Peggy Peck

October 11, 2004

Oct. 11, 2004 (San Francisco) — While picky eating is a normal part of childhood development, a subset of picky eaters can be categorized as "supertasters," a condition characterized by more taste buds than the general population, an anatomical difference that may explain an aversion to certain fruits and vegetables.

"About 25% of the population are supertasters with a heightened sensitivity to 6-n-propothiouricil (PROP)," John Snyder, MD, a consultant in pediatric gastroenterology, explained during his lecture here at the American Academy of Pediatrics (AAP) 2004 National Conference & Exhibition.

Dr. Snyder told Medscape that he learned about supertasters as the result of helping his school-age son complete a science project. He said the condition was described in a 1998 article in the Annals of the New York Academy of Science (Bartoshuk L. Ann NY Acad Sci. 1998;30:793-796) and again in a second paper from the same author in 2000 in the Journal of the American Dietetic Association (Duffy VB, Batoshuk L. J Am Dietetic Assoc. 2000;100:547-555).

PROP has a bitter taste, he said. "Broccoli, cauliflower, and cabbage all have PROP, as does grapefruit," Dr. Snyder said. He added that some people are categorized as "nontasters" because they do not detect any of PROP's bitter taste. About 25% of the population are nontasters, 50% of the population are normal tasters (who can detect some bitterness but not enough to make PROP-laden foods unpalatable). "Supertasters, on the other hand, find these foods revolting," Dr. Snyder said. He added that cooking does diminish the potent PROP taste.

In general, children are more likely to be supertasters than adults, which suggests that the sensitivity may diminish with age. "Also supertasters are more likely to be female than male and the condition is common in Asians, Africans, and South Americans," Dr. Snyder said. And supertasters often "consume fewer vegetables than normal tasters."

While the supertaster phenomenon may explain a quarter of picky eaters, Dr. Snyder said that most of picky eaters have acquired the behavior. When Dr. Snyder asked for a show of hands from attendees, almost all attendees indicated that picky eating is a common complaint from parents of toddlers, and two thirds of the audience said their own children were picky eaters.

A literature review suggests that picky eating is a part of normal development with "50% of children aged 18 to 23 months identified as picky eaters," according to Dr. Snyder.

Bradley Bullock, MD, a clinical instructor at Vanderbilt University School of Medicine in Nashville, Tennessee, told Medscape that "eating problems are one of the most common complaints that I see in my practice. Almost every parent of a toddler will report eating problems." Dr. Bullock, who is a member of the AAP meeting faculty, was one of about 200 pediatricians who attended Dr. Snyder's session.

His approach to managing picky eaters is to "define the distribution of responsibilities. Parents are responsible for the varieties of food offered, the environment in which the food is offered, and the time at which the food is offered. Children are responsible for how much food is eaten and whether or not food is eaten."

In addition, parents should restrict juice intake to four ounces per day because "100% of picky eaters fill up on fruit juices, consuming three to four servings a day," Dr. Bullock said.

Dr. Snyder said that introducing new foods is easier before age 18 months, but at any time period introducing new foods is not a simple task. It may take 10 to 15 attempts before a child is willing to eat new foods, he said.

And while both parents and pediatricians are often concerned about calorie intake of picky eaters, he said that picky eating does not automatically lead to nutritional deficiencies and that "most picky eaters do consume about 1,000 calories a day, which is the recommended intake for toddlers." But he cautioned that picky eaters often have too little variety in their diets. For that reason, he advised pediatricians that "when taking food histories it is important to ask about the types of food consumed."

Often high-calorie, low-nutrient foods are overrepresented in the diets of picky eaters, he said. For example, surveys of parents suggest that the most common vegetable consumed by picky eaters is French fries. This pattern can lead to excess energy intake "which may contribute to the epidemic of obesity," he said.

While agreeing that the child is responsible if he or she will eat and how much he or she will consume, Dr. Bullock asked Dr. Snyder about the use of "incentives." For example, "I have a patient who refuses to eat anything green. The parents are regularly offering green beans, peas and so on, but the child refuses to eat. In this case, I suggest offering an incentive — dessert — if the child eats a specified amount such as three peas," Dr. Bullock explained.

Dr. Snyder said incentives don't work because eventually "you run out of rewards." In an interview after the session, Dr. Bullock explained that while he agreed with most of Dr. Snyder's recommendations, he disagreed about the use of incentives. "I think there are cases where incentive use is appropriate," he said.

AAP 2004 National Conference & Exhibition: Session F170. Presented Oct. 9, 2004.

Reviewed by Gary D. Vogin, MD

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