food neophobia and ‘picky/fussy’ eating in children: a review
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Appetite 50 (2008) 181–193
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Research Review
Food neophobia and ‘picky/fussy’ eating in children: A review
Terence M. Doveya,d,�, Paul A. Staplesb, E. Leigh Gibsonc, Jason C.G. Halfordd
aDepartment of Psychology, Staffordshire University, College Road, Stoke-on-Trent, Staffordshire ST4 2DE, UKbDepartment of Psychology, University of Derby, Western Road, Mickleover, Derby DE3 9GX, UK
cClinical and Health Psychology Research Centre, School of Human and Life Sciences, Whitelands College, Roehampton University,
Holybourne Avenue, London SW15 4JD, UKdKissileff Laboratory for the Study of Human Ingestive Behaviour, School of Psychology, University of Liverpool, Eleanor Rathbone Building,
Bedford Street South, Liverpool L69 7ZA, UK
Received 18 August 2006; received in revised form 1 June 2007; accepted 24 September 2007
Abstract
Two factors have been shown to contribute to rejection or acceptance of fruits and vegetables: food neophobia and ‘picky/fussy’
eating. Food neophobia is generally regarded as the reluctance to eat, or the avoidance of, new foods. In contrast, ‘picky/fussy’ eaters are
usually defined as children who consume an inadequate variety of foods through rejection of a substantial amount of foods that are
familiar (as well as unfamiliar) to them. Through understanding the variables which influence the development or expression of these
factors (including age, personality, gender, social influences and willingness to try foods) we can further understand the similarities and
differences between the two. Due to the inter-relationship between ‘picky/fussy’ eating and food neophobia, some factors, such as
pressure to eat, personality factors, parental practices or feeding styles and social influences, will have similar effects on both magnitude
and duration of expression of these behaviours. On the other hand, these constructs may be differentially affected by factors such as age,
tactile defensiveness, environment and culture. The effects of these variables are discussed within this review. Behavioural interventions,
focusing on early life exposure, could be developed to attenuate food neophobia and ‘picky/fussy’ eating in children, so promoting the
ready acceptance and independent choice of fruits and vegetables.
r 2007 Elsevier Ltd. All rights reserved.
Keywords: Children’s eating; Food neophobia; ‘Picky/fussy’ eating; Social facilitation
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
Food neophobia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Food neophobia and age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Food neophobia, personality and gender. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
Food neophobia, social facilitation and social influence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Food neophobia and willingness to try novel foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Picky/fussy eaters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Measuring ‘picky/fussy’ eaters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Development of the ‘picky/fussy’ eater . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
The diet of ‘picky/fussy’ eaters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190
e front matter r 2007 Elsevier Ltd. All rights reserved.
pet.2007.09.009
ing author. Department of Psychology, Staffordshire University, College Road, Stoke-on-Trent, Staffordshire ST4 2DE, UK.
ess: [email protected] (T.M. Dovey).
ARTICLE IN PRESST.M. Dovey et al. / Appetite 50 (2008) 181–193182
Introduction
Despite comparative wealth and general affordability offoodstuffs in the Western world, concern has arisen overthe composition and lack of diversity seen in somechildren’s diets. Some authors have suggested that the lackof dietary variety in children’s diets is directly associatedwith intake of certain foodstuffs. Specifically in thesechildren, intake of fresh produce such as fruits andvegetables is replaced by unhealthy processed foodscharacterised by their high hedonic value that results fromtheir sugar, fat and salt content (Dennison, Rockwell, &Baker, 1998; Fisher & Birch, 1995). This limited but energydense (and presumably) hyper-caloric diet is widelyconsidered to be a key contributing factor to the rise inthe rates of childhood obesity (Falciglia, Couch, Gribble,Pabst, & Frank, 2000; Rigal et al., 2006) as well as theincrease in the prevalence of non-communicable diseases(e.g. type II diabetes) in children (Kaufman, 2002). Thus,Western health care systems are faced with the strangeparadox of excessive childhood weight gain accompaniedby essential nutrient deficiency in a substantial part of theirpatient population (Carruth et al., 1998).
Although the recommended daily intake of fruit andvegetables varies between countries, the general suggestionis that children, as well as adults, should consume at leastfive portions a day (Lassen, Thorsen, Trolle, Elsig, &Ovesen, 2003; Steinmetz & Potter, 1996). However, theconsistent picture is that many children do not consume therecommended number of portions of fruit and vegetablesand therefore are not getting sufficient micronutrients andfibre essential for normal healthy development. Worry-ingly, there appears to be no sign of an improvement inconsumption of fruits and vegetables by children, despiteubiquitous 5-a-day messages and small increases amongsome adult populations (Cockroft, Durkin, Masding, &Cade, 2005; Sproston &Mindell, 2006). Not only is the dietof these children deficient, but they may also be learninginappropriate feeding behaviours and food choices fromsignificant others (Cullen, Rittenberry, Olvera, & Bara-nowski, 2000). Given that these early eating habits may bepredictive of those in adulthood (Kelder, Perry, Klepp, &Lytle, 1994), they will ill-protect the child now, and, in thefuture, from the obesigenic environment into which theyhave been born.
In an effort to deal with this issue, both Governmentand media have focused on increasing the fruit andvegetable consumption of children. This focus has gen-erally raised awareness of the benefits of healthy consump-tion of fruit and vegetables within Western populations.However, attempts to instil more appropriate feedingbehaviour in children can prove difficult. Infants’ innatefood preferences and their development of taste perceptionprovide an inbuilt barrier to the acceptance of certaintypes of foods. Thus, it may often be counterproductiveto push a child to consume when they are rejectingnovel foods offered to them (Galloway, Lee, & Birch,
2003). A stressful feeding encounter is not likelyto stimulate a positive response from the child to noveland/or aversive tasting foods (Fisher & Birch, 1999;Francis, Hofer, & Birch, 2001; Johnson & Birch,1994). Indeed, positive parental child-feeding style isintegral to overcoming a child’s natural rejection of novelfoods.To persuade any child to adopt healthier food choices
requires interventions that consider the complex interplaybetween innate and rapidly acquired taste preferences(Desor & Beauchamp, 1986; Rozin, 1979; Visser et al.,2000), cognitive ability or attention span (El-Chaar,Mardy, Wehlou, & Rubin, 1996), cultural norms (Kannan,Carruth, & Skinner, 1999), parenting style/pressure (Gallo-way, Fiorito, Lee, & Birch, 2005), parental dietarypreferences and eating behaviours (Fisher, Mitchell,Smiciklas-Wright, & Birch, 2002; Gibson, Wardle, &Watts, 1998). However, arguably the strongest psycholo-gical barriers to increasing a child’s dietary variety are foodneophobia (Birch & Fischer, 1998; Falciglia et al., 2000)and ‘picky/fussy’ eating (Galloway et al., 2003). Thisreview will focus on these concepts and in what way theyaffect a child’s diet.Food neophobia has been identified as an inherent
adaptive personality trait (Milton, 1993). It is defined as therejection of foods that are novel or unknown to the child,while ‘picky/fussy’ eating is the rejection of a largeproportion of familiar (as well as novel) foods resultingin a habitual diet characterised by the consumption of aparticularly low variety of foods. Essentially, food neo-phobia is an integral constituent part or a subset of the‘picky/fussy’ eating. Evidence within the literature suggeststhat they are behaviourally distinct, with different factorspredicting the severity and expression of these twoconstructs (Galloway et al., 2003; Potts & Wardle, 1998;Raudenbush, van der Klaauw, & Frank, 1995); however,some papers suggest they are highly related (Pelchat &Pliner, 1986; Pliner & Hobden, 1992). Operational defini-tions for these two behaviours will be offered in each of thefollowing sections. Although they both have been sug-gested to be independent personality traits, food neophobiaand ‘picky/fussy’ eating have also been shown to be statedependent, i.e. depending on age and environment (Pelchat& Pliner, 1995). This age-specific influence on an allegedstable personality trait (Monneuse et al., 2004) may suggestit is not a trait at all; rather it might be an age-dependentstate (Rigal et al., 2006), which with the proper instructioncould be discarded as the child develops.The need to influence children’s food choices demands
an understanding of the developmental factors that impedetheir acceptance and consumption of fresh fruit andvegetables. Integral to developmental influences are factorssuch as food neophobia and ‘picky/fussy’ eating. Thenature of the interaction between these two behavioursneeds to be understood, along with the identification oftheir constituents. Finally, consideration about whatfactors sustain ‘picky/fussy’ eating through the different
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stages of childhood must also be understood beforesuitable interventions can be devised.
Food neophobia
It is evident that most individuals lose bitter tasteaversions and eventually learn to enjoy, to a greater orlesser extent, vegetables and beverages that are predomi-nantly bitter (Stein, Nagai, Nakagawa, & Beauchamp,2003), thus allowing an adaptive increase in dietary varietyin omnivores (Raynor & Epstein, 2001). This is particularlythe case for fruits and vegetables from the citrus andbrassicaceae family, and presumably reflects learned tasteacceptance brought about by repeat exposure (Birch &Marlin, 1982; Pliner, 1982; Rolls, 1994). It is now knownthat some of these foods contain high levels of phyto-chemicals that are associated with a lower risk ofdeveloping certain forms of cancer (reviewed by Birt,Hendrich, & Wang, 2001). Therefore, the identification andinvestigation of the mechanisms that reverse the aversionto these types of tastants is essential in improving illnessprevention through healthier diets. Integral to this goal isensuring that acceptance of these learned-to-be-liked foodsoccurs as early in life as possible, as childhood may containa critical period which informs adult consumption of allfruits and vegetables. Food neophobia is one importantfactor that can interfere with getting children to acceptthese foods (Kelder et al., 1994).
Food neophobia is often described as the reluctance toeat, or the avoidance of, new foods (Birch & Fischer, 1998).The term was derived from the earlier work of Rozin’s‘omnivore’s dilemma’ (Rozin, 1979; Rozin & Vollmecke,1986): a process described as an evolutionarily beneficialsurvival mechanism to help children avoid ingestingnoxious or toxic chemicals once they are adept and mobileenough to consider, pick up and consume ‘objects’ found intheir immediate environment but outside of their parentalguidance (Birch, Gunder, Grimm-Thomas, & Laing, 1998;Cashdan, 1998; Wright, 1991). In order to avoid eatingpotentially poisonous plants (Glander, 1982), children willnaturally reject bitter tasting foods (McBurney & Gent,1979), which has been suggested to be reliant on hedonicneurobiological mechanisms that are present at birth(Steiner, 1979) and can persist into adulthood (Steinet al., 2003). Food neophobia aids this avoidance mechan-ism through the child naturally rejecting potential foodsources that they have no experience with. Presentation ofa novel item of any kind may initiate a fear (or avoidance)response within the individual (Zajonc, 1968). Thus,rejection does not occur during tasting of the food, whichwould risk poisoning; rather it happens primarily withinthe visual domain. Therefore, foods that do not ‘look right’to the child will be initially rejected based on vision alone—for example, green vegetables (Harris, 1993). Evidence forthis rejection of foods by neophobic individuals based onvisual cues can be inferred from data on willingness to tryfood items (Backstrom, Pirttila-Backman, & Tuofila, 2004;
McFarlance & Pliner, 1997). Within this paradigm,participants are asked if they would be willing to tastedifferent food items. In the absence of the food itemsthemselves, it shows that people who have higher foodneophobia are more likely to reject food items beforetasting them, although it is accepted that previousexperiences of other tasted food items may also be beingutilised to make this judgement (Pliner, Pelchat, &Grabski, 1993). The inference here is that children buildup schemata of how an acceptable food should look, andperhaps smell, and so foods not sufficiently close to thisstimulus set will be rejected.Inevitably, if the food is recognised and accepted within
the visual domain, it will be tasted. The taste will then beassessed for its subjective value (either positive or negativeto the individual), which in turn is associated with thevisual image. Successful and continuous positive experi-ences with the food item will lower the child’s reluctanceto eat it. It would appear that up to 15 positive experiencesmay be required for successful acceptance of the fooditem into the child’s habitual diet (Birch, McPhee, Shoba,Pirok, & Steinberg, 1987; Wardle, Carnell, & Cooke, 2005;Wardle, Cooke et al., 2003), although there are only limiteddata on this point. This does appear also to have an age-dependent component, with children within their first yearof life needing only one exposure of a novel food item todouble consumption (Birch et al., 1998). Essentially, thehighly food neophobic child will have a larger fear reactionto a novel food item. This fear reaction will be by its verynature a negative experience, which, together with likelyconsequent negative emotions from the adult feeder, will betransferred to encoding of the exposed item (Burgess &Sales, 1971). Therefore, the highly food neophobic childwill have a larger negative experience to overcomefollowing presentation of novel food items than theirneophilic peers. The result of this interaction with novelfood items may lead to a different habitual diet (Skinner,Carruth, Bounds, Ziegler, & Reidy, 2002), as extendedperiods of exposure are required with food neophobicchildren that parents report cannot be achieved within theirmodern day time constraints (Birch et al., 1987).
Food neophobia and age
Although arguments about the exact nature of thedevelopment of food neophobia are ongoing, it has beenshown that expression of this behaviour decreases with age(Koivisto-Hursti & Sjoden, 1997), with most authorsreporting that, from a low baseline at weaning, it increasessharply as a child becomes more mobile, reaching a peakbetween 2 and 6 years of age (Addessi, Galloway,Visalberghi, & Birch, 2005; Cashdan, 1994; Cooke,Wardle, & Gibson, 2003). This trait then decreases as theindividual ages until it is at a relatively stable zenith inadulthood (McFarlane & Pliner, 1997). Contention in theliterature can be found, with some authors reporting ageneral decrease until early adulthood (Koivisto-Hursti &
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Sjoden, 1996; Rigal et al., 2006), while others suggest thatfood neophobia is stable from adolescence (13 years old)(Nicklaus, Boggio, Chababnet, & Issanchou, 2005). It islikely though that food neophobia continues to decreasethroughout childhood, adolescence and adulthood. Not todecrease would be maladaptive to survival and reproduc-tive rates in our species, as the omnivorous nature ofhumans means we have diverse nutritional needs thatcan only be gained from an equally varied diet (Raynor& Epstein, 2001). The gradient at which this loss ofneophobia occurs is probably less pronounced withinadolescent and adult populations in comparison tochildren. As children age, their experiences with foodstuffsare more varied and frequent; therefore they will becomeless neophobic because fewer things are novel to them andthey will have developed varied likes and dislikes (Cooke &Wardle, 2005).
Interestingly, it has also been shown that older peoplemay exhibit increases in food neophobia (Otis, 1984;Tuorila, Lahteenmaki, Pohjalainen, & Lotti, 2001). Aproposed lifespan model of food neophobia is shown inFig. 1. Currently it is not known whether the senior citizenis attempting to avoid foods that they do not know andtherefore have a perceptually higher probability of causingillness (particularly gastric discomfort) or whether therelatively lower food neophobia in younger generations is amodern development brought about by the increase in anddistribution of new food markets over the last century. If itis a response to a weakening health state (a naturalprogression as the person ages) then this form of foodneophobia may be related to perception of health state andstatus (including dental health). The stronger (in terms ofhealth) the senior citizens believe they are, the less foodneophobic they may be and the more perceived ‘risks’ withnovel foods they may take. In addition to this perception, itis well known that the elderly have difficulty with theirsenses, showing weaker abilities to detect (Cain & Stevens,1989; Cowart, 1989) and differentiate (Murphy, 1985) foododours. This weakened state may lead to distrust and thus
Childhood Adolescents
Life Span
Fo
od
Ne
op
ho
bia
Plinth variable between ages 2
Fig. 1. A potential lifespan model for le
nutrient deficiency (Betts, 1988). However, there is evidencethat suggests that having poor olfaction may result inincreased consumption of novel foods, because they willnot be put off by the novel smell (Pelchat, 2000).Conversely, a second explanation could be that the foodneophobia is somehow fixed during adulthood. Exposureto novel foods after this fixation time may not result in anincreased acceptance of these foods into the everyday dietof the individual.The increase in the ability to store foods for longer and
move them quicker means it is now logistically possible todraw on food markets from around the globe. Over recentdecades, there has also been a substantial increase in ethnicrestaurants in many towns and cities. Therefore, theincreased food neophobia in the older generation may bea by-product of that generation itself. Early life exposure ofthese more ‘ethnic’ foods within the older generation wouldbe much lower and, therefore, they may have more foodneophobia towards them. Either way, this would suggest acognitive involvement that is not as pertinent in childhoodfood neophobia and thus predictive of fruit/vegetableconsumption (Havas et al., 1998; Perry, Bishop et al., 1998;Perry, Lytle et al., 1998; Sorensen et al., 1999; Wardle,Cooke et al., 2003). As such, a differing mechanism to thatof the previously proposed evolutionary one is more likelywithin senior citizen populations. However, data on foodneophobia in older people are relatively scarce and theissue requires more research focus.
Food neophobia, personality and gender
Although it has been repeatedly proposed that foodneophobia is related to age (McFarlane & Pliner, 1997),individual differences do impinge on the acceptance ofnovel foods through an attenuation of the magnitude,duration and age of onset of highest levels of foodneophobia in the child. The most obvious personality traitthat has been offered is that of sensation seeking (Zucker-man, 1979). Individuals who are more sensation seeking by
Adulthood Old Age
-6
Food neophobia may increase inold age possibly due to health
concerns. More research required.
vels of food neophobia in humans.
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nature tend to have much lower levels of food neophobia(Galloway et al., 2003; Pliner & Melo, 1997; Walsh, 1993)probably through lower general neophobia (Pliner &Hobden, 1992). Recently, other personality factors havealso been positively associated with food neophobia,including trait anxiety (Galloway et al., 2003; Loewen &Pliner, 1999), openness (McCrae et al., 2002) and neuroti-cism (Steptoe, Pollard, & Wardle, 1995).
Of greater theoretical importance, though, is theinvolvement of emotion and emotivity (MacNicol, Murray,& Austin, 2003) in food neophobia. It would appear thatfood neophobia is related to feelings of disgust, andindividuals who attribute a feeling of disgust to novelfoodstuffs are likely to be less willing to try them (Martins& Pliner, 2005)—at least after the age of four as youngerchildren seem to be less affected by this association (Fallon,Rozin, & Pliner, 1984; Rozin, Millman, & Nemeroff, 1986).Feelings of disgust, and associated facial expressions, maybe related to foods that are bitter and/or potentiallyharmful in nature (Martins & Pliner, 2005; Steiner, 1973).Therefore, if the food ‘looks’ bitter (through the foodoffered sharing visual characteristics with previouslyexperienced bitter foods) or is emotionally associated withsubjective feelings of disgust, the child will reject it. It isessential to understand that the concept of food neophobiaonly extends to the point where the individual picks up thefood and places it in his mouth. Once the food is in themouth, it is understood that the ‘phobia’ to the new foodhas been, in essence, overcome. This has been shown with asignificant negative association between ‘expected pleasant-ness’ of novel foods and food neophobia (Raudenbush& Frank, 1999; Tuorila, Meiselman, Bell, Cardello, &Johnson, 1994), which is subsequently lost once the foodhas actually been tasted (Pliner & Hobden, 1992). It isunderstood, however, that food neophobia to a particularfood item can be reinforced from a negative experiencewithin the initial series of exposures.
Essentially, the acceptance or rejection of the food onceits novelty has been removed is outside the realm of foodneophobia, which is the rejection of the food based onvisual presentation, odour and amount of exposuresrequired to accept it. The rejection of the taste itself isthe remit of ‘picky/fussy’ eating research and flavour/consequence learning. Although exposure is integral tofood neophobia, ‘picky/fussy’ eating and flavour/flavour orflavour/nutrient learning, the distinction between the fieldsis the point of acceptance of the food itself. The reluctanceto try (or continue to try within the initial exposureepisodes) novel foods is a neophobic behaviour, whereasthe reluctance to accept the taste involves other processes.It is therefore important that researchers do not confusethese two issues.
To limit the perception of disgust, it is suggested thatnovel food is presented in a positive light, includinghighlighting the fun of preparation and cooking food.Foods highlighted positively have been shown to be morelikely to be accepted (Martins, Pelchat, & Pliner, 1997;
McFarlane & Pliner, 1997; Pelchat & Pliner, 1995).Importantly, a parent who creates pressure to consume anovel food offered, through frustration at the rejection ofthe item or by any other cause, may be adversely affectingthe child’s emotional state leading to attribution of feelingstowards the novel food. It has been consistently shown thatparental pressure to consume foods is associated withhigher expression of food neophobia (Fisher et al., 2002;Galloway, Fiorito, Francis, & Birch, 2006; Galloway et al.,2005; Wardle et al., 2005), although there may be someinstances where this may not be the case (Bourcier, Bowen,Meischke, & Moinpour, 2003). Consequently, futurepresentations of the food will be associated with theparents’ exasperations and the child will continue to rejectthe food (Pliner & Loewen, 1997). As mentioned above,exposure to a novel food does generalise to other non-exposed food items (Birch et al., 1998; Pliner et al., 1993).Therefore, it would be logical to suggest that an equallynegative exposure episode will be generalised too. Furtherresearch is required to substantiate this belief, especially asevidence is available to show that this generalisation maynot occur (Hobden & Pliner, 1995).In terms of sex differences, some studies have found
differences (e.g. women more neophobic; Frank & van derKlaauw, 1994) and others have not (e.g. Koivisto-Hursti &Sjoden, 1997). Similarly, a large Finnish survey reportedhigher neophobia in men than women (Tuorila et al.,2001). Yet, it has recently been shown that there are nodifferences in food neophobia between the sexes in youngadults, and if anything females are more disgust sensitivethan males (Nordin, Broman, Garvill, & Nyroos, 2004). Inaddition, food neophobia has been shown to be weaklyassociated with disgust sensitivity (Nordin et al., 2004). Theconfusing picture offered by these initial studies suggeststhat there is a complex interplay between sex and foodneophobia that has yet to be uncovered. It would appearthat more research into gender effects is still needed inorder to be sure of the magnitude of the effect, if any, of sexon food neophobia, and other variables which may interactwith it.
Food neophobia, social facilitation and social influence
Clayton (1978) defines social facilitation as an increase inthe frequency of a familiar behaviour pattern in thepresence of others displaying the same behaviour patternat the same time. In terms of eating behaviour, socialfacilitation will lead to an increase in the amount of foodconsumed by each individual depending on the increasingamount of people present (de Castro, 1997, 2001, 2002; deCastro & Brewer, 1992). The effect social facilitation hason food neophobia appears to be to decrease (acute)duration of expression (Visalberghi & Addessi, 2000).Therefore, the more the people around the child consumingthe novel food, the more willing the child will be to try it.One person will have a limited effect on the child’swillingness to try the novel food (Harper & Sanders,
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1975); however, for the greatest effect it is better if everyperson around the child is eating it at the same time (Birch,1980). This would suggest that a young child learns toaccept foods through observing significant others, ratherthan linguistic reasoning. However, the picture appears tobe becoming increasingly more complex, with parentalobservation (Birch & Fisher, 1998), parental style (Birch &Fisher, 1995), parental encouragement (Wardle, 1995), andin the case of older children peer negative comments(Cullen et al., 2000) and influence (Cullen et al., 2001), allaffecting uptake of healthy food choices.
For a child, the first social interaction they experience iswith their primary caregiver. Several factors of the primarycaregiver (usually evident as the mother) have been shownto affect food neophobia expression in children. Parentalfood neophobia (Carruth & Skinner, 2000; Pelchat &Pliner, 1986, 1995; Pliner, 1994), social economic status(SES) (Flight, Leppard, & Cox, 2003; Giskes, Turrell,Patterson, & Newman, 2002; Lien, Jacobs, & Klepp, 2002)and education level (Vereecken, Keukelier, & Maes, 2004)have all been shown to affect childhood food neophobiaand eating behaviours. Parental influence on food neopho-bia is generally considered to be through food modelling,mealtime structuring and parental style (reviewed else-where by Nicklas et al., 2001); however, it is important toremember that some parents have to overcome geneticexpression of food rejection. Although evidence for this isusually based on tastants (Breen, Plomin, & Wardle, 2006),learned association of tastes and appearance, based on thechild’s perception that ‘foods that look similar might tastesimilar’ (Raynor, Polley, Wing, & Jefrey, 2004), mayexacerbate behavioural expression of food neophobia incertain ‘phenotypic’ children who have strong tasteaversions (Glanville & Kaplan, 1965). This would manifestin a diet that is lower in food items that have tastes linkedto inherited dislikes, including but not specific to fruitsand vegetables (Drewnowski, Henderson, Hann, Berg, &Ruffin, 2000; Drewnowski, Henderson, Levine, & Hann,1999; for a review of genetic influences see Birch, 1999;Faith, 2005). Indeed, in a study of adults varying in geneticpredisposition to taste the bitter substance, 6-n-pro-pylthiouracil, only ‘tasters’ who were also food neophobicshowed a dislike for bitter or pungent foods (Ullrich,Touger-Decker, O’Sullivan-Maillet, & Tepper, 2004).Importantly, a recent study of family and twin samples inFinland and the UK found that about two-thirds ofvariation in food neophobia is genetically determined(Knaapila et al., 2007). In support of this, it is notablethat food groups for which acceptance is most hindered byfood neophobia, such as meat and fish, and fruit andvegetables (Cooke, Carnell, & Wardle, 2006; Cooke et al.,2003), are also those for which children’s preferences showgreater heritability (Breen et al., 2006).
Nevertheless, environmental influences on food accep-tance can be found very early in a child’s life. For example,evidence is available that children who are breastfed arefamiliar with the flavours of foods eaten by the mother, as
the mother’s diet is reflected in alterations to the flavour ofher breast milk (Mennella & Beauchamp, 1999; Sullivan &Birch, 1994), although undoubtedly appearance of the foodwill still remain novel to the child. Interestingly, a positiveinfluence of breast feeding has been shown to be limited tofruit intake rather than vegetable intake (Cooke et al.,2003), which suggests there is differentiation in acceptanceof these foods. Taken together, a child’s expression of foodneophobia can be determined from an early stage viaparental behaviours, diets and practices.It is clear that research into parental influences is integral
to understanding the developmental process and expressionof food neophobia. Although the influence of the parentseems to be limited to childhood, it does have the potentialto define magnitude and duration of food neophobia. Whatis not so well understood is whether parents can influencechildren to adopt different behaviours from their own, asresearch has not been able to disassociate completelywhether the child models parental behaviour or parentalwishes. It is likely that the child is actually modellingbehaviour, but with the right approach (i.e. non-pressured,non-threatening, non-authoritarian) it may be possibleto get the child preferentially to choose foods that thecaregiver does not like. However, a heavy investment oftime and energy from the adult is required, as it appearsthat a large number of repeat exposures are needed for thechild to accept the food (Wardle, Herrera, Cooke, &Gibson, 2003).Research has suggested that this social influence is also
attenuated by age of the child. Birch (1980) found thatyounger children (p3 years old) are more influenced byothers than older children (X4 years old), although this isnot a universal finding, with other authors suggesting thereis not a difference between older and younger children interms of social facilitation/influence (Harper & Sanders,1975). Once the child reaches adolescence, peer pressureappears to be more dominant in getting them to eat fruitsand vegetables (Shepard & Dennison, 1996). Therefore,during childhood the social importance of others indecreasing food neophobia switches from the caregiversand siblings to friendship circles and individuals perceivedto be more socially important for modelling acceptablebehaviour.One contentious aspect of the social influences on food
neophobia is that of sex. Some researchers have suggestedthat girls respond more to social pressures and peer modelsthan boys (Hendy & Raudenbush, 2000). However, othershave found no differences (Birch, 1980; Harper & Sanders,1975). This sex difference would make theoretical sense, asit has been demonstrated that girls, on average, developmore complex social interaction awareness skills earlierthan boys (Black, 1992; Neppl & Murray, 1997), althoughinconsistencies are available within developmental studiestoo (Duveen & Lloyd, 1988). Moreover, boys have highertendencies to reject others’ opinions and ideas (Black,1992). Condensed down, this would point to a role of sex inchanging food neophobia through social facilitation. By
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adolescence though this difference is not present, suggest-ing that boys have caught up on social awareness and areequally responsive to peer pressure and social influence interms of overcoming food neophobia (Meiselman, Mas-troianna, Buller, & Edwards, 1999; Pliner & Melo, 1997).
Children do not grow up within an environment devoidof social influences other than the parent, family and peergroup. Children also learn to prefer foods that are typicalof their cultural environment (Birch, Johnson, & Fisher,1995). Although culture is a product of those individualswithin it, the environment itself, either virtual (television)(Halford, Gillespie, Brown, Pontin, & Dovey, 2004) orgeographical (e.g. urban or rural environments) (Flightet al., 2003; Tuorila et al., 2001), may play a significant rolein food choice. Flight et al. (2003) have shown that degreeof urbanisation can affect food neophobia with ruralchildren being more neophobic than their urban counter-parts. This is explained through increased cultural diversityin urban areas and/or degree of isolation (Tuorila et al.,2001). However, recently we found in a pilot study thatfood neophobia was not related to urbanisation in England(Dovey & Shuttleworth, 2006). This may suggest that it isnot only being in a rural environment that can increasefood neophobia, but access to urban environments that isalso important. In Britain, even the most remote ruralenvironment can have access to an urban area within anhour. Therefore, in densely populated, culturally diverse,countries the same environmental influences may not be aspotent.
Food neophobia and willingness to try novel foods
The development of the concept of food neophobia wasto assess a person’s willingness to consume novel foodsoffered to them (Pliner & Hobden, 1992; Raudenbush &Frank, 1999).
However, most studies into willingness to try novel foodshave suggested that the correlations between this factorand food neophobia were weak (Flight et al., 2003; Tuorilaet al., 2001) usually having a low correlation coefficient.The reason for the significant result in these cases is due tothe relatively large sample sizes that have been investigated.Previous observations suggest that children may be usingtheir best guess or ‘what does it look like most’ in order totry and predict the potential taste of the offered food (Birchet al., 1998). We have anecdotally noted that many childrenin our studies confuse locally available fruits and vegeta-bles with each other (i.e. courgette/zucchini and cucumber),but, instead of saying they do not know what it is, theyoffer their best guess. In this way, the associations the childhas with this other food may be informing them about theirwillingness to try the food presented. Therefore, visual andother sensory aspects of the food are not necessarilyentirely novel to the child. It appears that their experiencesof other foods that look similar could be conflicting withtheir willingness to try the novel foods presented (Birchet al., 1998).
Picky/fussy eaters
‘Picky/fussy’ eating is behaviourally and theoreticallydistinct from food neophobia (Pelchat & Pliner, 1986;Pliner & Hobden, 1992). Measures for ‘picky’ eating are intheir infancy, making it hard to quantify this constructaccurately (Kauer, Rozin, & Pelchat, 2002). ‘Picky/fussy’eaters are usually defined as children who consume aninadequate variety of foods through rejection of foods thatare familiar (and unfamiliar) to them (Birch, Johnson,Andresen, Peters, & Shulte, 1991; Galloway et al., 2005,2003; Smith, Roux, Naidoo, & Venter, 2005; Story &Brown, 1987), although as a definition it has also includedconsumption of an inadequate amount of food (Rydell,Dahl, & Sundelin, 1995). Furthermore ‘picky/fussy’ eatingcan extend further than food neophobia through childrenrejecting food textures and not just a particular food(Smith et al., 2005). Therefore, unlike food neophobia,‘picky/fussy’ eating can extend into the realm of the flavourand feel of foods, as these children are inappropriatelyrejecting food textures, which can only be completelydetermined within the child’s mouth.In its basic form, ‘picky/fussy’ eating is differentiated
from food neophobia through the novelty value of the foodpresented. Food neophobia can remain as a part of a pickyeater’s behavioural profile (Pelchat, 1996), while ‘picky/fussy’ eating is not a part of food neophobia. As such,everything discussed above about food neophobia could beattributed to the picky/fussy eater; although the prevalenceof food neophobia will differ between individual children.It is important to note that these constructs are related(Potts & Wardle, 1998; Raudenbush et al., 1995), with oneconcept having an effect on another, but an increase inone does not necessarily lead directly to an increase in theother. Therefore, it is theoretically possible to have a childthat has no problem trying new foods, but will still rejectthem every time they are presented. Equally, it is alsopossible to have a child that is neophobic to new foods, butonce this is overcome then they will readily accept them. Inreality, this latter type of child would be more common, asthis is a natural developmental progression; however, thefirst type of extremely ‘picky/fussy’ child is more likely tobe problematic to nutritionists and psychologists. This firsttype of child may be nutritionally deficient and lessresponsive to dietary interventions than others, yet maynot be considered neophobic as they are rejecting foodsthey are familiar with. Such cases are still largelytheoretical as studies exploring ‘picky/fussy’ eating arerelatively recent and few in number. A possible theoreticalinteraction of ‘picky/fussy’ eating, food neophobia andexposure is shown in Fig. 2.
Measuring ‘picky/fussy’ eaters
Due to its recent theoretical development, pickiness hasbeen disparately measured in different papers, which mayhave added to the confusion of what the concept actually is
ARTICLE IN PRESS
Exposure
Refu
sal of
food
After 15 Exposures
First viewing of
the novel food
First taste of
the novel food
‘Picky/Fussy’ Child
Food Neophobic Child
Fig. 2. Likelihood for acceptance of fruits and vegetables in food neophobic and ‘picky/fussy’ eating children.
T.M. Dovey et al. / Appetite 50 (2008) 181–193188
(Potts & Wardle, 1998). Some studies have attempted tocharacterise ‘picky/fussy’ eating using the Child-FeedingQuestionnaire (Birch et al., 2001; Galloway et al., 2005,2003), through simply asking the caregiver if theyconsidered their child a picky eater (Carruth, Ziegler,Gordon, & Barr, 2004), or by designing a questionnaire oftheir own for the specific study (Kauer et al., 2002; Smithet al., 2005). Differences in measuring the ‘picky/fussy’construct will only lead to further confusion and proble-matic theoretical interpretation. Therefore, it is essentialthat a more applicable measure is offered and validated inchildren as quickly as possible. The first steps are in placeto achieve this (Kauer et al., 2002), but until progressionsin these psychometric tools are undertaken a full theore-tical interpretation based on research cannot be offered.
Development of the ‘picky/fussy’ eater
From a very young age, a child can communicate his/herlikes and dislikes to their caregiver. Younger children willcommunicate through body language (e.g. moving awayfrom the food offered or it away from them) or, if thecaregiver is persistent at making the child eat, through non-linguistic verbalisations (e.g. groaning or screaming). Asthe child ages, his/her communication with their caregiverbecomes more linguistic, with the child able to verbalisehis/her likes and dislikes. Interestingly, preliminary evi-dence is available to suggest that parents have an increasedperception of their child’s ‘pickiness’ as they get older(Carruth et al., 2004) (from 25% at 7–8 months to 35% at12–14 months to 50% at 19–24 months). Although thiscannot be completely disassociated from food neophobia,as this measure was not taken in this study, this may
suggest that, as the child has the ability to verbalise his/herdislikes, the parent perceives the rejection of a commonfood as being stronger. Alternatively, the parent may bemore willing to compare an older child’s rejection offamiliar foods to their own preferences. Inevitably, thisacceptance of familiar foods will be perceived as muchlower in the child compared to the adult. Equally, it couldbe an inappropriate understanding of the importance ofduration and frequency in exposing their child to foods(Wardle, Herrera et al., 2003) to overcome both his/herfood neophobia and ‘pickiness’. In reality, it is probably acombination of all of these factors alongside the confusionbetween food neophobia and ‘pickiness’ that is accountingfor this perceptual increase in ‘picky/fussy’ eaters ratherthan a differential age of onset.A recent study has also suggested that children who are
overly ‘picky/fussy’ eaters may also be tactilely defensive(Smith et al., 2005). Tactile defensiveness is characterisedas an overreaction, or offence, resulting in withdrawal fromthe sensation of being touched, either by another person, orby something in their environment, which most wouldconsider inoffensive (Royeen, 1986; Wilbarger, 2000). Thisseparate construct may allow researchers independently todefine those with clinical levels of ‘picky/fussy’ eating, orindeed may allow a latent measure for ‘picky/fussy’ eatingitself. Being tactilely defensive may mean that the child isoverly sensitive to oral touch (Smith et al., 2005) leading tothe rejection of foods with certain textures. This rejectionof food texture can also be informed through individualdifferences, as one child may reject ‘softer’ foods whileanother would reject ‘harder/ crunchier’ foods (Wilbarger,2000). In either instance, understanding this texturerejection in ‘picky/fussy’ eating may allow the parent to
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present foods that will not be rejected on these grounds.This interaction between tactile defensiveness and pickyeating should be investigated further.
The diet of ‘picky/fussy’ eaters
The nutrient intake of ‘picky/fussy’ eaters appears toreflect that of non-‘picky/fussy’ eaters on most aspects oftheir diet. There are, however, some distinct differencesbetween the two groups. ‘Picky/fussy’ eaters consume feweramounts of foods containing vitamin E, vitamin C, folateand fibre, probably due to their lower consumption offruits and vegetables (Galloway et al., 2005) compared tonon-‘picky/fussy’ eaters. Lower levels of these specificnutrients may lead to cell damage (Burton & Traber, 1990;Royack, Nguyen, Tong, Poot, & Oda, 2000), immunolo-gical weakness (Hemila, 2003) and digestive problems(Bosaeus, 2004). The digestive problems, in particular, mayincrease ‘picky/fussy’ eating through inappropriate asso-ciations with foods they have just eaten to abdominal painsbrought on by constipation. Furthermore, Carruth et al.(2004) reported that ‘picky/fussy’ eaters were less likely toconsume dishes that were mixed together, like many pastadishes. This makes the parent’s job harder, as ‘picky/fussy’eaters will also reject foods that they can see; therefore,trying to increase acceptance through ‘hiding’ fruits andvegetables within other more liked foods may be proble-matic within ‘picky/fussy’ eaters but not food neophobicchildren. This may be another way to differentiate thesetwo concepts.
In contrast to food neophobia, it does not appear that‘picky/fussy’ eaters compensate for the lack of fruits andvegetables through consuming higher amounts of fat(Galloway et al., 2005). Indeed, some evidence suggeststhat ‘picky/fussy’ children have lower BMIs then non-‘picky/fussy’ eaters and yet are not underweight (Marchi &Cohen, 1990). However, other research groups havesuggested the opposite (Carruth & Skinner, 2000).Although an interesting finding, caution is advised whenreferring to these children as having a behavioural defenceto the obesogenic environment. ‘Picky/fussy’ eating isassociated with essential nutrient deficiency (Gallowayet al., 2005) and other inappropriate forms of environ-mental processing such as tactile defensiveness (Smith etal., 2005). It has also been negatively associated withmonths spent in breast feeding and the caregiver’svegetable intake (Galloway et al., 2003), although it isnoted that the predictive value of the model for these lasttwo variables was weak. Furthermore, evidence is availablethat ‘picky/fussy’ children may consume more sweetenedfoods (Carruth et al., 2004). This may suggest an over-reliance on hedonic value, i.e. acceptance encouraged bychildren’s innate liking for sweetness. Consequently, thereis a risk that such children may establish a habit of over-consumption of energy dense, highly palatable foods,eventually culminating in excessive weight gain. However,so far there are no longitudinal data to support this.
Summary
In summary, food neophobia and ‘picky/fussy’ eatingare related constructs that are theoretically and behaviou-rally different. Food neophobia is part of, but does notaccount for the entirety of, a ‘picky/fussy’ eater’s beha-vioural profile. It is a constituent of ‘picky/fussy’ eatinglimited to willingness to try novel foods. The impact offood neophobia is limited to the point where the childplaces the food in his/her mouth, but may continue to havea negative effect on willingness to try foods for up to 15daily exposures, or if a negative event is successfullyassociated with the novel food item within these initialexposures. The influence of food neophobia on a person’swillingness to try novel foods diminishes from the first tasteprocessed as a positive experience. After this time, rejectionof the taste itself is not part of a food neophobic child’sbehavioural profile. Persistent rejection, or an increasedneed for exposure in order for a child to accept a particularfood, must be considered as part of ‘picky/fussy’ eating.This differentiation may explain the previous weakcorrelations between food neophobia and foods that areactually tasted.Due to the inter-relationship between ‘picky/fussy’
eating and food neophobia, some factors such as pressureto eat, personality factors, parental practices/styles andsocial influences will have similar effects on both magni-tude and duration of expression. Whereas these constructsmay be differentially affected by factors such as age, tactiledefensiveness, environment and culture, it is likely thatboth ‘picky/fussy’ eating and food neophobia are person-ality traits, with substantial genetic contributions. Theirdevelopmental aspects are associated with child mobility,resulting in a slower maturation time period in ‘picky/fussy’ eating compared to food neophobia. This issuggested because the ‘picky/fussy’ child must haveexperience with a variety of foods and food textures beforethey can be defined as ‘picky/fussy’. The need for the childto develop safely within his/her environment without therisk of poisoning, as well as to learn what is edible andwhat is not, means that food neophobia will be higher untilexperiences are fully consolidated. However, it is importantto note that this early childhood phase of increased foodneophobia and ‘picky/fussy’ eating can inform adultdietary variety and nutrient intake and so should behandled with informed care.Differential characterisations of children who are ex-
treme ‘picky/fussy’ eaters and have a low level of foodneophobia (if this is indeed possible) may allow a betterunderstanding of what discriminates these two concepts.One such factor, exposure, which has been well researchedin food neophobia, may suggest differences between ‘picky/fussy’ eating and this concept, especially as one is definedas the rejection of novel foods while the other is rejection offamiliar (and unfamiliar) foods. It is likely that the ‘picky/fussy’ eater will require many more exposures in order toaccept the food in comparison to a ‘normal’ food
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neophobic child. Another factor that may prove beneficialis the non-clinical measurement of tactile defensiveness inchildren who are ‘picky/fussy’ eaters. It may be possible, insome cases, to overcome ‘picky/fussy’ eating throughaddressing this factor.
Conclusion
It is clear that children are not consuming enough fruitsand vegetables during childhood, which if left uncheckedwill lead to a generation of unhealthy nutrient-deficientadults. It appears that overcoming food neophobia and‘picky/fussy’ eating is integral to getting children to adopt ahealthy diet and eat fruits and vegetables. To overcome thisproblem, further research is needed to understand theseconcepts, and to deliver a multi-faceted approach to getchildren independently to choose and to include fruits andvegetables in their diets. Although ‘picky/fussy’ eatingresearch is in its infancy, it is possible to draw on evidencefrom food neophobia studies to show the potential benefitthat this behavioural manipulation can have on children’s,adolescents’ and the future adults’ health and eating habits.Unfortunately, the current access to and preference forhighly hedonic, energy dense foodstuffs mean that, withoutadequate provision and early intervention, achieving thiswill be an uphill struggle.
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