Another important factor in the “creation” of an avoidant eater is worry. Imagine a situation where a weaning infant refuses to eat dinner for a couple of days without apparent reason. That mother may start worrying about the child’s food intake and make an extra effort to convince them to eat on the third day. If that is perceived by the child as a negative experience, they may refuse to sit in the high chair from now on, for example. This will worry the mother even further. It may also attract criticism and shame to that mother who, without appropriate support and guidance, will keep pressing the child to eat. This further upsets the child and they will continue refusing to eat or become very selective about what they eat, and the cycle goes on… Dr. Katja Rowell, an American paediatrician, beautifully describes this cycle in her book Feed Me, Love Me (1).

It’s important to also mention that some children may present avoidant eating habits due to psychological or physical issues. Conditions like Attention Deficit and Hyperactivity Disorder (ADHD), autism, anxiety, depression, cognition problems etc can impair a child’s ability to developing healthy eating habits, thus exhibiting avoidant eating behaviours (2), as well as children with dysphagia (swallowing issues) (3).

In these cases, avoidant eating, can be seen more as a symptom and addressing it may not even be appropriate. For example, avoidant eating can be present in the behaviour of a child victim of trauma. Attempts to change this child’s eating behaviour may even exacerbate their problems, thus addressing the trauma must be the priority.

HOW COMMON IS IT?

It’s very hard to put a number on the prevalence of avoidant eating behaviour in children. That’s because researchers find very different rates in different parts of the world, in different age brackets. For example, 5.6% of 4 year-olds in the Netherlands are believed to be avoidant eaters, whilst the prevalence in the USA is a staggering 50% of 2 year-olds. Although the drop from 50% at 2yo to 5.6% at 4yo might make you think that 4 year-olds might have grown out of avoidant eating, another study in China found that 59% of 7–12 year-olds were avoidant eaters (4). Not very conclusive, huh?

This is all based on parents and other caregivers’ perspectives as they were the ones who answered the researchers’ questionnaires (4). I wonder how the figures would turnout to be if researchers have questioned the children instead… topic for another article. 😉

There isn’t a widespread consensus about how to define this behaviour (5). That’s is another complicating factor for understanding how prevalent fussy eating is (4,5). How can researchers find out how many fussy eaters there are in a population if they have trouble even defining what makes a child to be characterised as a fussy eater in the first place? For example, from the 7-12 year-olds Chinese I mentioned before, 59% were found to be characterised as such, but the category was inflated by the inclusion of children who were ‘somewhat fussy’ as well as those who were ‘always fussy’ (4).

Anyways… Many definitions published in research share the same terms in this one:

"An avoidant eater often refuses new foods and only accepts a limited range of foods."

It is important to highlight the word OFTEN here, meaning “always fussy”.

And the most common signs of avoidant eating are;

So, there you have some guidance to spot children who may need some extra support to get out of the vicious cycle of avoidant eating.

Early childhood is when eating habits are formed (6) and it’s problematic when adults – parents, guardians and educators – aren’t properly prepared to deal with this behaviour. Depending on how the adults respond to the child’s challenging eating behaviour, this phase can last for longer than it would naturally last and can even endure for life. The longer it lasts, the more difficult it will be to be changed. (4,7)

Education is key here. We must understand what’s going on so we can find the best way to support each child in our care. And there are so many opportunities to support children’s food education in the early years learning environment. It’s up to us, educators, to spot those opportunities and make the most of them.