as toddlers.
The way in which a food is served also affects food preference. For example, as seeing foods eaten increases familiarity and acceptance, feeding an infant food in pouches or mixing several different foods together into a mush does not enable this. Commercial baby food can be problematic because typically several foods are mixed together, disallowing individual food taste or colour recognition, and also, many infant “vegetable” meals contain up to 49% fruit. The mixture may be appealing to the baby but it has been found that infants fed commercial baby food 10 or more times per week are more likely to become fussy eaters. It is no surprise that babies weaned onto these sweet mixtures tend to refuse vegetables when they are later offered them as part of a meal.
Which foods are served together can also make a difference. For example, the perception of sweetness is relative, and when added sugars are avoided, fruit is perceived as tasting sweeter. Likewise, when vegetables are served with fruit, the vegetables taste less sweet, and as children naturally prefer sweet foods, the vegetables are less likely to be eaten. For this reason, I don’t recommend putting fruit on your child’s plate with vegetables.
Once solids are introduced there are certain feeding behaviours that need to be established in infants to set them up for a smooth transition to family meals by about 12 months of age. If these are neglected or delayed, feeding difficulties and fussy eating can eventuate. For example, the delayed introduction of lumpy foods has been found to increase the likelihood of fussy eating. The first six months of eating are crucial, and practices such as the establishment of regular meal times, including the baby in family meals, continuing to offer foods that have been refused in the past and continuing to introduce new foods will all help reduce the chance of fussy eating emerging later.
Parental feeding behaviour at the time solids are introduced and beyond is also crucial in helping to prevent fussy eating. For example, pressuring a baby or child to eat is counterproductive and actually increases the chance of fussy eating developing, as is rewarding eating or using food as a reward for behaviour. On the other hand, practicing division of responsibility where the parent alone decides what food is offered and where and when it is offered and the child alone decides only how much to eat has been found to help prevent and overcome fussy eating.
In the second year of life
Between the age of 12 months and two years is an important time for parents to consolidate the good feeding habits that were initiated in the first six months of eating. It is during this period that toddlers might experiment with being fussy with food, and it’s important for parents to not only continue to consistently avoid applying any pressure on their child to eat, but to also not offer alternatives to refused family meals or foods or to prepare special meals for their child.
Based on the research findings, I’ve written a list of recommendations for preventing fussy eating, available as a free download when you join our mailing list.
Learning to eat and developing good eating habits takes time, and is about so much more than just getting food into your baby or “getting them to eat”. Parents have a vital role in gently and patiently helping their child learn to love eating the healthy foods offered to them.