Fussy Eaters: Calming the Meal-time Battleground

Dr Rob Hicks

Disclosures

July 24, 2020

"It's good for you". "Eat your greens". "Oh come on - you liked it yesterday".  For those of us who are parents this might sound all too familiar. Five-a-day – it can be difficult to get one-a-day into the mouth of a fussy eater, or even one a week for that matter. And as healthcare professionals it can be a challenge too.

As a parent you do your best, and that includes giving your child healthy food options. We're bombarded with what constitutes a healthy diet, a healthy lunchbox, so there's no shortage of information. Bottom-line, we've a good idea about what should be going into our children. But, the resources available to help may be limited. Moreover, we may not have cracked the fussy eating problem within our own family so can't even offer the benefit of our own experiences.

Many parents approach mealtimes with trepidation, with dread, even fear. Why? Because although the healthy option is sitting on the plate - maybe even artistically set out into an attractive face - we know that battle is about to commence, and the spoils are quite literally likely to end up, well, spoiled.

It becomes a vicious cycle. The child has to have food so, worn down and exhausted, we give them what they'll eat. Then we feel guilty about not providing the healthy diet they should be having. Anxiety builds about how our lack of success in providing them with a healthy diet will affect their health and wellbeing. And so the cycle continues.

Step in, the Child Feeding Guide, an online guide developed by fussy eating experts at Aston University and Loughborough University, with the aim of easing the stress and anxieties caused by fussy eaters, and getting healthy food into them.

Medscape UK spoke to the experts behind the guide.

Stress for All

Professor Claire Farrow, from Aston University, one of the experts involved in the guide says, "Most children who are fussy eaters will still be getting a range of foods and enough dietary variety to ensure a healthy diet." However, she commented that on the whole fussy eaters do tend to eat less folate and fibre, and tend to consume less vitamin E and C, which can lead to problems with digestion and weaken immunity. But she emphasises the effect of fussy eating extends beyond the fussy eater.

"Fussy eating can also lead to a lot of stress and anxiety for parents and can be stressful for families, especially if children have a very restricted diet and refuse a wide range of foods." She adds that having a fussy eater can make activities such as eating out, or even going to other people's houses for play dates or dinner, very difficult. "If children will not eat foods that are available in these settings this can be very challenging." She explains how parents often report that they feel anxious about fussy eating and worry about their child's health if they are not getting a varied diet.

Fussy eating can also make family meals difficult, and not just because of mealtime table stress. "If the 'cook' ends up preparing different meals to accommodate fussy eating", says Prof Farrow, "this can be time consuming and stressful, especially if food is still rejected after spending time and money accommodating for fussiness." As we know all too well, parents of fussy eaters often spend a lot of time trying to find ways to encourage children to eat a wider range of foods. "The reality is that these strategies tend to work very slowly, and it can be frustrating for everyone, particularly for parents, if changes are not seen quickly" she says.

A New Resource

Initially the Child Feeding Guide was created says Dr Gemma Witcomb, senior lecturer in psychology at Loughborough University, "to pass on what we knew - as psychologists working in feeding and eating research - with parents who may be struggling with feeding a child". Dr Witcomb explained how having her own children, and going through a difficult weaning process with her youngest, she was aware that the information she was getting from the NHS was quite limited and, crucially, was missing a lot of really key information related to the psychology of feeding a child. "When we spoke to other parents, it was clear that many were experiencing difficulties but did not know where to turn for help." She pointed out that the "lack of any credible, trustworthy source of information on feeding children was apparent". This becomes even more important given how many parents may be faced with the challenge of feeding a fussy eater. Although exact figures are hard to come by Dr Farrow says, "The prevalence of fussy eating in the literature varies from 5% to 60% across different studies."

What, Why, What To Do

"Crucially, the guide offers education and information that helps parents/caregivers understand the psychology underpinning child feeding and eating." says Dr Witcomb. She highlights how this is very important because in order to be really effective in tackling a problem it's important to know why something is happening. "So, we explain the five most common feeding issues, taking a 'What, why, what to do' approach." As well as the information, she explains how the guide offers practical tips and a number of interactive tools to help users monitor changes in behaviours and track progress. "Our most popular tool is the Exposure Monitor, which allows parents/caregivers to monitor how many times they have offered a food, in what form, and the child's resulting eating behaviour." She says that, "a simple tool can help to ensure that foods are offered enough times" and that, 15-20 times is perfectly normal before a food starts to be accepted, but many parents give up before this. The Exposure Monitor tool "highlights any patterns in liking and preference", and "providing tangible tools can also help to relieve some of the stress because parents/caregivers feel more empowered," she explains.

Information to Share

The response from people who have used the Child Feeding Guide has been "really positive" according to Dr Emma Haycraft, a reader in psychology at Loughborough University. "Parents have told us that they've found it reassuring, that they really like understanding why behaviours are happening, and that the information is credible and helpful." She adds that health professionals who have used it have commented that they now "have reliable information about fussy eaters to share" and that this "evidence-based, independent information is very important for frontline practice". 

"Childcare professionals find it really helpful for raising staff awareness around the impact that their own behaviour around food can have on children", she says, "and find that it has changed the way in which they approach meal and snack times with children in their care."

Positive Changes

The team's research findings following the launch of the guide have been published in the Nutrition Bulletin journal. "Our findings showed some positive changes in mums who used the Child Feeding Guide over a period of 4 weeks" said Dr Haycraft. "We found that their levels of general anxiety decreased and so did their reported use of pressure for their child to eat, and also they were less likely to restrict their children's access to foods for health reasons." She added that in her opinion their findings were encouraging as the Child Feeding Guide aims to provide reassurances to alleviate anxiety as well as to educate users about recommended feeding behaviours. "Both pressure and restriction have been shown in the research to disrupt children's abilities to respond to their internal hunger and fullness cues, so it's really great to see that parents' use of these practices decreased after using the guide," she said.

Since creating the website and webapp for parents, "we have expanded our resources to include face-to-face and online training and resources for anyone dealing with child feeding, including health professionals and childcare staff" says Dr Witcomb.

Dr Farrow reassures parents saying, "Most children will go through a phase of fussy eating at some point during the primary school years, but for only a small percentage of children will fussy eating be a significant concern and the child will need professional attention and support." She adds further reassurance saying that it "is very common and children do tend to grow out of fussy eating".

So, what else can we do to help the parents and carers of fussy eaters, and for those trying to help them? The team shared their top tips with us:

Keep offering foods - It can take time for children to learn to like a food so keep offering foods on different occasions. The more familiar a food is, the more likely a child is to try it.

Be a good role model - Children are more likely to eat a food if they see you eating it too.

Keep mealtimes fun and relaxed - Avoid forcing or pressuring a child to eat more than they wish or to eat something that they don't want to, and try to avoid making a big deal out of it if a food is refused.

Involve children in food-related decisions and activities - Offering children a choice (carrots or broccoli with dinner?) and involving them in food shopping and preparation are all good ways to help children feel more in control of their food environment, which can help them to be more likely to eat a wider variety of foods.

Keep calm and carry on - Fussy eating and food refusal are part of children's development so try not to worry if they refuse to eat a food on one day. Offer it again on another day and think about all the foods your child has eaten over a week rather than just in that one meal.

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