|
Article Excerpt
The toddler years represent a challenging time characterized by rapid development that can be exciting, as well as frustrating. Though the toddler is beginning to establish his or her independence, he or she is still reliant upon a caregiver to provide for all basic needs. This may present a bit of a problem if the toddler's desires differ from those of the caregiver. This behavior is perhaps most evident in the development of eating behaviors in young children. In the interest of offering their children the best start possible, parents of toddlers will come to their primary care providers searching for answers and recommendations to a myriad of concerns regarding dietary intake. Many parents are well aware of the need to establish healthy dietary habits early in life, as well as, the link between poor nutrition and adverse health conditions (Fisher & Birch, 1995). Concerns peak when the child demonstrates an unwillingness to try novel or unfamiliar foods, termed food neophobia (Carruth & Skinner, 2000). We, as primary care providers, must be prepared to offer sound advice and solid recommendations to these parents as they struggle to provide their children with the tools necessary to become healthy, happy adults.
The Picky Eating Phenomenon
Three primary components play a role in the picky eating phenomenon. These components are development, personal preferences, and the family.
The role of development. To develop appropriate recommendations, it is necessary to gain an understanding of the determinants of dietary patterns in young children. The literature provides support for the idea that picky eating is a developmental process for toddlers. Johnson (2002) described food acceptance patterns and the emergence of eating patterns in relation to physiologic growth, age, and emotional development. In infancy, a child is a depletion-driven eater who consumes only milk and has no desire for other foods. As the child grows, he or she develops a physiologic need for more nutrients and is, therefore, transitioned to solid foods. This is followed by the stage of food neophobia and the "terrible twos," when the child attempts to assert his or her independence and to establish some sense of autonomy. Johnson (2002) sees this as a normal part of development that leads to frustration, anxiety, and power struggles between the parent and child. Eventually, the child develops cognitively in the preschool years to begin to understand physiologic and social cues needed to respond appropriately to adults and will not engage in these power struggles as readily (Johnson, 2002). This clearly represents a stage of development that resolves as the child matures.
Martins (2002) describes toddlers' neophobia as a developmental phase that is rooted in a historical practice, which has remained ingrained despite the evolution of our culture. She purports that this may be an innate phase that may have served a protective function during the time when humans foraged for food. A fear of unfamiliar foods decreased the likelihood of inadvertently eating a harmful toxin at a time when this was a significant threat. Even though this is no longer an ominous threat to survival, toddlers are innately programmed to be a bit skeptical of unfamiliar food items and, thus, demonstrate picky eating habits for a period of time (Martins, 2002).
Picky eating, though it may appear to be dangerous to the child's well being, will not, in most cases, be a detriment to the child's health. Birch and Fisher (1995) report that almost all children will self-regulate the ingestion of the appropriate amount of nutrients needed to sustain growth and further development. In other words, the toddler will eat what is needed to support his or her growth. Satter's (1990) work indicating that a child will assume responsibility for whether or not he or she will eat and what amount will be ingested further supports this notion. This innate or automatic mechanism demonstrates that the child's picky eating behavior is to some degree internally mediated, which implies that there is a developmental component.
The role of personal preferences. In addition to the belief that picky eating is a developmental phase, research provides support for the fact that children demonstrate personal preferences, which will help determine the food choices they make. By reviewing the psychologic influences on dietary intake of children found within the literature and tying them in with her own ideas, Birch (1998) concluded that few food preferences are innate. Rather, they are found through trial and error of the child. When these preferences are determined, young children simply eat what they like with no regard to fat, cholesterol, or sodium content. She purports that these preferences, when considered in the context of family values, attitudes, and beliefs and with respect to emotional states, help determine future dietary and intake patterns (Birch, 1998).
Fisher and Birch (1995) provide further evidence on the importance of food preferences in the development of eating behaviors. The authors studied children aged 3 to 5 years old to determine the importance of food preferences in the development of dietary intake patterns. The researchers observed each participant's 24-hour food intake from prepared choices that consisted of healthy and unhealthy food options. Each child's actual intake was compared with the results of the Fat Preference Assessment obtained earlier in the study. The authors hypothesized that children with a strong preference for high fat foods were more likely to eat foods high in fat. This proved to be true as the measured fat intake ranged from 25% to 42% of total consumed energy. The higher percentages were observed in those children demonstrating a greater preference for high fat foods (Fisher & Birch, 1995). Understanding the role of preferences in dietary choices of toddlers is critical to identifying appropriate interventions to address neophobic food behaviors.
In examining the importance of personal preferences in toddlers' food choices, a brief discussion regarding the impact of exposure to novel flavors via mother's milk in breastfed infants is critical. Mennella, Jagnow, and Beauchamp (2001) hypothesized that exposure to a particular flavor in breast milk or amniotic fluid would modify an infant's response to and acceptance of that flavor when transitioned to solid foods. In a study of 46 mothers and their infants, the authors offered one group of pregnant women carrot juice 4 times per week during the last trimester of pregnancy and water during the first 2 months of lactation. The second group was given water during the pregnancy and carrot juice during lactation, while the third was offered water throughout both pregnancy and lactation. At about 6 months of age, the infants' diets were complemented with cereal. Approximately 4 weeks later, the flavor of carrot was added to assess responses. Each mother rated her child's enjoyment of the new food item according to a 9-point scale with 9 indicating the food was liked very much and 1 implying that the food was not liked at all. The researchers analyzed each infant's response based on facial expressions and negative responses including gaping, head turning, brow lowering, and nose wrinkling. These authors found that the infants exposed to the carrot flavor prenatally or in breast milk exhibited fewer negative responses and facial expressions when presented with it when weaning to solid foods, thus supporting their hypothesis (Mennella et al., 2001). This significant finding lends support to the idea that food exposures may play a pivotal role in acceptance of novel foods and unfamiliar flavors.
An earlier study examined the outcomes of garlic ingestion by nursing mothers on the odor of their breast milk and the subsequent suckling behaviors...
|
