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Original Paper |
Nutrition Department (B.R.C., J.S., K.H.) College of Human Ecology, University of Tennessee, Knoxville, Tennessee
Child and Family Studies Department (J.M.), College of Human Ecology, University of Tennessee, Knoxville, Tennessee
Gerber Products Company (F.C., D.O.), Fremont, Michigan
Address reprint requests to: Betty Ruth Carruth, PhD, RD, Nutrition Department, University of Tennessee, Knoxville, TN 37996-1900
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONMATERIALS AND METHODSRESULTSCONCLUSIONSACKNOWLEDGMENTSREFERENCES |
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Methods: An incomplete block design provided two interviews at randomly assigned times (24, 28, 32, or 36 months) of Caucasian mothers from upper socioeconomic (n=74) and lower socioeconomic status (n=44). Using trained interviewers, 6 days of food intake, two administrations of a questionnaire about toddler’s eating behavior, and one administration of the Family Environment Scales were collected in the home. MANOVA, discriminant function analysis, and logistic regression procedures were used to determine significant differences between picky and non-picky eater groups.
Results: Picky eaters had lower dietary variety (p=.03) and diversity scores (p=.009) than non-picky eaters. Mothers of picky eaters compared to those of non-picky eaters used persuasion (p=.0001) and ranked their child’s eating behaviors as more problematic (p=.0001).
Conclusion: Toddlers perceived by their mothers as picky eaters had significantly lower dietary variety and diversity scores. Parents need information and strategies to increase the number of foods acceptable to their toddlers and to develop a sound feeding plan.
Key words: toddler, picky eater, dietary quality
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSCONCLUSIONSACKNOWLEDGMENTSREFERENCES |
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As infants begin to eat from the family table and to imitate the parent’s food-related behaviors, a conflict may arise between what the child desires and what the parents consider the amount and quality of foods to be consumed. This conflict can evolve into the child being labeled as neophobic, finicky, or having a feeding problem [6]. Behaviors associated with these labels involve avoidance of foods or entire classes of foods and acceptance of a limited number of foods [5,6]. The major nutritional issue involves whether a variety of foods and in age appropriate amounts are consumed by the toddler. The frustrated mother may try to accommodate the picky eater and to develop strategies that increase the amount and quality of foods consumed. However, if mothers use rewards, prodding or punishment to encourage eating, this may contribute to the picky eater phenomenon [6]. Moreover, consistent food intake that is characterized by food avoidance or a limited variety of acceptable foods may result in the formation of undesirable food habits.
Within families, there are functional characteristics that may enhance certain behaviors either negatively or positively [7]. This social climate, as characterized by cohesion, conflict, control, organization, and other parameters, may influence food intake of family members. Kintner, Boss, and Johnson [8] found a significant positive relationship between dietary intake and family characteristics of cohesion and independence.
According to Costanzo and Woody [9], parents who are concerned about an area of child development may exert more control over their child about that area. This idea could apply to mothers who perceive their child’s food intake as inadequate and who try persuasion, rewards, and even coercive methods to increase food intake. Based on Moos and Moos’ topology of family social environments [7], functional characteristics of the family, such as conflict and control over family activities, can influence the feeding process.
The purpose of this study was to determine the variety and diversity of foods consumed by toddlers perceived by their mothers as picky eaters and non-picky eaters. It was hypothesized that picky eaters compared to non-picky eaters would have significantly lower dietary variety and diversity scores, and socioeconomic status and the family environment would be significantly related to dietary scores and picky eater status.
The investigators have followed a group of Caucasian children (2 to 36 months) from upper socioeconomic status (USES) families. Beginning as early as 8 months, some mothers perceived their child as being a picky eater. Although only six USES mothers consistently over time (8 to 36 months) said their child was a picky eater, the total number of mothers at each interview period who reported picky eating behaviors increased as the children grew older. This research project about the picky eater phenomenon and effect on dietary quality evolved from similarities in behaviors described by mothers in the longitudinal study and the overall concern expressed about their toddlers’ food patterns.
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MATERIALS AND METHODS |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSCONCLUSIONSACKNOWLEDGMENTSREFERENCES |
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Interviews
Each mother/toddler dyad was interviewed twice during the 24 to 36 month period. The interview schedule was randomly sequenced for each subject so that the amount of information increased without burdening the subjects. The design also reduced cost of collecting data. The first interview occurred at 24, 28, or 32 months and the second at 28, 32 or 36 months.
Data collected in the first interview included: 2-day food records and one 24-hour recall of foods (3 different days) consumed by the toddler and the mother’s response to the Family Environment Scales (FES) [7]. FES was developed to measure individuals’ perceptions about their nuclear family environment. The instrument has three dimensions (Relationship, Personal Growth, System Maintenance) and 10 subscales that make up the dimensions (Fig. 1). Test-retest reliability for the subscales range from r=.68 to .86. Within normal families the FES scores are considered stable over a 12 to 24 month period [7].
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In the second interview, 2-day food records, one 24-hour recall, and the modified questionnaire were repeated. For LSES mothers, a pre-interview was completed 4 months prior to interview 1 to confirm that screening criteria were met and to provide participants with instructions about keeping food records. Food intake of toddlers who attended day care during meal/snack time (n=58, interview 1; n=70, interview 2) were recorded by day care personnel and/or the mother. Height and weight were measured at each interview, using standard equipment and protocols [12].
Dietary variety and diversity scores for each interview were calculated from reported food intake. The Variety Index for Toddlers (VIT) was determined using the Food Guide Pyramid and serving sizes adapted for 2-year-olds [13]. Foods consumed in amounts less than one-half of a recommended serving size and foods with little nutritional value were excluded in the calculations. The VIT scores potentially ranged from .00 to 1.00. When servings of a food group exceeded the minimum recommended number of servings/day, scores for that food group were truncated. This prevented high intakes of one food group from compensating for an inadequate number of servings from other food groups. A single food could not comprise more than one-third of the total score for a food group. The Diversity Index for Toddlers (DIT) was defined as the total number of different foods consumed over 3 days, and any amount of food consumed was counted. The range of diversity scores varied from a minimum of 15 at 28 months to a maximum of 43 at 32 months.
Nutrient analyses of toddlers’ dietary data were performed with Nutritionist IV computer software [14]. Nutrient amounts were compared to the Recommended Dietary Allowances (RDA) for children, ages 1 to 3 years [15]. Achieving 100% of the recommended amount for each nutrient was the standard set for meeting the RDA.
Analyses
Descriptive data were generated using SAS PROC FREQ [16] for demographic information, responses to FES, dietary variety and diversity scores by picky eater status, height/weight data, and numerical ratings given by mothers for behavioral items on the questionnaire. For the open-ended questions, mothers’ responses were categorized by the method of Taylor and Brogan [17] into major themes.
To test the hypothesis that mothers’ perceptions of their toddlers as picky or non-picky eaters were related to variety and diversity of their toddlers’ diets, general linear model procedures were used [16]. Picky eater status was the independent and dietary variety and diversity scores were the dependent variables.
To determine the relationship between family environment and picky eater status, stepwise regression models using FES scores (subscales and dimensions) as the independent and dietary VIT and diversity scores as the dependent variables were developed [16]. To assess whether characteristics of the family discriminated between picky or non-picky eater status, discriminant function analysis was performed with picky eater status as the group criterion and mothers’ responses on FES as predictor variables. Effects of age and picky eater status on dietary VIT and diversity scores were determined with MANOVA. To predict picky eater status, SES, FES scores on subscales, age, dietary VIT and diversity scores were entered as independent variables in logistic stepwise regression models.
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RESULTS |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSCONCLUSIONSACKNOWLEDGMENTSREFERENCES |
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In describing limited food choices, mothers said the toddler "eats only a few things," "eats nothing but peanut butter and jelly," and "eats the same thing over and over." This type of limiting behavior was called "finickiness" by Pelchat and Pliner [6]. To describe the toddler’s behavior toward unfamiliar foods, mothers of "picky eaters" stated that (he) "is unwilling to try new things, anything new at all" and "wants to eat the same thing - won’t try anything new." In some cases, a familiar food prepared differently was viewed as novel. Some toddlers avoided entire food groups, with vegetables as the group most frequently avoided. Avoidance actions of the toddler were described as "refuses to eat vegetables," "eats very few nutritious foods and eats only junk," and "will eat any kind of meat as long as (mother) calls it chicken." The term neophobia has been used to describe a child’s unwillingness to try novel or unfamiliar foods [5,6,18].
Several exposures may be necessary before a child accepts a new food [3]. In this study, the highest frequencies reported for exposing the child to unfamiliar foods away from home was 1 to 3 times/month (n=56 mothers) and 6 to 11 times/year (n=32 mothers). Similar results were reported for the number of mothers (n=62) who exposed their toddler to new foods at home, i.e., 1 to 3 times/month, and 6 to 11 times/year (n=31 mothers). To determine those foods that were disliked, mothers averaged trying a new food 2.5 times (range 1 to 12 times) before deciding.
For some of the picky eater group, individual preferences involved both presentation and preparation of the food. For example, preference included "it (food) has to be in a certain form on the plate," "corn is on one side and bread without crust on the other side," or "picks things apart...doesn’t like foods mixed." Appearance of the food in some cases prevented the toddler from accepting the food, e.g., "yuk."
Mothers of picky and non-picky eaters ranked their responses (1 to 7) to a series of questions about their child’s and their own behaviors. Each question had descriptors specific to that question, and some questions used inverted values for ranking, i.e., 7 could be the least or most favorable response to that item. For example, "to what extent does your child’s eating behavior bother you?" The descriptor ranged from "not at all bothered" (1) to "bothered to a great extent" (7). As shown in Table 3, there was a significant mean difference between groups. Mothers of picky eaters thought their child had a feeding problem; eating behavior was ranked poor; the toddler ate inadequate amounts of foods that mothers thought their child should eat; and the toddler did not eat a wide variety of foods. Mothers of picky eaters used persuasion, and fixed special foods for their children more than mothers of non-picky eaters. No significant difference was found between groups for giving rewards (p=.14).
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Family Environment and Picky Eater Status
The normative means for the 10 subscales and mean FES scores for the picky and non-picky eater groups are graphed for comparison in Fig. 1 [7]. The higher the scale score, the stronger the family characteristic, i.e. religious/moral. T-tests of mean scale scores by picky eater status indicate no significant difference between groups. Mean FES scores also were not significantly different between the upper and lower socioeconomic mothers. Similarly, functional characteristics of the family did not differ significantly (p>F=.49) by picky eater status, using picky eater status as the group criterion and mothers’ responses on FES as independent variables.
FES Effect on Variety and Diversity Scores
Using stepwise regression analyses, models were developed to determine the effect of family environment on dietary VIT and diversity scores. Mothers’ scores from FES (subscales and dimensions) were treated as independent variables and dietary VIT or diversity scores as independent variables. Although the model for effect of family on dietary VIT was significant (p=.007, F=4.68), the amount of variance explained by FES was low (R2=.18). For dietary diversity, findings were nonsignificant.
SES Effect on Dietary Scores and Picky Eater Status
MANOVA analyses show no significant difference for dietary variety (p=.16) or diversity (p=.64) by SES or picky eater status. This finding is further supported by unsolicited similar comments from mothers in each group about their toddler’s limited acceptance of a wide variety of foods.
Height/Weight and Picky Eater Status
Results of t-tests [15] for comparing mean heights and weights for picky (n=42) vs. non-picky eaters (n=75) show no significant differences in growth parameters. The mean height and weight of male picky eaters was 35.0±1.5 in, 29.4±3.3 lbs; for females 34.7±1.2 in, 27.6±3.1 lbs, respectively. For the non-picky eaters, mean height of males was 35.2±1.5 in, 29.8±3.1 lbs and for females, 34.0±1.6 in, 27.6±4.2 lbs, respectively. These values are within normal ranges for the 24 to 36 month age.
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DISCUSSION |
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Mothers described feeding problems, such as rejection of entire classes of foods, that were reported by Pelchat and Pliner [6]. These rejection behaviors negatively influenced the dietary scores of picky eaters as shown by both the variety of foods eaten and the total number of foods eaten per day (diversity index).
Some toddlers repeated the same behavior over and over, i.e., "avoids vegetables", "eats only peanut butter and jelly". The repetitive behaviors may become more bothersome to mothers when their child reaches a certain age. The fact that some mothers were first bothered by their child’s eating behavior in an age range of 9 to 36 months reflects differing thresholds of tolerance dependent upon the particular behaviors exhibited. This range of ages also could reflect that picky eating behaviors occurred at different times across the 9 to 36 months of this study.
The number of food exposures can influence the shift from a toddler appearing to be picky about food to accepting a wide variety of foods. Birch and Marlin [4] found that as the number of exposures to a food increased, the child’s preference for that food increased. Up to 10 exposures were required to achieve clear changes in acceptance [3]. The importance of multiple experiences to achieve food acceptance has been reported for infants [3] and adults [18]. In our study, mothers reported about the same number of exposures for foods eaten away from home and at home i.e., 1 to 3 times/month and 6 to 10 times/year of food exposures. Also the average number of times that foods were tried before mothers decided their child liked or disliked a food was less than three times. The limited number of food exposures and trials to determine the toddler’s food likes and dislikes are probably insufficient to anticipate that toddlers will learn to accept a wide variety of foods. If insufficient exposure results in multiple food or food group rejections, parents may consider this problematic eating behavior.
During the 24 to 36 month period, autonomy and independence issues about foods likely contributed to the picky eater phenomenon. Any new food experience can become a power struggle between parent and child. Some of the mother’s comments typify frustration: "he will visually decide he doesn’t like something" or "one time she’ll eat it and next time she won’t even touch it - yukky! gross!" In this data, it is clear that exposure and autonomy are intermingled effects on toddlers’ food consumption patterns.
The use of persuasion and rewards, such as giving desserts and verbal praise, may create some of the situations described by mothers as picky eater behaviors. According to Buck, Marlin, and Rotter [19], having a child eat a food in order to gain a reward lessens the child’s liking for that food, e.g., vegetables. A positive social context for verbal praise (as a reward) is considered positive in developing food likes and dislikes [19]. In general, families in this study had low conflict, high cohesion, and promoted independence in their toddlers; verbal praise could be more effective than dessert rewards.
The nonsignificant findings for family environment and socioeconomic status on the toddlers’ dietary scores are contrary to published literature. However, there was a homogeneity, including ethnicity and family characteristics, among participants in the study that may not be applicable to other groups and to the purported effect of the family on food patterns of children. Similarly, the cultural milieu for food choices and preferences may be more homogeneous for families in this study than in other areas of the country.
A lack of consensus among researchers for an operational definition for "picky eating" is an inherent limitation in studying this topic. That is, there are reports of behaviors [5] and food preferences of preschool children [6] that mothers in this study would call "picky eater" behaviors. Developmentally, however, children go through stages of autonomy that can influence food acceptability. Over time, mothers may be less or more bothered by their toddler’s behavior during the feeding process, and this is a co-variant in studying picky eating behaviors.
In this study, mothers’ perceptions were recorded, but not always in the same sequencing of information collected between the two interviews. Because perceptions were collected in the toddler’s natural setting, results could differ if there was an operational definition for "picky eater" behaviors, e.g., an objective observer saw an eating occasion, and then the observer completed the questionnaire. However, the objective observer approach does not reflect many mothers’ experiences over time with many toddlers.
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CONCLUSIONS |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSCONCLUSIONSACKNOWLEDGMENTSREFERENCES |
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Practical applications of the finding relate to education of the mother and to experiential approaches for the toddlers. Parents need suggestions about age appropriate experience that help the toddler to accept a wide variety of foods, and to consume adequate amounts of foods that consistently meet energy and nutrients allowances over time.
More emphasis should be placed on enabling parents and caregivers by providing strategies that lead to a sound feeding plan for their toddlers. Parents in this study need information about the effect of multiple food exposures on the child’s food likes and dislikes, the use of reward systems, the importance of a social context for eating, and influence of the parent’s example on their child’s likes and dislikes. Our results indicate that although mothers had varying levels of tolerance for picky eater behaviors, most mothers look to health care providers for assurance that the bothersome food-related behaviors may be only temporary and for advice about how to help their child develop desirable food habits for the future.
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ACKNOWLEDGMENTS |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSCONCLUSIONSACKNOWLEDGMENTSREFERENCES |
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This research was funded by Gerber Products Company, Fremont, MI.
Received April 1, 1997. Accepted October 1, 1997.
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REFERENCES |
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| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Scores for Toddlers, 24 to 36 Months of Age