Infant feeding can be a source of considerable stress for parents. Children who refuse to eat the 'right' foods or appear particularly fussy can give particular cause for concern. Health visitors and other early year's practitioners have little solid advice to pass on to these worried parents despite often being the first port of call, as the evidence surrounding any potential detrimental effects of being a fussy or 'faddy' eater as an infant or toddler is limited and conflicting.

There is relatively little evidence about whether parents' perceptions of their child being a 'fussy eater' really reflect differences in diet compared with other children. Some studies suggest that children who are faddy in their eating tend to eat less and more slowly, potentially suggesting lower energy intake. Carruth et al (1998), reported that "picky eaters" had lower dietary variety and diversity scores, the only study we are aware of examining such an association. The largest study published to date (Dubois et al, 2007a) based on 2103 Canadian children aged 2.5 to 4.5 years showed that 'picky' eaters consumed less energy, fat and protein compared with children whose parents reported no concerns about fussy eating. Parents are likely to worry that a fussy eating child will not grow sufficiently. However, supplementing a fussy child's diet with energy-dense foods could result in fussy eaters being more likely to develop obesity. Only a handful of studies have been performed to date examining the associations between faddy eating and growth. These primarily cross-sectional studies provide conflicting evidence , have not looked at height growth, suffer from small sample sizes and only one has been performed in the UK (Wright et al, 2007).

The only UK study was based on the Millenium cohort (Wright et al, 2007), reporting a prevalence of "faddy" eating (defined by a single question) of 8% among 445 children aged 30 months. These children were found to have gained less weight compared to those who weren't "faddy" eaters. Picky eaters in an Israeli study (Ekstein, 2010) were more likely to be underweight compared to a control group (total n=34). In a study of 240 Portugese children aged 3-13, Viana et al (2008) reported a small negative association with "food fussiness" (defined by combining multiple questions) and BMI. Finally, Gregory et al (2010) found no association between child food fussiness and BMI in their sample of 156 Australian 2-4 year olds.

In addition, the definition of a faddy eater varies across these studies and has been ascertained at different ages making comparisons difficult. Designating a child as a faddy eater has previously been based on one simple question (Wright et al, 2007; Mascola et al 2010) through to combining responses to at least 6 questions (Carruth et al, 1998; Gregory et al, 2010; Viana et al, 2008). It is not clear what the impact of using different definitions is on the associations between picky eating, diet, and growth. Furthermore, no studies (to our knowledge) have explored whether picky eaters in early childhood are likely to remain picky eaters throughout childhood.

The aim of the current study is to use a large UK-based prospective cohort study to fill the gaps in the literature by a) examining different ways of defining faddy eaters; b) assessing the persistence of faddy eating throughout childhood; c) determining whether faddy eaters (particularly during toddlerhood when it causes the most concern) consume a balanced diet or not by examining associations with dietary intake and in particular with the Variety index; d ) determine any associations between being a faddy eater in infancy/toddlerhood and 1) height, weight and BMI growth throughout childhood and 2) early adult body composition, BP and other cardiovascular risk factors.

References

BR Carruth, J Skinner, K Houck, J Moran, F ColettaD Ott. The phenomenon of "Picky eater": A behavioural marker in eating patterns of toddlers. J Am Coll Nutr 1998; 17: 180-186.

TM Dovey, PA Staples, EL Gibson, JCG Halford. Food neophobia and 'picky/fussy' eating in children: A review. Appetite 2008: 50; 181-193.

L Dubois, AP Farmer, M Girard, K Peterson. Preschool children's eating behaviours are related to dietary adequacy and body weight. Eur J Clin Nutr 2007a; 61: 846-855.

L Dubois, A Farmer, M Girard, K Peterson, F Tatone-Tokuda. Problem eating behaviours related to social factors and body weight in preschool children: A longitudinal study. Int J Behav Nutr and Phys Act 2007b; 4: 9.

S Ekstein, D Laniado, B Glick. Does picky eating affect weight-for-length measurements in young children? Clin Pediatr 2010; 49: 217-220.

JE Gregory, SJ Paxton, AM Brozovic. Maternal feeding practises, child eating behaviour and body mass index in preschool-aged children: a prospective analysis. Int J Behav Nutr and Phys Act 2010; 7: 55.

AJ Mascola, W Bryson, WS Agras. Picky eating during childhood: A longitudinal study to age 11 years. Eating Behaviours 2010; 11: 253-257.

V Viana, S Sinde, JC Saxton. Children's eating behaviour questionnaire: associations with BMI in Portugese children. Br J Nutr 2008; 100:445-450.

CM Wright, KN Parkinson, D Shipton, RF Drewett. How do toddler eating problems relate to their eating behaviour, food preferences and growth? Pediatrics 2007; 120: e1069.