Food neophobia and enjoyment of tactile play: Associations between preschool children and their parents

Olfactory performance and odor liking are negatively associated with food neophobia in children aged between 3 and 9 years

BACKGROUND

Child food neophobia, i.e., rejection or avoidance of novel foods at a young age, is a prevalent nutrition problem that affects the quality of children's diet and impedes the development of healthy food preferences. Sensory sensitivity can relate to the degree of food neophobia, but previous studies rarely focused on the olfactory component of this problem in children.

OBJECTIVE

We aimed to thoroughly examine the relationship between various aspects of olfactory sensitivity and food neophobia in children.

METHODS

246 children aged between three and nine years took part in a food neophobia assessment as well as in a comprehensive, psychophysical olfactory testing.

RESULTS

We found that certain smell perception aspects such as lower odor liking, poorer odor identification ability as well as lower sensitivity to an unknown non-food odor all significantly predicted higher food neophobia in children. Among individual characteristics of either a child or a caregiver, only the child's age significantly and positively predicted food neophobia. The exploratory model looking into the role of family environment factors predicting self-reported food neophobia in children revealed that food neophobia was associated with lower control given to a child in this child's feeding process, as well as with a more frequent use of food as a reward in feeding.

CONCLUSIONS

We suggest that suppressed olfactory perception and performance can play a unique role in child nutritional difficulties. The study inspires further considerations of olfaction-engaging interventions to counteract food-neophobia in children.

Arousal and the modulation of sensory experience: evidence from food-related emotions

Across sensory systems, several stimulus collative characteristics, including intensity, novelty, complexity and perceived dangerousness, are known to elicit high levels of physiological and psychological arousal. It has become apparent that food rejections by both children and adults are frequently linked to such arousal-inducing characteristics. This paper examines how arousal and arousability are important elements in responding to stimuli generally, but specifically to foods, ultimately influencing food preferences and choices. It is clear that responses to sensory properties are subject not just to variations in perceptual sensitivity due to genetics or experience-as in the case of widely rejected qualities such as bitterness or pungency-but also to the arousal potential of those stimuli. Moreover, this is linked to various enduring aspects of personality, suggesting that the impact of arousal on food choices is merely one aspect of a more general sensory sensitivity. The impact of diet on various health outcomes underlines the importance of understanding the relationship of arousal to food choices. This article is part of the theme issue 'Sensing and feeling: an integrative approach to sensory processing and emotional experience'.

Methodological approaches to assess tactile sensitivity in the food context-A scoping review

In contrast to taste sensitivity, the assessment of texture or tactile sensitivity has received relatively little attention in the food context. Texture plays an important role in food preferences and food intake, and individual differences make it important to understand physiological drivers of perception as tactile sensitivity. The multi-dimensional and dynamic aspects of texture perception suggest there is not one single method that can explain individual differences. This scoping review aims to systematically map methods assessing tactile sensitivity, in the context of food, highlighting differences in approach and implementation. Eligibility criteria included papers describing methods to assess individual differences in tactile sensitivity, that involved human participants and the context was relevant to food behavior. Sources are peer-reviewed publications of original research in English. In mapping the methods, we assessed how they relate to food texture parameters (mechanical, geometrical, and surface) and the dynamics of breaking down (touch with hand, first bite/sip, oral processing, residual or after-swallowing sensations). We also review other parameters associated (oral processing, preference, diet and food intake behavior). The literature in this relatively young area is still very fragmented and it is difficult to have a clear picture regarding best practices or recommendations for the measurement of tactile sensitivity in the food context. Future studies should aim to methodological harmonization for application in the food behavior area, with a design of experiment combining different aspects of tactile sensitivity to food, focusing on the thresholds and perceived intensity of textural parameters as well as affective and behavioral responses, and covering the whole spectrum of tactile texture perception (mechanical, geometrics, and surface), including the dynamics of perception.

Child characteristic correlates of food rejection in preschool children: A narrative review

Dietary habits formed in early childhood are key for establishing a healthy diet later in life. Picky eating and food neophobia - the two main forms of food rejection in young children - form an important barricade to establishing such healthy habits. Understanding these types of food rejection is thus essential for promoting healthy eating behaviour in both children and adults. To this end, the present narrative review aims to provide an overview of food rejection research in preschool-aged children, focusing on recent advances in the cognitive literature. Specifically, we evaluate the link between children's cognitive development, chemosensory perception and affective evaluation of food, food knowledge, decision-making strategies, anxiety and disgust sensitivity, and food rejection behaviour. Longitudinal and experimental studies are necessary to establish how the relationships between food rejection and cognitive processes develop over time and to determine their causal directions.

Bringing down barriers to children's healthy eating: a critical review of opportunities, within a complex food system

This narrative review revises the scientific evidence of recent years on healthy eating in children and adolescents, making sense of promising avenues of action, from a food system perspective. A conceptual framework is provided to better understand how eating habits of children and adolescents are shaped to identify key multisectoral approaches that should be implemented to promote healthier diets. The following influencing factors are discussed: individual factors (physiological and psychological factors, food preferences and food literacy competencies), factors within the personal and socio-cultural food environments, external food environments, and the supply chain. In each section, the main barriers to healthy eating are briefly discussed focussing on how to overcome them. Finally, a discussion with recommendations of actions is provided, anchored in scientific knowledge, and transferable to the general public, industry, and policymakers. We highlight that multidisciplinary approaches are not enough, a systems approach, with a truly holistic view, is needed. Apart from introducing systemic changes, a variety of interventions can be implemented at different levels to foster healthier diets in children through fostering healthier and more sustainable food environments, facilitating pleasurable sensory experiences, increasing their food literacy, and enhancing their agency by empowering them to make better food related decisions. Acknowledging children as unique individuals is required, through interpersonal interactions, as well as their role in their environments. Actions should aim to enable children and adolescents as active participants within sustainable food systems, to support healthier dietary behaviours that can be sustained throughout life, impacting health at a societal level.

Factors associated with the early emergence of atypical feeding behaviours in infants and young children: A scoping review

BACKGROUND

Atypical feeding behaviours such as significantly limited food preferences, hypersensitivity to food textures or temperatures and pocketing food without swallowing are common concerns in child health. Current reports indicate an inter-relationship between early growth, feeding problems and developmental disorders, yet little is known about how these behaviours develop in early childhood. There is also a lack of consensus about clinical definitions for atypical feeding behaviours, diagnostic thresholds and the associated precursors. To date, there has been no synthesis of the extant literature about factors associated with the early onset of atypical feeding behaviours in young children.

OBJECTIVE

This scoping review aimed to characterize the factors associated with the early emergence of atypical feeding behaviours in typically developing young children.

METHODS

CINAHL, MEDLINE, PsycINFO and Scopus databases were searched. Studies published in the last 5 years were included if they examined factors associated with the development of atypical eating behaviours in infants and young children. Of the 2137 records obtained after the search strategy was applied, 202 full-text articles were retrieved for a more detailed examination and to ensure they met the inclusion criteria. This resulted in 54 studies being included in this scoping review.

RESULTS

Of the 54 studies, three studies analysed precursors responsible for atypical feeding behaviours, and 51 studies discussed the factors associated with the early emergence of feeding difficulties. Multiple factors, including genetic factors, breastfeeding, late introduction of solids and lumpy foods, complementary feeding techniques, parental mental health, prematurity and child factors including temperament, were identified. There is inconsistent evidence for the associations between breastfeeding exposure and feeding difficulties.

CONCLUSIONS

This study identified multiple factors potentially associated with the early onset of atypical feeding behaviours in young children; however, there is insufficient evidence at this time to support specific recommendations for early feeding practices in young children. More methodologically rigorous studies are needed to extend these findings.

The lived experience of parenting a child with sensory sensitivity and picky eating

“Picky eating” is a common behaviour seen in childhood in both clinical and nonclinical populations. Sensory processing difficulties have been repeatedly associated with food refusal and picky eating behaviours. The aim of this study was to explore the lived experiences of parents/caregivers who have a child displaying both sensory processing differences and picky eating behaviours utilising Interpretative Phenomenological Analysis (IPA). Participants were recruited from social media support groups for parents of picky eating children. Pre‐selection criteria utilised an adapted short sensory profile questionnaire to ensure the children displayed probable/definite taste‐smell, audio‐visual and tactile sensory sensitivities. Twelve participants fulfilling the required criteria were interviewed face to face utilising a semi‐structured interview schedule. Interviews were transcribed and analysed following IPA guidelines and three common themes are presented here: Battling for control of the sensory environment, Living with stigma and, disapproval, and Staying positive and moving forward. The findings show the very considerable day‐to‐day challenges of parenting a child with sensory issues with food, including a lack of support and criticism from others. It was apparent that the parents in our study gradually adopted a positive and accepting attitude to their child's eating. This acceptance allowed them to have positive interactions around food with their child such as cooking and playing with food, suggesting that experiential activities serve an important purpose in this population. Further research should examine whether parental interventions based on acceptance of child eating behaviour, and commitment to gradual positive food interactions would be the best strategy to support parents and children.

Picky eating in children with sensory processing difference led to specific behaviours around food, for example, the identification of very small sensory differences in foods, and between different brands of the same foods. This caused disruption at family mealtimes, extra food preparation work, and judgement from others.

Parents all expressed a need for better awareness and support from health professionals and the wider public. Those who used online support groups found great comfort and advice from parents experiencing similar problems

Parents seemed to go on a journey of acceptance of their child's behaviour, and tried to adopt positive food parenting strategies. In particular, they used experiential learning strategies such as playing with, cooking with, and shopping for food which allowed them to interact with their child and food in a positive way.

VeggieSense: A non-taste multisensory exposure technique for increasing vegetable acceptance in young children

Vegetable consumption falls well below recommended levels for children in the UK. Previous research has found that repeated non-taste sensory exposure over the course of several days increases young children's willingness to touch and taste vegetables. The current study examined the impact of a one-off multisensory non-taste exposure intervention that took place on a single day on children's willingness to taste and intake of the exposed vegetables. Children (N = 110) aged 3- to 4-years-old were assigned to one of three intervention groups or to a control group. Children in all groups participated individually in a single activity session delivered in their nursery. Children in the intervention conditions took part in fun activities that provided either (a) visual exposure, (b) smell and visual exposure, or (c) smell, touch and visual exposure to six raw and prepared vegetables. Children in the control group engaged in a visual exposure activity with non-food items. After the exposure activities, all children were offered the prepared vegetables to eat; their willingness to taste and intake of the vegetables were measured. Results confirmed previous findings of sensory exposure activities increasing children's willingness to taste and intake of vegetables and revealed linear trends in both measures of acceptance with the number of senses engaged; children who took part in smell, touch and visual activities showed the highest level of acceptance. Findings suggest that multisensory exposures are effective in increasing consumption of vegetables in young children and that the effect of sensory exposure to healthy foods may be cumulative, with the more senses engaged prior to offering a food, the better.

Subjective touch sensitivity leads to behavioral shifts in oral food texture sensitivity and awareness

Neurotypical individuals have subjective sensitivity differences that may overlap with more heavily studied clinical populations. However, it is not known whether these subjective differences in sensory sensitivity are modality specific, or lead to behavioral shifts. In our experiment, we measured the oral touch sensitivity and food texture awareness differences in two neurotypical groups having either a high or low subjective sensitivity in touch modality. To measure oral touch sensitivity, individuals performed discrimination tasks across three types of stimuli (liquid, semisolid, and solid). Next, they performed two sorting exercises for two texture-centric food products: cookies and crackers. The stimuli that required low oral processing (liquid) were discriminated at higher rates by participants with high subjective sensitivity. Additionally, discrimination strategies between several foods in the same product space were different across the groups, and each group used attributes other than food texture as differentiating characteristics. The results show subjective touch sensitivity influences behavior (sensitivity and awareness). However, we show that the relationship between subjective touch sensitivity and behavior generalizes beyond just touch to other sensory modalities.

Food Texture Acceptance, Sensory Sensitivity, and Food Neophobia in Children and Their Parents

This study aims to explore whether children's food texture preferences are associated with different levels of sensory sensitivity and food neophobia, as well as with other variables, such as parental texture preferences. An online questionnaire was completed by 70 children aged 6-13 years old, alongside one of their parents. Generic texture preferences of children and parents were investigated with the Child Food Texture Preference Questionnaire (CFTPQ). Parents provided background information about their children by completing the Food Neophobia Scale (FNS), the Short Sensory Profile (SSP) and a Food Frequency Questionnaire (FFQ). The results showed that children who differed in their texture-liker status also differed in their levels of food neophobia and sensory information processing: children who preferred softer and non-particulate versions of foods were found to be more neophobic and sensory sensitive across all sensory domains. No relationship was found between parental and children's texture preferences.

Low adherence to traditional dietary pattern and food preferences of low-income preschool children with food neophobia

OBJECTIVE

To associate dietary patterns and food neophobia in low-income preschoolers.

DESIGN

This was a cross-sectional study using a semi-structured questionnaire for socio-demographic data, birth conditions and breast-feeding history. Food neophobia was assessed using an adapted version of the Child Food Neophobia Scale. Children's nutritional status was assessed using BMI-for-age and height-for-age Z-scores. Dietary patterns were estimated using a semi-quantitative FFQ through exploratory factor analysis. Multiple linear regression was used to test for an association between food neophobia and dietary pattern adherence.

SETTING

Philanthropic childhood education schools in Aracaju, an urban community in northeastern Brazil, between July and December 2017.

PARTICIPANTS

Two hundred fourteen children aged 3-6 years and their parents.

RESULTS

The percentages of low/medium and high food neophobia among preschoolers were 85·9 % and 11·2 %, respectively. Children with high food neophobia more frequently consumed ultra-processed foods rich in sugars (snacks, filled and unfilled cookies and sweets), as well as protein-rich foods (white meat, cheese and yogurt). Three dietary patterns were identified (traditional, snacks and school snacks). Children with a high level of neophobia had lower adherence to traditional dietary patterns.

CONCLUSIONS

A high level of food neophobia among socially vulnerable preschoolers is an eating behaviour related to unhealthy eating and is associated with the poorest diet in typical foods.

Oral Sensitivity to Flowability and Food Neophobia Drive Food Preferences and Choice

The study aimed to investigate the role of sensitivity to flowability on food liking and choice, the relationship between sensitivity to flowability and food neophobia, and its role in food liking. Five chocolate creams were prepared with different levels of flowability, and rheological measurements were performed to characterise them. One hundred seventy-six subjects filled in the Food Neophobia Scale and a food choice questionnaire (FCq). The FCq was developed to evaluate preferences within a pair of food items similar in flavour but different in texture. Secondly, the subjects evaluated their liking for creams (labelled affective magnitude (LAM) scale) and the flowability intensity (generalised labelled magnitude (gLM) scale). The subjects were clustered into three groups of sensitivity and two groups of choice preference. The effect of individual flowability sensitivity on food choice was investigated. Finally, the subjects were clustered into two groups according to their food neophobia level. The sensitivity to flowability significantly affected the liking of chocolate creams and the solid food choice. The liking of chocolate creams was also affected by the individual level of neophobia (p = 0.01), which, in turn, was not correlated to flowability sensitivity. These results confirm that texture sensitivity and food neophobia affect what a person likes and drives what a person chooses to eat.

Aversive textures and their role in food rejection

Texture is a prominent feature in foods and consequently can be the reason a food is accepted or rejected. However, other sensory attributes, such as flavor/taste, aroma, sound, and appearance may also lead to the rejection of food and motivations other than unpleasantness exist in unacceptance. To date, these motivations for food rejection have been studied in isolation and their relationships with psychological factors have not been tested. This study measured reasons people reject a food and probed into the specifics of texture rejection. A large U.S. sample (N = 473) was asked to rate their motivations for rejecting a food, list foods that were disliked due to unpleasant sensory attributes, specify the unpleasant sensory attribute(s), and complete an assessment of general touch sensitivity. Results showed 94% of individuals reject a food due to its texture, a rate comparable to flavor-based rejection. Looking at the number of foods being rejected, flavor was the most common food attribute, followed by texture and then aroma. From a linguistic standpoint, aversive textures encompass a large vocabulary, larger than liked textures, and the same food may be rejected due to a single or combination of texture terms. Viscosity (e.g., slimy) and hardness (e.g., mushy) are the most common aversive texture types, but through cluster analysis subsets of individuals were identified that are more aversive to other textures. This study emphasizes the role of aversive textures in food rejection and provides many avenues for future investigations.

A Proximal Perspective on Disgust

The functional basis of disgust in disease avoidance is widely accepted; however, there is disagreement over what disgust is. This is a significant problem, as basic questions about disgust require knowing if single/multiple forms/processes exist. We address this issue with a new model with one form of disgust generated by multiple processes: (a) pure disgust experienced during gastrointestinal illness; (b) somatosensory disgust elicited by specific cues that activate the pure disgust state; (c) anticipatory disgust elicited by associations between distance cues for somatosensory disgust and requiring threat evaluation; (d) simulated disgusts elicited by imagining somatosensory and anticipatory disgust and frequently involving other emotions. Different contamination processes interlink (a–d). The implications of our model for fundamental questions about disgust (e.g., emotion status; continuation into animals) are examined.

Observations of Toddlers' sensory-based exploratory behaviors with a novel food

BACKGROUND

Food neophobia hinders the acceptance of healthy foods in young children, and may be overcome by repeated food exposure. Prevalent literature states that children exhibit five sensory-based exploratory behaviors (SBEBs): smelling, licking, spitting, manipulating and/or swallowing as they progress towards accepting a novel food, yet there is a paucity of research on these behaviors. This study aimed to use direct observations of SBEBs across first-time exposures to hummus to (1) determine the prevalence of five SBEBs (smelling, licking, spitting, manipulating and swallowing) in 12-35 month olds, (2) quantify the psychometric properties of the SBEB assessment; and (3) examine the association of SBEBs with parent-assessed food fussiness, and consumption of the novel food.

METHODS

Direct observations of SBEBs during a 15-20 min snack time were conducted by trained staff members for 55 hummus-naïve toddlers ages 12-35 months, across 16 exposures to a novel food (hummus). Parents completed the child eating behavior questionnaire. Hummus consumption was measured using digital plate waste method.

RESULTS

Very low base rates of spitting (0.06%), smelling (0.97%) and licking (1.95%) were observed but manipulation (26.36%) and swallowing (62.15%) were more prevalent. Observation data on two behaviors over 16 occasions gave rise to a reliability coefficient from our G study portion of our generalizability analyses of Eρ² = 0.65. SBEBs did not significantly associate with parent-assessed food fussiness, nor hummus consumption.

CONCLUSIONS

Although literature refers to the prevalence of SBEBs, we did not observe this for three proposed behaviors. We did observe manipulation, but more research is needed to determine if there are additional SBEBs not noted in the literature, and to better delineate the process that leads to acceptance/rejection of novel food.

Sensory sensitivity mediates the relationship between anxiety and picky eating in children/ adolescents ages 8-17, and in college undergraduates: A replication and age-upward extension

This study explores the relationships among anxiety, sensitivity to sensory stimuli, and picky eating (PE). An earlier study in 95 children ages 5-10 found that sensory sensitivity fully mediated the relationship between anxiety and picky eating. We replicated this finding in a sample of 158 children, ages 8-17, and in 813 young adult college students. As in the previous child sample, the relationship between anxiety and picky eating appears to be mediated by sensory sensitivity. This relationship extends into adolescence and young adulthood and holds even in a sample of children with obsessive-compulsive-spectrum and anxiety disorders. However, there may be developmental differences in the relationship between sensory sensitivity and PE; the magnitude of this relationship was significantly greater for children than young adults. Although there was a trend towards a stronger relationship in a subsample of young adults with high anxiety, the effect was still smaller than that observed in children, suggesting that this difference is developmental and not completely driven by higher anxiety in the child sample. Sensory sensitivity is a candidate mechanism of picky eating, although the cross-sectional nature of this study means that we cannot address whether it is an etiological or maintaining mechanism, or both. Implications for behavioral treatment of picky eating in clinically anxious and non-clinical samples are discussed.

The influence of parental food preference and neophobia on children with phenylketonuria (PKU)

Background

In a previous case-control study, we demonstrated that children with PKU and non-PKU controls preferred sweet foods. Additionally, children with PKU exhibited food neophobia, with no preference for bitter tasting foods associated with the taste of phenylalanine (Phe)-free L-amino acid supplements.

Objective

In an observational extension study, we evaluated the influence of parental food choice and neophobia on their children's taste preferences and food neophobia.

Methods

Male and female parents/caregivers of 35 children with PKU and 35 control parents, completed a neophobia and food frequency questionnaire for comparison using the same questionnaires that they completed for their children.

Results

Both groups of children (PKU and non PKU control) were rated as more food neophobic and exhibited more neophobic behaviour than parents, although children with PKU more so than non-PKU controls (PKU food neophobia p < 0.0001vs control 0.001; PKU general neophobia p = 0.003 vs control p = 0.04). Both groups of children ate significantly more sweets, sweetened drinks and potato fries than their parents but differences were greater for children with PKU who also consumed more high carbohydrate (low protein) staple foods such as bread and pasta, and more sweet snacks such as biscuits than their parents. Non-PKU control children's food choices were closer to their parent's choices.

Conclusions

In PKU, parental food choices and their food neophobia have limited influence on their children's eating habits. Food neophobia in children with PKU may be associated with fear of eating unfamiliar foods potentially containing a source of protein or aspartame. Their preference for sweet foods may be influenced by limited food choices and habitual consumption of artificially sweetened L-amino acid supplements.

Understanding Food Fussiness and Its Implications for Food Choice, Health, Weight and Interventions in Young Children: The Impact of Professor Jane Wardle

PURPOSE OF REVIEW

This review examines the concepts of fussy eating and food neophobia in the context of key determinants of the development of children's food preferences. We discuss the evidence for genetic versus parental and other environmental influences on the ontogeny of these behavioural traits and the implications of current knowledge for interventions that attempt to lessen the impact of these traits on children's diets. Finally, we consider whether these traits increase the risk of a child becoming obese, or alternatively, underweight and malnourished.

RECENT FINDINGS

Fussy eating and neophobia are related concepts with both genetic and environmental aetiologies. Parent-child correlations and heritability estimates are moderate to high for both traits, but aspects of the family environment remain influential in young children, although no longer in young adults. Parental strategies based around repeat tasting opportunities can improve acceptance of disliked foods in even the fussiest children. Fussy eating and neophobia are not risk factors for obesity but could limit growth in severe cases. Fussy eating and food neophobia are common concerns for parents, though health risks are low. Dissemination of evidence-based strategies to parents that can encourage a more varied diet in young children would be helpful.

Temperamental approach/withdrawal and food neophobia in early childhood: Concurrent and longitudinal associations

The purpose of the present study was to investigate whether temperamental approach/withdrawal processes were concurrently and longitudinally associated with parent ratings and behavioral observations of food neophobia at 4.5 years of age. Additionally, maternal feeding practices were examined as potential moderators of the association between toddler temperament and food neophobia. Data were drawn from a longitudinal study following individuals (n = 82) from infancy through early childhood. At 18 months of age, toddlers were observed in an unfamiliar laboratory setting with an experimenter and their reactions were coded. At 4.5 years of age, the children were again observed in an unfamiliar setting and were also offered three novel foods (lychee, nori, and haw jelly). The number of foods they refused to taste was used as a measure of behavioral neophobia. Finally, mothers reported on their child's food neophobia and temperament, as well as their own feeding practices. As expected, temperament was associated with concurrent measures of food neophobia at 4.5 years of age. Also, low approach children who exhibited high negative affect and low positive affect in response to novelty at 18 months of age had higher levels of food neophobia at 4.5 years of age compared to their peers. Furthermore, evidence emerged to show that these neophobic tendencies in low approach children were strengthened by a maternal pressuring feeding style. Collectively, the results of this study emphasize that children who have low levels of temperamental approach are at a heightened risk for developing food neophobia during childhood.