Appetite 103 (2016) 286e293

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Appetite
journal homepage: www.elsevier.com/locate/appet

Picky eating: Associations with child eating characteristics and food

intake
Klazine van der Horst a, *, Denise M. Deming b, Ruta Lesniauskas c, B. Thomas Carr c, d,
Kathleen C. Reidy b
a
Nestl
e Research Center, Lausanne, Switzerland
b
Nestl
e Nutrition, Global R&D, Florham Park, NJ, USA
c
Carr Consulting, Wilmette, IL, USA
d
Charles Sturt University, Wagga Wagga, NSW, Australia

a r t i c l e i n f o a b s t r a c t

Article history: Food rejection behaviors such as picky eating are of concern for many parents and attempts to increase
Received 17 July 2015 healthy food intake can cause distress at mealtimes. An important limitation in most of the picky eating
Received in revised form studies is that they cover few characteristics of picky eating behaviors and use limited measures of food
13 April 2016
intake. The objective of this study was to explore the associations between picky eating, child eating
Accepted 22 April 2016
characteristics, and food intake among toddlers 12e47.9 months old (n ¼ 2371) using data from the 2008
Available online 24 April 2016
Feeding Infants and Toddlers Study (FITS). Logistic regression was used to examine associations between
demographic and feeding characteristics and picky eater status. Differences in food group intake be-
Keywords:
Food intake
tween picky and non-picky eaters were analyzed. Picky eaters were more likely to be neophobic, texture
Eating behavior resistant, and to eat only favorite foods, In addition, the parents of picky eaters tend to offer new food a
Toddler greater number of times than those of non-picky eaters before deciding that the child does not like it.
Picky eating Picky eaters showed significant lower intakes of eggs, burritos/tacos/enchiladas/nachos and sandwiches
than non-picky eaters. Picky eaters consumed fewer vegetables from the “other vegetables” category and
less raw vegetables than non-picky eaters. Neophobia, eating only favorite foods and difficulties with
texture are all important characteristics of picky eaters which need to be integrated in studies measuring
picky eating behaviors. Food intake of picky eaters differs only slightly from non-picky eaters. Because
picky eating is a major parental concern, feeding strategies and advice related to the relevant charac-
teristics of picky eating behavior need to be developed and assessed for their effectiveness.
© 2016 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license
(http://creativecommons.org/licenses/by/4.0/).

1. Introduction potential lack of nutrients in the child's diet. However, there is no

clear evidence from existing studies that nutrient intake differs
Many parents struggle to teach their children healthy eating between picky eaters and non-picky eaters (Carruth & Skinner,
behaviors because food rejection behaviors such as picky eating 2000; Carruth, Ziegler, Gordon, & Barr, 2004; Carruth et al., 1998;
and neophobia are common in preschool children (Cardona Cano Dubois, Farmer, Girard, & Peterson, 2007). A consistently reported
et al., 2015; Mascola, Bryson, & Agras, 2010). Picky eating can difference in food intake, is the lower vegetable intake in picky
cause distress in families, and in their attempts to increase healthy eaters (Cooke et al., 2004; Cooke, Wardle, & Gibson, 2003; Dubois
food intake, parents might use wrong strategies that hinder the et al., 2007; Galloway et al., 2005; Galloway, Lee, & Birch, 2003;
development of healthy eating habits (Galloway, Fiorito, Lee, & Jacobi, Agras, Bryson, & Hammer, 2003). Some studies also report
Birch, 2005). Parents are mainly concerned about their child's lower intakes of meat and fish (Cooke et al., 2003; Dubois et al.,
rejection of healthy foods like fruits and vegetables and the 2007; Tharner et al., 2014). For intake of sweets and snacks,
studies show inconsistent results (Galloway et al., 2005; Tharner
et al., 2014). A potential reason for not finding a consistent differ-
ence in food intake between picky and non-picky eaters could be
* Corresponding author. Nestec Ltd., Nestle  Research Center, Public Health
related to the number and age of the children studied and mea-
Nutrition, Vers-chez-les-Blanc, PO Box 44, 1000 Lausanne 26, Switzerland.
E-mail address: [email protected] (K. van der Horst). surements used. Most published studies on food intake in picky

http://dx.doi.org/10.1016/j.appet.2016.04.027
0195-6663/© 2016 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
 K. van der Horst et al. / Appetite 103 (2016) 286e293 287

eaters had a limited sample size (Carruth & Skinner, 2000; Carruth 2. Methods
et al., 1998; Galloway et al., 2003; Galloway et al., 2005; Jacobi et al.,
2003) and limited dietary intake measures from food frequency 2.1. Study design
questionnaires from which detailed information on food group
intake cannot be calculated (Cooke et al., 2004; Cooke et al., 2003; The 2008 Feeding Infants and Toddlers Study (FITS) is a cross-
Tharner et al., 2014). Therefore, in the current study, a 24-h recall sectional, dietary intake study of a random sample of US infants
was used to explore food intake in picky eaters in a large nationally and children from all states and the District of Columbia weighted
representative sample of young children to overcome these to reflect vital records birth data. The purpose of the FITS study was
limitations. to explore the diets and feeding practices of US infants and children
Another limitation in most of the picky eating studies is that from birth to 47.9 months. The FITS 2008 study consisted of a
they cover only one or a few characteristics of picky eating be- recruitment interview to collect data on child and household
haviors due to the absence of a single definition of picky eating characteristics, including feeding practices and eating behaviors,
(Taylor, Wernimont, Northstone, & Emmett, 2015). Picky eating is a and a dietary interview composed of a 24-h dietary recall. All study
term used to cover a broad set of behavior issues without a concise instruments and protocols, including incentives and informed
definition (Boquin, Moskowitz, Donovan, & Lee, 2014; Jacobi, consent procedures, were reviewed and approved by an indepen-
Schmitz, & Agras, 2008). Two main eating characteristics that dent institutional review board, Public/Private Ventures in Phila-
parents use to describe their picky eating child are: unwilling to try delphia, PA. Extensive details of the recruitment, design, dietary
new foods and consuming a limited type and amount of food data collection and analysis methods, and study limitations were
(Boquin, Moskowitz, et al., 2014; Jacobi et al., 2003). Some studies described elsewhere (Briefel et al., 2010).
use a single item to measure picky eating, not covering any of the
picky eating characteristics (Carruth et al., 2004), while other 2.2. Measures
studies use a series of questions that address several aspects of
picky eating, such as the fussiness subscale of the Child Eating Telephone interviews were conducted with the primary care-
Behavior Questionnaire (Wardle, Guthrie, Sanderson, & Rapoport, giver. For all children, data included one 24-h recall of the child's
2001). Other studies focus solely on neophobia, which is one food intake as well as demographic characteristics of the child and
aspect of picky eating (Birch, McPhee, Shoba, Pirok, & Steinberg, caregiver (e.g. child age, gender, child ethnicity, household income,
1987; Cooke, Carnell, & Wardle, 2006; Cooke et al., 2003; mother's education, child height and weight (based on parents self-
Coulthard & Thakker, 2015). report), birth order of the child, breastfeeding information), and
The influence of texture and sensory aspects on food prefer- child eating characteristics i.e. picky eating and neophobia. All
ences was explored in former studies, however often without a foods and beverages reported in the 24-h dietary recalls were
specific focus on picky eating behaviors. From these studies it is assigned to food groups using the FITS 2002 classification scheme
known that in general, children in the second year of life will start (Fox, Condon, Briefel, Reidy, & Deming, 2010; Fox, Pac, Devaney, &
to reject foods they initially accepted and will place higher Jankowski, 2004; Siega-Riz et al., 2010). Main food categories such
importance on the physical properties of food such as color and as fruits, milk and milk products, vegetables, and the sub-groups of
texture (Williams, 2013). Experiences with different textures early this classification scheme were used in this analysis. Food intake
in life might facilitate infants' acceptance of more complex tex- estimates were based on foods as consumed; food mixtures such as
tures at a later stage (Blossfeld, Collins, Kiely, & Delahunty, 2007; soup and pasta-based dishes were considered single items and not
Coulthard, Harris, & Emmett, 2009; Le Reverend, Edelson, & Loret, broken down into their constituent ingredients (i.e. vegetables
2014; Lukasewycz & Mennella, 2012; Lundy et al., 1998; consumed in mixed dishes were not counted in the vegetable food
Northstone & Emmett, 2013; Werthmann et al., 2015). Even group). Caregivers were asked whether they considered their child
though the importance of texture on the development children's to be a very picky eater, a somewhat picky eater, or not a picky eater
food preferences is recognized in studies, texture acceptance (Carruth et al., 2004). The following child eating characteristics
seems to be a concept that is currently not measured in were measured: texture acceptance, periods of consumption of
commonly used questionnaires to assess picky eating, such as the only favorite foods, neophobia and how many times parents offered
fussiness subscale of the Child Eating Behavior Questionnaire a new food. The exact wording of the items and answering options
(Wardle et al., 2001) or the Preschooler Feeding Questionnaire can be found in Table 1. These questions were evaluated in a pilot
(Baughcum et al., 2001). Recent findings from qualitative and test to validate the content of the child eating characteristics
quantitative studies on picky eating confirmed that picky eaters questions to ensure that the participants understood what was
exhibit negative reactions to sensory properties of foods, partic- being asked.
ularly texture and aroma (Boquin, Moskowitz, et al., 2014;
Nederkoorn, Jansen, & Havermans, 2015; Russell & Worsley, 2.3. Analyses
2013). It is therefore important to integrate and further explore
the role of texture acceptance together with other picky eating A large proportion of infants are breastfed and in the first year of
characteristics. life infants make the transition from a milk diet to eating family
The aim of the present study was to explore how the main foods. In the second year of life children start to reject foods and
characteristics of picky eating; neophobia, texture acceptance and place higher importance on the physical properties of food
the consumption of only favorite foods are related to a single (Williams, 2013), therefore, only children 12e47.9 months old were
measure of picky eating. The second objective was to explore the included in the analysis (n ¼ 2371). Chi-square tests were con-
intake of major food categories between picky and non-picky ducted to assess differences in picky-eating characteristics across
eaters, and to determine which foods contribute most to the dif- the three categories of picky eating: not picky, somewhat picky and
ferences in intake found in major food categories based on a 24- very picky as reported by the parents. Picky eaters demonstrated to
h dietary recall in a nationally representative sample of US pre- have similar but more pronounced eating characteristics (resis-
schoolers. tance to new foods and texture) as somewhat picky eaters. There-
fore, data for children who were considered as “very picky” and
“somewhat picky” were combined into one group to make a
288 K. van der Horst et al. / Appetite 103 (2016) 286e293

Table 1
Prevalence of demographic and child eating characteristics by picky eater status.

Not picky Somewhat picky Very picky P-valuea

(n ¼ 1315) (n ¼ 815) (n ¼ 241)
b
N (SE) % N (SE) % N (SE) %

Gender 0.843
boys 660 (2.3) 51.6 436 (2.9) 53.7 136 (5.2) 53.2
Girls 655 (2.3) 48.4 379 (2.9) 46.3 105 (5.2) 46.8
Age 0.000
12e23.9 months 600 (1.8) 42.7 256 (2.2) 25.5 61 (2.9) 17.7
24e35.9 months 395 (1.9) 32.1 268 (2.5) 33.1 70 (5.1) 37.3
36e47.9 months 320 (1.6) 25.2 291 (2.7) 41.4 110 (4.8) 45.0
Birth order 0.003
First child 422 (2.1) 31.5 355 (3.0) 43.8 106 (4.9) 39.4
Not first child 835 (2.1) 68.5 455 (3.0) 56.2 127 (4.9) 60.6
Breastfeeding 0.005
Ever breastfed 1068 (1.4) 84.1 641 (2.5) 78.3 179 (4.8) 71.3
Not ever breastfed 233 (1.4) 15.9 164 (2.5) 21.7 60 (4.8) 28.7
Weight-for-age-percentile 0.863
1st Weight-for-age quartile 264 (2.0) 21.0 147 (2.3) 18.6 48 (4.4) 24.6
2nd Weight-for-age quartile 334 (2.1) 28.1 194 (3.1) 29.7 73 (4.5) 26.1
3rd Weight-for-age quartile 266 (2.1) 22.2 186 (2.7) 25.0 49 (4.1) 20.7
4th Weight-for-age quartile 325 (2.2) 28.8 187 (2.7) 26.7 51 (5.5) 28.6
Ethnicity 0.041
Non-Hispanic White 991 (2.1) 55.0 644 (3.0) 59.7 168 (4.8) 45.7
Non-Hispanic Black 85 (1.5) 12.5 65 (2.4) 16.6 19 (3.7) 16.2
Other 97 (1.2) 8.4 53 (1.3) 8.1 23 (1.8) 7.2
Hispanic 142 (2.1) 24.1 53 (2.8) 15.6 31 (5.5) 31.0
Mother's education 0.006
9th grade or less 19 (0.8) 2.3 8 (1.6) 3.0 7 (1.7) 3.6
10th to 11th grade 32 (0.7) 3.1 20 (0.7) 2.2 8 (4.9) 10.9
Completed high school 216 (1.8) 18.1 146 (1.8) 15.5 60 (4.6) 27.5
Some post-secondary 403 (2.1) 31.1 248 (2.8) 30.6 70 (3.7) 23.6
Completed college 404 (1.9) 27.4 243 (2.7) 29.9 55 (4.2) 21.3
Some graduate work/degree 240 (1.8) 18.0 150 (2.4) 18.8 39 (2.8) 13.2
Household income 0.262
Under 10,000 42 (1.0) 4.8 32 (1.0) 4.4 13 (2.9) 7.8
10,000 to 19,999 64 (1.3) 6.1 47 (2.7) 11.3 13 (4.3) 13.3
20,000 to 34,999 151 (1.6) 13.5 87 (2.5) 14.9 26 (3.6) 14.5
35,000 to 49,999 189 (1.6) 16.1 112 (2.0) 14.1 40 (5.0) 18.5
50,000 to 74,999 289 (1.7) 21.0 187 (2.4) 21.3 58 (4.0) 21.6
75,000 to 99,999 221 (2.0) 18.9 132 (2.1) 15.9 35 (3.7) 13.5
100,000 to 149,999 163 (1.7) 13.2 91 (1.8) 11.0 23 (0.7) 9.2
150,000 and over 78 (1.4) 6.5 48 (1.8) 7.1 8 (0.6) 1.6
How many times do you offer a new food before you decide your child does not like it 0.000
Once 51 (1.4) 6.0 26 (1.3) 4.6 8 (1.1) 2.5
Twice 146 (1.7) 13.3 101 (2.4) 15.1 24 (3.6) 12.2
Three to five times 537 (2.3) 40.9 408 (3.0) 52.9 116 (5.0) 44.7
Six to ten times 103 (0.8) 6.1 94 (1.7) 10.7 40 (3.3) 16.1
More than ten times 164 (1.4) 11.9 162 (1.7) 15.0 43 (5.0) 18.1
Child likes everything 307 (1.9) 21.8 15 (0.8) 1.8 7 (3.1) 6.6
How does child react to new foods 0.000
Willing to try new foods 1010 (1.8) 78.8 297 (2.9) 37.6 47 (4.7) 25.9
Have to be convinced to try new foods, but generally accepts them 272 (1.8) 19.8 370 (3.0) 47.0 62 (5.3) 29.0
Does child generally resist new foods? 22 (0.4) 1.5 134 (1.8) 15.4 130 (5.0) 45.1
Which best describes child's acceptance of different food textures 0.000
Willingly eats a number of different food textures 1085 (1.9) 81.3 471 (3.0) 56.4 59 (4.0) 23.9
Resists eating certain food textures 184 (1.8) 16.0 261 (2.9) 32.8 99 (5.1) 42.4
Refuses to eat certain food textures 34 (0.8) 2.7 70 (2.1) 10.9 78 (5.3) 33.8
Within the last month has child gone through periods where he/she will only eat favorite foods 0.000
Yes 394 (2.2) 31.9 493 (2.8) 62.8 198 (4.3) 79.5
No 918 (2.2) 68.2 320 (2.8) 37.2 43 (4.3) 20.5
a
P-value from Chi-square test.
b
Percentages are calculated within each picky eating category to facilitate comparison between the categories of picky eating.

dichotomous variable for picky eating with groups of sufficient size. ethnicity, weight-for-age quartile, birth order, ever-breastfed sta-
This is a similar approach as the publication on the FITS data from tus, mother's level of education, household income, number of
2002 (Carruth et al., 2004), and studies with similar measures of times new foods are offered, willingness to try new foods, will-
picky eating (Boquin, Smith-Simpson, Donovan, & Lee, 2014; Jacobi ingness to try different textures, and eats-only-favorite-foods sta-
et al., 2003; Shim, Kim, Mathai, & Team, 2011). Logistic regression, tus. Analysis of variance, including age in days as covariate, was
combining somewhat and very picky eaters into one group, was used to assess differences in food group consumption between
used to examine associations with picky eater status using the picky and non-picky eaters. In the case of significant results, the
following variables in the adjusted model: child's gender, age, sub-categories of the relevant main food category were further
 K. van der Horst et al. / Appetite 103 (2016) 286e293 289

explored with analysis of variance, with age in days as covariate. All had a lower energy intake from mixed dishes than non-picky eaters
analyses were conducted at the 95% confidence level (p ¼ 0.05) and (d ¼ 38.6 Kcal, p ¼ 0.008).
weighted so that the results were representative of the US age and To further explore the differences between picky and non-picky
racial/ethnic distribution of children up to age 4 years. All analyses eaters aged 12e47.9 months, the sub-categories of the food groups
were conducted using the Statistical Analysis System (version 9.3, with significant differences in intake were analyzed (Table 4).
SAS Institute, Cary, NC, 2012) using the appropriate sample weights Within the meats and other proteins food group, picky eaters had a
and design effects. significantly lower intake of eggs than non-picky eaters (d ¼ 6.5 g,
p ¼ 0.004). Within the mixed dishes food group, picky eaters had a
3. Results significant lower intake of the burritos, tacos, enchiladas and na-
chos group (d ¼ 3.0 g, p ¼ 0.03) and sandwiches (d ¼ 5.4 g,
3.1. Sample p ¼ 0.01). Within the vegetables food group, picky eaters consumed
less raw vegetables and vegetables from the other vegetables
Of the sample, 52% (n ¼ 1232) were males and 48% females (artichoke, asparagus, beets, Brussels sprouts, cabbage, cauliflower,
(n ¼ 1239). Most of the toddlers were from non-Hispanic white celery, cucumber, eggplant, green beans, lettuce, mushrooms, okra,
ethnicity (76%), 7% were non-Hispanic black, 9.5% were Hispanic, onions, pea pods, peppers, tomatoes/tomato sauce, wax/yellow
and 7.3% were from “other” or multiracial groups. About 8.9% of the beans, zucchini, summer squash) than non-picky eaters. Analysis of
children lived in a household with an annual income level below the other vegetables category showed that picky eaters had a
$20,000 and 17.2% lived in a household with an annual income significantly lower intake of other raw vegetables (4.5 g) compared
above $100,000. About 47.7% of mothers had a college degree or to non-picky eaters (8.6 g) (Table not shown). To ensure that
higher. Other sample characteristics can be found in Table 1. combining somewhat and very picky eaters did not lead to un-
derestimation of the results, analyses were repeated for the group
3.2. Prevalence of picky eating and associations with child eating of very picky eaters which confirmed that and no findings were
characteristics missed.

Among, 12e47.9 month old young children, the percentage of 4. Discussion

caregivers who described their child as a very picky eater was 10.2%
and the percentage of somewhat picky eaters was 34.4%. Table 1 This study aimed to explore the characteristics of picky eating
describes the prevalence of child eating characteristics by picky behavior and the associations between picky eating and food group
eater status. Picky eating was more common in older children, first intake in toddlers. The results showed that in addition to the typical
born children and never breastfed children. Most parents of infants reported characteristics of picky eating such as neophobia and fa-
indicated that they offer a new food up to three to five times before vorite food consumption (Carruth & Skinner, 2000; Carruth et al.,
deciding that the child does not like it, with percentages ranging 2004; Dovey, Staples, Gibson, & Halford, 2008), texture resistance
between 41% and 53% in the three categories of picky eating. The is also significantly associated with picky eating. The current study,
percentage of parents who report to offer a new food 6 times or using a 24-h recall in a large representative sample of US toddlers
more to their child, was higher for parents of very picky eaters showed that picky eaters consumed less meat and other protein
(34%) and somewhat picky eaters (26%) than non-picky eaters sources, less vegetables, and consumed less energy from mixed
(18%). Child picky eating characteristics were more prevalent in dishes than non-picky children. Exploring the sub food categories
very picky eaters compared to non-picky eaters. Neophobia was highlighted significant differences in the consumption of eggs,
reported in 45% of the very picky eaters versus 1.5% in non-picky sandwiches, burritos/tacos/enchiladas/nachos, other vegetables
eaters. Texture refusal was reported in 34% of very picky eaters and raw vegetables.
versus 3% in non-picky eaters. Periods of only eating favorite foods The association between texture resistance and pickiness re-
was reported in 80% of very picky eaters versus 32% in non-picky ported in the current study, confirms the results from qualitative
eaters. and quantitative studies in which was shown that tactile sensitivity
The logistic regression analysis, showed inverse associations may play a role in food acceptance among picky eaters (Boquin,
between age, not being the first child, and being ever breastfed Moskowitz, et al., 2014; Nederkoorn et al., 2015). These findings
with picky eating (Table 2). Ethnicity was found to be significantly indicate that food texture is an important factor for food rejection
associated with picky eating, showing children of non-Hispanic in picky eaters. The on average lower intake of raw vegetables and
black ethnicity to be more likely to be picky. A lower education eggs in picky eaters might also indicate difficulty with the texture of
status of the mother was also found to be associated with higher foods. In the current study, raw vegetable intake was shown to be
likelihood of picky eating. All child eating characteristics: neo- low for all toddlers, but this was more pronounced in picky eating
phobia, texture acceptance and eats-only-favorite-foods were toddlers. Slimy or mushy textures (Boquin, Moskowitz, et al., 2014;
significantly associated with picky eater status. Neophobic and Russell & Worsley, 2013) and tough foods that require chewing can
texture resistant children, and children who showed periods where be especially unappealing for the child (Russell & Worsley, 2013).
they would only eat favorite foods were more likely to be picky Raw foods might be more difficult to eat for picky eaters as they
eaters. The parents of picky eaters offer a new food a greater might have more tactile sensitivity than the non-picky eaters
number of times than those of non-picky eaters before deciding (Nederkoorn et al., 2015). A higher sensitivity to touch could cause
that the child does not like it. children to dislike the feel of a particular food in their mouth, which
could be a reason for the lower consumption of eggs that was found
3.3. Food groups for picky eaters. Eggs, depending on the preparation, have a
rubbery texture and/or a specific flavor that might be difficult for
Table 3 shows the amount consumed in grams and kilocalories picky eaters. Other factors, such as a bitter taste might also influ-
of the various food groups picky and non-picky eaters based on the ence picky eaters’ food intake. No evidence was found as indicated
24-h recall data. Picky eaters had a lower intake of meats and other by the no significant difference in the intake of dark green vege-
protein sources (d ¼ 16 g, p ¼ 0.002) and a lower intake of vege- tables (Negri et al., 2012). The difference found in the consumption
tables (d ¼ 11.8 g, p ¼ 0.041) than non-picky eaters. Picky eaters also of mixed dishes might relate to specific vegetables or foods that are
290 K. van der Horst et al. / Appetite 103 (2016) 286e293

Table 2
Multiple logistic regression analyses between demographics, child eating characteristics and picky eater status of preschoolers.a

Predictors OR 95% Wald P-value

Confidence Limits

Gender (boy) 0.87 0.61 1.25 0.453

Age
12e23.9 months 0.49 0.32 0.77 0.007
24e35.9 months 0.65 0.41 1.01
36e47.9 months 1.00
Birth order (not first child) 0.58 0.40 0.84 0.004
Breastfeeding (never breastfed) 1.88 1.22 2.89 0.004
Weight-for-age-percentile
1st Weight-for-age quartile 1.05 0.63 1.75 0.956
2nd Weight-for-age quartile 1.00 0.62 1.62
3rd Weight-for-age quartile 0.91 0.56 1.46
4th Weight-for-age quartile 1.00
Ethnicity
Non-Hispanic White 1.37 0.76 2.47 0.044
Non-Hispanic Black 2.90 1.31 6.40
Other 1.02 0.43 2.41
Hispanic 1.00
Mother's education
9th grade or less 1.35 0.17 10.48 0.015
10th to 11th grade 5.33 1.68 16.93
Completed high school 1.86 0.93 3.75
Some post-secondary 2.49 1.37 4.53
Completed college 1.40 0.79 2.51
Some graduate work/degree 1.00
Household income
Under 10,000 0.64 0.22 1.90 0.172
10,000 to 19,999 1.77 0.58 5.40
20,000 to 34,999 1.87 0.72 4.85
35,000 to 49,999 1.24 0.51 2.99
50,000 to 74,999 1.13 0.50 2.56
75,000 to 99,999 1.11 0.48 2.56
100,000 to 149,999 0.67 0.26 1.71
150,000 and over 1.00
How many times do you offer new food before you decide the child does not like it?b
Child likes everything 1.00 0.000
Once to five times 8.49 3.46 20.85
Six times and more 11.70 4.59 29.85
How does your child react to new foods?
Willingly tries new foods 1.00 0.000
Has to be convinced to try new foods, but generally accepts them 4.72 1.24 2.96
Resists new food 17.45 3.77 14.56
Which best describes your child's acceptance of different textures?
Willingly eats a number of different food textures 1.00 0.000
Resists eating certain food textures 1.91 1.24 2.96
Refuses to eat certain food textures 7.41 3.77 14.56
Within the last month, has your child gone through periods where he/she will only eat favorite foods? (no) 0.38 0.26 0.54 0.000
a
All factors listed in the Table were included in the regression model.
b
This question was assessed with 6 answering categories: child likes everything, once, twice, three to five times, six to ten times and more than ten times, and categorized in
the three reported groups.

Table 3
Main food group consumption by picky eater status (grams and Kcal)a.

Not picky (n ¼ 1315) Picky (n ¼ 1056) P-value Not picky (n ¼ 1315) Picky (n ¼ 1056) P-value

Gram (SE) Gram (SE) Kcal (SE) Kcal (SE)

Fruit 262.9 (9.0) 253.7 (12.5) 0.557 143.8 (4.8) 138.7 (6.2) 0.525
Grains and grain products 100.1 (4.2) 101.0 (4.3) 0.883 213.8 (7.2) 223.9 (7.3) 0.337
Meats and other protein sources 76.9 (3.9) 60.9 (3.2) 0.002 172.4 (8.3) 145.7 (7.8) 0.021
Milk and milk products 457.6 (13.0) 470.0 (14.9) 0.536 293.3 (8.7) 300.3 (9.1) 0.582
Mixed dishes 110.3 (5.8) 95.3 (6.0) 0.085 172.5 (10.4) 133.9 (9.0) 0.008
Other foods and beverages 248.0 (12.2) 234.1 (13.4) 0.457 41.0 (3.0) 37.1 (3.2) 0.396
Sweets, sweetened beverages, and desserts 140.5 (7.8) 161.4 (10.1) 0.109 158.3 (6.2) 177.4 (8.7) 0.075
Vegetables 69.7 (4.1) 57.9 (3.8) 0.041 55.3 (3.4) 53.7 (4.5) 0.785
Supplements 10.2 (4.2) 10.0 (2.7) 0.973 5.9 (2.2) 8.8 (2.5) 0.385
a
Analysis of Variance between picky eaters and non-picky eaters, with age in days as covariate. Significant values (p < 0.05) are indicated in bold.

in the mixed dish that are rejected by the picky eater. A previous Based on the results of various studies, the texture resistance
study found that a disliked food can act as a contaminant to liked characteristic of picky eating should be taken into account when
food during childhood (Brown, Harris, Bell, & Lines, 2012). conducting future studies on picky eating behaviors by
 K. van der Horst et al. / Appetite 103 (2016) 286e293 291

Table 4
Consumption of meats and other protein sources, sweets, sweetened beverages, desserts and vegetables by picky eater statusa.

Not picky (n ¼ 1315) Picky (n ¼ 1056) P-value Not picky (n ¼ 1315) Picky (n ¼ 1056) P-value

Gram (SE) Gram (SE) Kcal (SE) Kcal (SE)

Meats and other protein sources

Babyfood meats 0.2 (0.1) 0.2 (0.1) 0.695 0.3 (0.1) 0.2 (0.1) 0.596
Dried beans and peas 6.7 (1.1) 4.7 (1.0) 0.165 8.7 (1.5) 6.2 (1.4) 0.191
Eggs 16.0 (1.7) 9.5 (1.3) 0.004 26.5 (2.7) 16.9 (2.5) 0.010
Non-babyfood meats 50.8 (2.9) 43.0 (2.8) 0.059 120.1 (7.1) 105.7 (7.4) 0.163
Peanut butter, nuts and seeds 2.8 (0.4) 2.6 (0.4) 0.669 16.0 (2.4) 15.1 (2.2) 0.795
Vegetarian meat substitutes 0.5 (0.2) 0.9 (0.4) 0.396 0.8 (0.4) 1.5 (0.7) 0.351
Mixed dishes
Beans and rice, other bean mixtures 0.0 (0.0) 0.0 (0.0) 0.318 0.0 (0.0) 0.0 (0.0) 0.318
Beef with vegetables and/or rice/pasta 5.1 (1.3) 4.0 (1.2) 0.561 5.7 (1.3) 5.1 (1.7) 0.762
Burrito, taco, enchilada, nachos 4.5 (1.0) 1.5 (0.6) 0.031 11.3 (3.0) 2.9 (1.4) 0.028
Chicken or turkey with vegetables and/or rice/pasta 10.0 (1.9) 8.1 (1.8) 0.457 11.9 (2.6) 8.8 (2.1) 0.322
Chili 0.4 (0.2) 0.4 (0.2) 0.798 0.4 (0.2) 0.3 (0.2) 0.663
Fish or shellfish with vegetables and/or rice/pasta 0.4 (0.2) 1.2 (0.6) 0.181 0.5 (0.3) 1.5 (0.7) 0.169
Macaroni and cheese 15.6 (1.9) 18.1 (3.1) 0.508 28.6 (3.5) 34.0 (6.4) 0.465
Pizza 11.1 (2.0) 8.6 (1.4) 0.351 27.8 (5.0) 22.1 (3.7 0.396
Pork/ham with vegetables and/or rice/pasta 1.7 (0.9) 0.6 (0.3) 0.184 2.4 (1.3) 0.8 (0.4) 0.253
Pot pie/hot pocket 1.4 (0.5) 0.7 (0.5) 0.352 2.5 (0.8) 2.1 (1.4) 0.782
Sandwich 13.4 (1.6) 8.0 (1.3) 0.012 39.0 (4.8) 22.9 (3.6) 0.009
Soup 19.5 (3.1) 22.5 (4.6) 0.588 11.0 (2.1) 9.8 (1.8) 0.705
Spaghetti, ravioli, lasagna 27.1 (3.0) 21.5 (2.7) 0.180 31.2 (3.5) 23.6 (3.1) 0.121
Vegetable typeb
Yellow/orange 11.0 (2.4) 9.6 (2.2) 0.695 5.0 (1.0) 5.3 (1.5) 0.866
Dark green 6.8 (1.4) 5.5 (1.1) 0.448 2.7 (0.6) 2.2 (0.5) 0.526
White potatoes 19.1 (2.1) 18.9 (1.8) 0.937 30.2 (2.9) 32.4 (3.9) 0.645
Other starchy 8.7 (1.0) 8.3 (1.1) 0.829 8.4 (1.1) 7.7 (1.1) 0.656
Other vegetables 24.0 (2.1) 15.6 (1.6) 0.002 9.0 (0.9) 6.1 (0.7) 0.010
Vegetable preparation method
Cooked 51.8 (3.1) 48.1 (3.6) 0.447 48.7 (3.3) 50.3 (4.5) 0.778
Raw 11.6 (1.5) 5.0 (0.8) 0.000 3.9 (0.6) 1.6 (0.3) 0.000
Babyfood Vegetable 4.0 (1.0) 4.5 (1.2) 0.762 1.8 (0.5) 1.7 (0.5) 0.954
a
Analysis of Variance between picky eaters and non-picky eaters with age in days as covariate. Significant values (p < 0.05) are indicated in bold.
b
Yellow/orange (carrots, sweet potatoes, winter squash, pumpkin), Dark green (broccoli, spinach, other greens, Romaine lettuce), White potatoes (French fries and other
fried potatoes, mashed, baked, boiled), Other starchy vegetables (corn, green peas, lima beans, black-eyed peas), Other vegetables (artichoke, asparagus, beets, Brussels
sprouts, cabbage, cauliflower, celery, cucumber, eggplant, green beans, lettuce, mushrooms, okra, onions, pea pods, peppers, tomatoes/tomato sauce, wax/yellow beans,
zucchini, summer squash). The “Other vegetables food group was created based on the relatively low frequency of consumption of each reported vegetable.

incorporating this characteristic in questionnaires or by developing Appropriate texture introduction from weaning to early childhood
a new picky eating questionnaire that tries to cover the eating is important in order to progress to lumpier and more difficult
characteristics of picky eating more broadly than the existing foods in the first year of life and to raw foods and vegetables in
measures. Various recent reviews address a similar need for toddlerhood (Coulthard et al., 2009; Northstone, Emmett,
consensus on the definition of picky eating and improvement of Nethersole, & Alspac Study Team, 2001).
assessment tools as this had led to the wide variation in the defi- The limitations of this study include the untrained parental
nition of picky eating in studies with limited comparability report of picky eater status and limited measurement of picky
(Lafraire, Rioux, Giboreau, & Picard, 2015; Taylor et al., 2015). eating and other child eating characteristics. The use of a more
Another area of research that still need to be addressed is the effect extensive measure on picky eating, for example the Children's
of picky eating on food intake, with better quality data (Taylor et al., Eating Behavior Questionnaire (Wardle et al., 2001), would have
2015). given a more in-depth analyses of children's eating behaviors as it
It may be possible to whittle down picky eating by relatively also measures acceptance of new foods, acceptance of a variety of
simple actions, such as not allowing grazing and presenting rejec- foods and if the child is difficult to please with meals. However,
ted foods for tasting at least six times or more (Caton et al., 2013; texture acceptance is not covered in this questionnaire. The cross-
Caton et al., 2014). In the current study, the parents of picky sectional nature of the study also has to be taken into account.
eaters offered a new food a greater number of times than those of Even though various age groups were analyzed, what causes or is
non-picky eaters before deciding that the child did not like it. It an effect of picky eating cannot be concluded. Longitudinal studies
might be because the parents consider their child as a picky eater, on picky eating behaviors are scarce but necessary to confirm
so they are treating them as such by putting more effort in having findings on the effects on dietary intake (Taylor et al., 2015). Even
the children tasting new foods. It can also be that parents of picky though this study included a well-recognized measure of food
eaters, due to their concerns about their child's nutrition status intake, the 24-h recall has its own limitations. A single 24-h recall is
might be more active in seeking and implementing feeding advice not considered to be representative of habitual diet at an individual
from professionals (Ong, Phuah, Salazar, & How, 2014). Parent use level due to day by day variability and the methodology is adequate
and the effectiveness of these recommended feeding strategies for for surveying intake in a large group and estimating group mean
picky eaters need to be a future topic of research to enable intakes of diet. Errors in memory and conceptualization of food
appropriate intervention strategies and advice for parents (Taylor portion sizes can cause bias. Even though significant, differences in
et al., 2015). Advice on how to deal with the picky eater texture intake were small ranging between 12 g for vegetables and 16 g for
difficulties should also be part of the recommendations to parents. meat and other protein sources. Differences could have been
292 K. van der Horst et al. / Appetite 103 (2016) 286e293

influenced by the reported portion sizes and biased by parents' eating traits. PLoS One, 9(5), e97609. http://dx.doi.org/10.1371/
journal.pone.0097609.
perception of the picky eaters' intake. However it would be less
Cooke, L., Carnell, S., & Wardle, J. (2006). Food neophobia and mealtime food
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(2004). Demographic, familial and trait predictors of fruit and vegetable con-
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Neophobia, eating only favorite foods and difficulties with dx.doi.org/10.1079/PHN2003527.
texture are all important characteristics of picky eaters which need Coulthard, H., Harris, G., & Emmett, P. (2009). Delayed introduction of lumpy foods
to children during the complementary feeding period affects child's food
to be integrated in studies measuring picky eating behavior. With acceptance and feeding at 7 years of age. Maternal and Child Nutrition, 5(1),
the increasing clarity about the main characteristics of picky eating, 75e85. http://dx.doi.org/10.1111/j.1740-8709.2008.00153.x.
a validated measure is needed to advance research in the field of Coulthard, H., & Thakker, D. (2015). Enjoyment of tactile play is associated with
lower food neophobia in preschool children. Journal of the Academy of Nutrition
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Dubois, L., Farmer, A. P., Girard, M., & Peterson, K. (2007). Preschool children's eating
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related to the relevant characteristics of picky eating behavior need of Clinical Nutrition, 61(7), 846e855. http://dx.doi.org/10.1038/sj.ejcn.1602586.
Fox, M. K., Condon, E., Briefel, R. R., Reidy, K. C., & Deming, D. M. (2010). Food
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