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

The Development of the Food Averse Questionnaire: A Measure of Food Avoidance in Children With and Without Autistic Spectrum Conditions

The aim of this study was to 1) develop a measure of avoidant eating behaviours for both typically developing children (TD), and those with Autism Spectrum Conditions (ASC), and 2) to examine whether these current behaviours are associated with reports of early feeding difficulties in both populations. In study one (n = 336) parents of 4- to 14-year-old children completed a series of questions about food avoidance. Three subscales of food avoidance were identified with a total scale of 31 items; avoidant, rigid-inflexible, and texture sensitive. Analyses found that scores on these subscales were associated with related measures of picky eating, food neophobia, sensory sensitivity and cognitive inflexibility, as well as lower fruit, vegetable, dairy and protein consumption. In study two, 225 children aged 4-14 years and their parents were recruited (143 TD and 78 ASC). Children with ASC were more likely to have feeding problems during the transition to family foods and in the toddler eating period in comparison to TD children. Additionally, children with ASC showed, at the time of the study, higher avoidance, rigid-inflexible eating and texture-sensitive eating behaviours than TD children. This study has developed a reliable scale for food avoidance for children with and without ASC diagnoses. Food avoidance is more severe in children with ASC than in TD children and these difficulties may start before them receiving an ASC diagnosis. Further work is needed to examine the usefulness of this scale in clinical and nonclinical populations.

Is Hunger the Best Sauce for Unfamiliar Foods? A Study Investigating the Effect of Hunger on Young Children's Food Intake of a Familiar and Unfamiliar Fruit

Sufficient fruit and vegetable intake is crucial for healthy development, yet many children fail to meet the recommended levels, partly due to food rejection. This study aimed to identify an effective, easy-to-implement strategy to increase fruit intake in children by examining the impact of hunger on the consumption of a familiar and unfamiliar fruit. Additionally, it explored the moderating role of picky eating within this relationship. A total of 177 children aged 4-6 were assigned to a hungry condition (food-deprived for 3-4 h) or a non-hungry condition (food-deprived for less than 30 min). The children were then asked to taste either a familiar fruit (apple) or an unfamiliar fruit (lychee), with up to 9 pieces available for tasting. It was hypothesized that children in the hungry condition would consume more fruit compared to those in the non-hungry condition, and that intake would be higher for the familiar fruit than the unfamiliar fruit. Additionally, the effect of hunger on intake was expected to be moderated by picky eating, with a weaker effect in children who were more picky eaters. Results from a 2x2 ANOVA showed hunger significantly increased fruit consumption, regardless of familiarity, and the familiar fruit was consumed more than the unfamiliar fruit. No interaction between hunger and fruit familiarity was found, and picky eating did not moderate the relationship between hunger, familiarity, and intake. These findings suggest that mild hunger can be an effective strategy to increase children's fruit intake, and offering fruits when children are hungry may promote healthier eating.

Food Fussiness Processes in Middle Childhood: Application of a Dual-Processing Model Using Measures of Temperament

BACKGROUND

Analyses based on a dual-processing approach can contribute to a better understanding of the processes involved in food fussiness in children. This approach combines reactive or automatic avoidance responses together with regulatory processes, such as inhibitory control. Previous research has mainly focused on the avoidance response rather than both avoidance and regulatory control.

OBJECTIVE

The main purpose of the research was to investigate possible processes associated with food fussiness in children older than early childhood and into middle childhood (here, 5-to-12-year-olds) based on a dual-processing approach.

METHODS

The food fussiness subscale of the Children's Eating Behavior Questionnaire (CEBQ) and the impulsivity, fear, shyness and inhibitory control subscales of the Children's Behavior Questionnaire (CBQ) were used. Multivariable regression examined bottom-up/top-down temperament measures as components of the food fussiness process, with the main effects and interactions. ANOVA examined differences in the temperament measures for non-fussy, moderately fussy and severely fussy children.

RESULTS

The regression analysis showed that higher food fussiness was associated with lower impulsivity and lower inhibitory control. There also was a significant interaction between impulsivity and inhibitory control, suggesting that higher food fussiness for some children was associated with a combination of low impulsivity (more behavioral inhibition) and low inhibitory control.

CONCLUSIONS

The results suggest that an analysis of food fussiness in terms of higher bottom-up avoidance in tandem with lower top-down inhibitory control is a helpful approach to the interpretation of the core processes involved in food fussiness in children. A better understanding of the fussiness processes can guide approaches to preventive interventions, including for parents of children with food fussiness.

Enhancing Vietnamese Students' Acceptance of School Lunches Through Food Combination: A Cross-Over Study

BACKGROUND/OBJECTIVES

Vegetable leftovers constitute more than half of Vietnamese school lunch waste, partly due to limited ingredient variety, which may reduce meal acceptance.

METHODS

This cross-over study assessed the impact of diversifying vegetable options on intake and satisfaction among 40 students at a suburban Vietnamese primary school. Five new menus were developed by redistributing a 100 g vegetable portion into smaller servings of multiple vegetable types, combining them creatively with protein-rich foods or rice while maintaining nutritional value and cost. Students alternated between current and new menus over four weeks. Sensory evaluations using a 5-point hedonic scale and food weighing were conducted daily.

RESULTS

Most students increased vegetable intake during the new menu period. Mean intake was significantly higher with new menus (81.5 g; 95%CI: 77.1-85.9) compared to current menus (71.1 g; 95%CI: 65.2-75.1) (p < 0.001).

CONCLUSIONS

These findings demonstrate that enhancing vegetable variety in combination can significantly improve intake and sensory characteristics without additional costs. This scalable strategy offers a practical solution for schools to foster healthier eating habits among students.

Autistic traits and ARFID-associated eating behaviors in preschoolers: Mediating effects of sensory processing patterns

OBJECTIVE

This study aimed to examine the association between autistic traits and Avoidant Restrictive Food Intake Disorder (ARFID)-associated eating behaviors in preschool-age children and investigated whether this association was mediated by sensory processing patterns.

METHOD

A cross-sectional, parent-reported study was conducted between July 2022 and March 2023 among 503 preschoolers aged 4-6 years in China. Parents provided assessments of their children's autistic traits using the Social Responsiveness Scale, sensory processing patterns using the Short Sensory Profile 2, and ARFID-associated eating behaviors using the Nine Items ARFID Screen. The mediation model based on ordinary least squares regression was employed to test the mediating effects of sensory processing patterns between autistic traits and ARFID-associated eating behaviors.

RESULTS

The results indicated significant associations among autistic traits, ARFID-associated eating behaviors, and sensory processing patterns. Moreover, mediation analyses revealed that sensory processing patterns played a partial mediating role in the relationship between autistic traits and ARFID-associated eating behaviors. Specifically, autistic traits were observed to weaken ARFID-associated eating behaviors, particularly picky eating and poor appetite, through Registration, while simultaneously fostering them through Sensitivity and Avoiding.

DISCUSSION

Our study is limited to some extent by the inability to draw longitudinal conclusions from cross-sectional data. Nevertheless, it underscores the significance of early identification and intervention for food avoidance/restriction behaviors due to sensory processing abnormalities in children with heightened autistic traits. This proactive approach may contribute to mitigating ARFID-associated eating behaviors that might drive clinical symptoms of ARFID.