Assessing children’s willingness to try new foods: Validation of a Portuguese version of the child’s food neophobia scale for parents of young children

Neophobia, sensory experience and child's schemata contribute to food choices

PURPOSE

The aim of the present review is to analyze dynamic interactions between nutrigenomics, environmental cues, and parental influence, which can all lead to children's neophobic reactions and its persistence in time.

METHODS

We reviewed studies available on electronic databases, conducted on children aged from birth to 18 years. We also considered official websites of Italian Institutions, providing advice on healthy eating during infancy.

RESULTS

Modern day societies are faced with an eating paradox, which has severe and ever-growing implications for health. In face of a wider availability of healthy foods, individuals instead often choose processed foods high in fat, salt and sugar content. Economic reasons surely influence consumers' access to foods. However, there is mounting evidence that food choices depend on the interplay between social learning and genetic predispositions (e.g., individual eating traits and food schemata). Neophobia, the behavioral avoidance of new foods, represents an interesting trait, which can significantly influence children's food refusal. Early sensory experiences and negative cognitive schemata, in the context of primary caregiver-child interactions, importantly contribute to the priming of children's food rejection.

CONCLUSIONS

As neophobia strongly affects consumption of healthy foods, it will be relevant to rule definitively out its role in the genesis of maladaptive food choices and weight status in longitudinal studies tracking to adulthood and, in meanwhile, implement early in life effective social learning strategies, to reduce long-term effects of neophobia on dietary patterns and weight status.

LEVEL OF EVIDENCE

Level II, controlled trials without randomization.

Instruments to Evaluate Food Neophobia in Children: An Integrative Review with a Systematic Approach

Food neophobia (FN), a frequent disorder in childhood, profoundly impacts the quality of a diet, restricting the intake of nutrients to maintain proper nutrition. Therefore, using the appropriate tools to assess FN in children to promote healthy eating habits is essential. The study aimed to develop an integrative review with a systematic approach to identify the instruments to measure FN in children and analyze their differences. The included studies (n = 17) were more concentrated in Europe, demonstrating the possible lack of dissemination of the topic at a global level. Among the 18 tools, 6 were represented by adaptations of the Food Neophobia Scale (FNS) and the Children's Food Neophobia Scale (CFNS), and one was the CFNS itself, demonstrating the relevance of these pioneering tools. The need to meet mainly cultural and cognitive criteria led to the creation of other instruments (n = 11). A diversity of approaches concerning the respondents, age range, items, scales, and validation methods was revealed. Modifications to the tools in some nations highlighted their adaptability and effectiveness in addressing regional variations. The instruments can contribute to additional research to help us better understand the prevalence of FN in children, resulting in their health and well-being.

Examining links between child temperament and feeding, eating, and weight outcomes: An updated systematic review of the literature

BACKGROUND

Weight outcomes have been associated with child temperament, defined as individual differences in reactivity and self-regulation. The current systematic review aims to provide an updated summary of the evidence linking temperamental negative reactivity, surgency, and regulation superfactors to early childhood feeding, eating, and weight outcomes.

METHODS

PubMed, PsycINFO and Embase databases, as well as scientific meeting programs, were searched using keywords and subject headings. Publication dates were limited to 2012-2019 as prior reviews were published in 2012 and 2014. Identified studies were eligible if they included children ages 0-5 years, a measure of child temperament, and a measure of parent/caregiver feeding, child eating, or child weight. 7113 studies were identified and 121 met inclusion criteria.

RESULTS

Feeding, eating, and weight outcomes were largely unrelated to overarching negative reactivity, surgency, and effortful control superfactors. Examination of individual temperament dimensions suggested difficult temperament was frequently linked to non-responsive feeding practices, whereas elevated emotionality and decreased self-regulation were linked to maladaptive eating behaviors, and lower inhibitory control to adiposity. Analyses with infants reported greater percentages of significant associations compared to children, and cross-sectional studies generally reported fewer significant associations than other study designs.

CONCLUSIONS

Difficult temperament, greater emotionality and lower self-regulation and inhibitory control were the aspects of temperament most consistently related to poorer early childhood feeding, eating, and weight outcomes. Associations tended to be stronger in infancy, and when examined within a non-cross-sectional study design. Findings can inform the development of tailored efforts to promote healthy eating and growth throughout childhood.

The Chinese version of the child food neophobia scale and its reliability and validity in preschool children

OBJECTIVE

To translate the English version Child Food Neophobia Scale (CFNS) into the Chinese version and test its reliability and validity in preschool children.

METHODS

To create the Chinese version of the CFNS, it was translated, back-translated, and cross-culturally adapted. The use of the Chinese version of CFNS by 575 parents of preschool children in two kindergartens in Yangzhou City was investigated using cluster sampling to assess the reliability and validity of the scale.

RESULTS

The Chinese version of CFNS has nine items in total. The scale-level average content validity index (S-CVI/Ave) is 0.983. Exploratory factor analysis (EFA) extracted 2 common factors, and the cumulative variance contribution rate was 49.437%. Confirmatory factor analysis (CFA) showed that the 2-factor model was well fitted. The Cronbach'α coefficient of the scale was 0.759, the Cronbach'α coefficients of the two factors were 0.735 and 0.713, the split-half reliability was 0.788, and the test-retest reliability was 0.756.

CONCLUSION

The Chinese version of the Child Food Neophobia Scale has good reliability and validity in preschool children and can be used as an assessment tool for food neophobia in preschool children in China.

PRACTICE IMPLICATIONS

This study has gone through a rigorous translation process, and the CFNS may support future exploration of food neophobia in preschool children. Food allergy factors in the results may be the next step in the research, and several studies are still needed to understand the relationship between food allergy and food neophobia.

Food Neophobia among Brazilian Children: Prevalence and Questionnaire Score Development

This study aims to create and validate a score to classify food neophobia among Brazilian children (from the ages of 4 to 11 years) and investigate the prevalence of food neophobia. This descriptive cross-sectional population-based study is conducted following three steps: (i) the application of an instrument to identify food neophobia in Brazilian children by their caregivers; (ii) the instrument’s score definition; and (iii) the evaluation and characterization of the national prevalence of food neophobia among Brazilian children. The scores were categorized into three levels, based on the tertial approximation: low, moderate, and high. The study had 1112 participants, and the prevalence of high food neophobia was observed in 33.4% of Brazilian children. The prevalence of food neophobia allowed us to identify this behavior in Brazilian children and better understand the population. Boys were significantly more neophobic than girls. The general neophobia score and domains did not significantly differ between Brazilian regions and age groups. It is worrying that food neophobia did not decrease with advancing age. The score for the complete instrument with 25 items, or the 3 domains, makes its use practical. It can be used to assess neophobia with more caution, evaluate the most neophobic children, and enable more targeted professional interventions to promote healthier and sustainable eating habits.

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.

The Effect of Learning Module Program on Mothers’ Ability to Adapt to New Foods, Feeding Styles, and Self-efficacy to Their Children with Avoidant Restrictive Food Intake Disorder

BACKGROUND: The education to improve a mother’s knowledge is deemed to be important because it may improve children’s nutritional status. AIM: The aim of this study was to examine the effects of learning module program on the mothers’ ability to adapt to new foods, feeding styles, and self-efficacy to their children with avoidant restrictive food intake disorder (ARFID). METHODS: Quasi-experimental design was used to evaluate the effectiveness of learning module program. Fifteen mothers of experimental group were given four meetings within 4 weeks. Each meeting ran about 50 min. Fifteen mothers of control group were conducted home visit and received twice education about the health principals of feeding children. Both experimental group and control group had pre-test and post-test. The data were analyzed using Chi-square test, Fisher’s exact test, and Mann–Whitney U-test. RESULTS: The participants of the experimental group have shown bigger surge of new foods adaptation (t = –2.973, p < 0.003), feeding style (t = –4.646, p < 0.001), self-efficacy (t = –3.652, p = 0.001) than the control group has. CONCLUSION: The findings indicated that the learning module program was deemed to be effective to improve mothers’ ability to adapt to new foods, feeding styles, and self-efficacy to their children with ARFID.

ASSESSMENT OF EATING BEHAVIOR AND FOOD NEOPHOBIA IN CHILDREN AND ADOLESCENTS FROM UBERABA-MG

OBJECTIVE

To investigate and compare the eating behavior and food neophobia of children and adolescents from different age groups, body mass index per age, and sex.

METHODS

This was a cross-sectional study, with a convenience sample, involving 150 children and adolescents aged 3 to 13 years, of both sexes, treated at a pediatric outpatient clinic of a teaching hospital in the municipality of Uberaba-MG, Brazil. Subscales of the Child Eating Behavior Questionnaire (CEBQ) were used to evaluate eating behavior, and the Child Food Neophobia Scale (CFNS) was used to evaluate food neophobia.

RESULTS

Higher scores were found in the subscales "food responsiveness" (p=0.015), "enjoyment of food" (p=0.002), and "emotional overeating" (p=0.009) among older children and adolescents. Younger children had higher scores in the subscales "satiety responsiveness" (p=0.004) and "slowness in eating" (p=0.001). There was a tendency toward higher scores for "food responsiveness" (p=0.005) and "emotional overeating" (p=0.013) in participants with severe obesity. There were no differences in the scale of food neophobia. Overall, food neophobia positively correlated with lack of interest in food and negatively correlated with interest in food.

CONCLUSIONS

The study showed significant differences in some domains of eating behavior among children and adolescents of the sample; however, no differences were found regarding food neophobia. These results may contribute to the improvement of future interventions related to infant eating behavior and food neophobia.