The long-term health of picky eaters – A Q&A with Dr Caroline Taylor

Are picky-eaters doomed to long-term bad health? This is the fear of many of the members of the Mealtime Hostage Parenting Science Gang, and so we were delighted to welcome Dr Caroline Taylor to talk to us about her research looking at the children from the Children of the 90s study who reported picky eating behaviour.

Caroline: Hi! I’m a Research Fellow in the Centre for Academic Child Health at the University of Bristol. I’m interested in the diets of pregnant women (and how that affects the health of the developing baby) and the diets of children.

I’ve been running a project using data from the Children of the 90s study here in Bristol looking at picky eaters – what it is about their families or their early feeding that makes them more likely to become picky, how it affects their diets, and whether there are long-term effects on health, growth and development.

Q:  Thanks so much for joining us. Some of us are aware of Children of the 90s (we know it as ALSPAC), but it’s new for some of us. Can you tell us a little about it? It’s not just about picky eating…..

Caroline: The Children of the 90s study or ALSPAC is a birth short study – about 14,000 pregnant women living around Bristol were recruited in 1991/2 – they and their child have been followed up ever since – so the ‘children’ are about 27 now and some are having children of their own.

They have completed lots of questionnaires about all sorts of aspects of their lives over the years and attended clinics for all sort of measurements and samples. They’ve also given us information about their diets at regular intervals.

Q: What measures of health have you used in the study? And what definition / parameters did you have to define picky eaters?

Caroline: Nowadays there are lots of specially designed questionnaires to identify picky eaters – asking about aspects of the child’s behaviour around food – for example the Child Eating Behaviour Questionnaire (CEBQ). That hadn’t been developed when our children were small, so we used a question on whether the child was choosy about food at the age of three years.

There’s no accepted definition of a picky eater, but it usually involves rejection of new foods and reluctance to eat even some familiar foods.

Most children will grow out of being a picky eater in early primary school – with growing independence and wider friendship groups. But there is ‘hard core’ who don’t and they may need some extra help from a health professional.

Q: Were there any surprises in your findings about the long-term health of this group of children?

Caroline: I think we were quite surprised that we could still see differences in the diets of children who we had identified as being picky at the age of 3 years when they were 10 years old (compared with non-picky children). These differences had mostly disappeared by age 13 years.

PSG A: Wow! Were they the same sorts of differences (eg they wouldn’t eat veg at 3 and still didn’t at 10), or did their preferences change?

Caroline: We saw a similar diet profile at age 3, 7 and 10 – low in fruit and veg and meat, but by 13 these differences were disappearing.

PSG F: Interesting. So something magical happens between 10 and 13…isn’t that when kids often have another growth spurt as well? My son is 8 and is improving (almost imperceptibly). I imagine there are developmental pieces at play.

Caroline: I think that rather than something magical, its probably just a long-term move towards acceptance of a broader range of foods. We have to remember that no one food is essential for life and health – it’s about quality of the diet over weeks and months that counts.

PSG E: My 9 year old ate and enjoyed an apple the other day. He even told me how much he enjoyed it. Apparently I’ve been buying the wrong ones for years!!! Who knew??!!

Q:  I’m mum to a 7 year old fussy eater – no meat, no vegetables, no fruit. She is on vitamins and under the care of a play therapist but nothing works. She is constipated, with impacted bowels – she is on movicol and has been since 2. She’s described as restrictive eating

Caroline: I’m so sorry to hear this. Restrictive eating doesn’t have a clear definition clinically but I guess it would be severe picky eating. I hope you are getting some help and support with trying to widen her diet as well.

Reluctance to eat fruit and veg is really common in picky eaters – we definitely recorded that in our study. And also meat.

With regard to bowel problems, because picky eaters limit their fruit and veg intakes, their fibre intakes can be very low. This means they are more likely to be constipated. Show them that you enjoy fruit and veg, but don’t apply any pressure to eat. You may need to keep offering the same food many times until it becomes familiar enough for them to try it.

PSG C: We’ve tried that – we have even offered chocolate or cake as a reward for taking a bite. She is physically gagging at the thought.

Caroline: I would not advise making food a battle – much better to be as relaxed as possible around mealtimes. Family meals are really important, with home cooked meals and everyone eating together when possible.

PSG C: We really struggle with eating – even her packed lunch is coming back full. At what point does it become eating disorder?

Caroline: Eating disorders have very clear diagnostic criteria. Picky eating would be seen more as a transitory behaviour that most children will grow out of.

PSG A: What sort of proportion of the kids in your study showed transitory picky eating? Did most of them grow out of it, or were there some for whom it was a longer term issue?

Caroline: When we looked at longer-term picky eating up to the age of 7 years, there were a group of children in whom the behaviour persisted. Most will grow out of it in early school years. Some researchers think that picky eaters are more likely to get eating disorders later on, but there’s no really good evidence on this.

Q: Is there a way to know if a child is a picky eater because they want to assert themselves and their independence or because there is a real issue such as illness or teething or perhaps because of sensory issues?

Caroline: There is certainly an element of children wanting to have control – it builds up into a battle. It can be really hard to break out of, but the more relaxed about food parent can be, the better.

Q: How about illnesses? Do picky eaters suffer more from, for example, colds?

Caroline: That’s really difficult to look at in our type of study, because colds are so common and can be related to lots of different aspects of health. Our picky eaters didn’t really have any nutrient deficiencies overall so I thinks it’s unlikely though.

Q: Long term detrimental effects of a restricted diet is something that really worries me, as I suppose it does for the parents of a lot of children that don’t eat a wide range of fresh fruit and veg. It’s hard not to get caught up in the healthy eating hype and worry. I’m really hoping that your research results can ease this concern.

Caroline: When we look at long-term growth in our picky eaters up to age 17 years, there was no difference in growth compared with non-picky eaters – some reassurance there. But there was a small group that tended to be thin in adolescence – maybe these are the few who get ‘stuck’ as a picky eaters and need some early help.

PSG B: What professional help is best for those who don’t grow out of their picky eating?

Caroline: I’d start with your GP or health visitor. They should be able to direct you to more specialist services where needed – perhaps a dietitian or maybe a health psychologist, or a paediatrician.

Q: What measures of health were used for the study?

Caroline: We looked at a couple of things – because of the low fruit and veg intake we looked at constipation. None of the children in the study were eating enough dietary fibre, but the picky eaters were especially low and this was linked with constipation. We’d like to help parents encourage their children to eat lots of fruit and veg.

We also looked at growth – height and weight – up to age 17 years – there were no differences between the picky eater and non-picky eaters, which is reassuring for parents.

PSG I: Did any of the picky eaters in your study have other underlying health conditions that may affect their eating, such as coeliac disease? My little girl is 2, was/is a picky eater and she was recently diagnosed with coeliac. Since being gluten-free she’s now willing to try more things.

Caroline: We did have a few children who had coeliac disease, but because they are so few, we were not able to look at them as a group because our statistical models would be invalid with low numbers.

Q: Caroline – could you tell us more about the differences you found between the “picky” and “very picky” eaters when you looked at their long-term health?

Caroline: The main measure we had of long-term health was growth – height and weight – which is a good reflector of health and development in general. We looked at growth up to age 17 years – there was no difference between picky eaters and non-picky eaters. When we look at the diets, there was no difference in the calorie intakes at age 3, 7, 10 or 13, so this all seems to fit together. I think this is reassuring for parents that there are no obvious long-term harm done from early picky eating.

PSG A: So in the cohort you were looking at, the picky eaters were only restrictive in variety, not in calories.

Caroline: Yes, that’s right. Picky eaters tend to have low dietary variety, but they eat enough calories.

PSG B: Were there any children in the study who were not taking in enough calories? What about your “very picky” eaters?

Caroline: Even the very picky eaters were eating enough calories – it was the balance of their diets that were not quite as good as they could have been.

Q: In your article in The Conversation, you write, “When the results were plotted on reference growth charts the values were consistently just above the 50th centiles, which indicates the average measurement for all children in the population. This shows that the children were growing normally.”

The target growth for any individual cannot possibly be the same as the statistical mean for a population. What measurement did the researchers use to measure (and determine) normal growth in the children?

Caroline: We used reference growth charts which are designed to show whether individual children are growing ‘normally’ over time. For an individual, if the trajectory starts to drop of the centile they are tracking along, then that would be a concern. For a cohort study like ours, we plotted the mean values for a large group of children – for a group we would want to see the trajectory tracking at or above the 50th centile, as this is the average value for a population.

Q: What questions has your research raised? What do you think needs to happen next?

Caroline: I would like to know more about the persistent picky eaters – it would be good to work out how to identify them at an early age because I think they are the ones who might benefit from support when they are young. They might be the ones who are more prone to becoming adult picky eaters, which is socially very restrictive and difficult.

PSG B:  I’d love for some research into early identification and prevention!

PSG A : Does the Children of the 90s data have anything in it that might enable further work comparing the mental health of the typical/picky/very picky eaters?

PSG H: I’d like some research into the that. Hopefully it would then lead onto better support/ help for the children & their adults.

Caroline: There are data on mental health scores up to the present day – so age 26 or 27 years. That would be good to look at! We’d need some more funding …

We are hoping to do some work with health professionals to provide better information for parents.

PSG B: Which health professionals? This seems to be a big grey area, particularly in the UK!

Caroline: We’d like to work with professional organisations such as the British Dietetic Association for example.

PSG B: Please also consider speech therapists and occupational therapists. Both professions offer a lot in the field of picky eating internationally but less so in the UK – it’s a gap that needs to be addressed in my opinion.

PSG B: Thanks Caroline Taylor, really grateful for your time and for doing the research. It will be hugely reassuring for many parents. Looking forward to any future studies!

Caroline: Thank you everyone – it has been a privilege to work with the Children of the 90s data and I’m grateful to all the participants in the study.

PSG J: Thank you. It’s very reassuring to hear about your research.

If you are interested in the Children of the 90s study, you might enjoy our Q&A about the study with Dr Suzy Gage.

If you’d like to find out more about picky eating research, why not check out our Q&As on:

You can read all our Q&A sessions, on loads of different parenting-related subjects on the website.

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