Childhood fussy/picky eating behaviours: a systematic review and synthesis of qualitative studies

Abstract

Fussy/picky eating behaviours are common across childhood. Recent reviews of the fussy eating literature focus on quantitative research and do not adequately account for families' subjective experiences, perceptions and practices. This review aims to synthesise the increasing volume of qualitative work on fussy eating. A systematic search of relevant databases was carried out. Studies were included if they were qualitative, published since 2008, with a primary focus on families' experiences, perceptions and practices regarding fussy eating, food neophobia, or food refusal in children (aged one to young adult). Studies with clinical samples, or relating to children under one year were excluded. Ten studies were eligible for this review and were synthesised using meta-ethnography (developed by Noblit and Hare). This review provides a comprehensive description and definition of fussy eating behaviours. A conceptual model of the family experience of fussy eating was developed, illustrating relationships between child characteristics (including fussy eating behaviours), parent feeding beliefs, parent feeding practices, mealtime emotions and parent awareness of food preference development. Our synthesis identified two ways in which fussy eating relates to mealtime emotions (directly and via parent feeding practices) and three distinct categories of parent beliefs that relate to fussy eating (self-efficacy, attributions and beliefs about hunger regulation). The model proposes pathways which could be explored further in future qualitative and quantitative studies, and suggests that parent beliefs, emotions, and awareness should be targeted alongside parent feeding practices to increase effectiveness of interventions. The majority of studies included in this review focus on preschool children and all report the parent perspective. Further research is required to understand the child's perspective, and experiences of fussy eating in later childhood.

Knowledge, Attitudes and Practices of Australian Trainee Childcare Educators Regarding Their Role in the Feeding Behaviours of Young Children

“…The literature suggests that childcare educators adjust their feeding practices in response to child food refusal (verbal and non-verbal), using controlling feeding practices (coercion, threats, insistence and spoon-feeding) [42,54] and the provision of alternatives (rather than repeated exposure of the target food) [52] appears to be common practice. When reflecting on the efficacy of a childcare educator to respond to child food refusal, Wolstenholme et al (2020) [67] described a carer's beliefs about attributions for fussy eating behaviour and hunger regulation to be highly influential. Carers who are able to determine if food refusal is due to sensory sensitivity or neophobia and who support self-regulation are less likely to regard children as fussy eaters and more likely to utilise responsive child feeding practices [67].…”

“…When reflecting on the efficacy of a childcare educator to respond to child food refusal, Wolstenholme et al (2020) [67] described a carer's beliefs about attributions for fussy eating behaviour and hunger regulation to be highly influential. Carers who are able to determine if food refusal is due to sensory sensitivity or neophobia and who support self-regulation are less likely to regard children as fussy eaters and more likely to utilise responsive child feeding practices [67]. These authors also described relational efficacy (beliefs and confidence in another person's estimation of one's own ability) as important as self-efficacy (beliefs and confidence in one's own ability) when upskilling carers about child feeding.…”

Associations of Early Parental Concerns and Feeding Behaviors with Child’s Diet Quality through Mid-Childhood

“…Webber et al showed that parents pressure their child to eat in response to concerns about inadequate intakes or because they perceive their child as too thin [43]. A review of qualitative studies also suggested that parental pressure to eat is associated with fussy eating in children, an association that is likely to be bi-directional [44].…”

Fussy eating in toddlers: A content analysis of parents' online support seeking

“…This study provides a unique insight into parents' concerns about fussy eating in toddlers, through an analysis of support seeking questions posted on the social media platform Reddit. Although previous studies have examined parents' perceptions and management of fussy eating behaviour (Wolstenholme et al, 2020), this is the first study to analyse parents' presentations of fussy eating using an online discussion forum. As such, this study revealed new insights into parents' feeding concerns they may not have felt comfortable articulating else-…”

“…Original posts were retained for analysis as this study was focused on the support seeking practices of parents presenting with fussy eating concerns, yielding 329 posts, which were exported to Microsoft Excel for further refinement (Figure 1). Of these posts, 130 were related to fussy eating based on existing literature definitions of common food fussiness behaviours (e.g., food refusal and limited liked foods; Taylor et al, 2015;Wolstenholme et al, 2020). Data retrieved included post date and time, user pseudonym and the original post title and body.…”