Food neophobia in children

Food neophobia versus fussy eating

Food neophobia is defined as the attitude towards food which consists in reluctance to eat new foods and avoidance of trying un-known products [1–6]. This phenomenon belongs to the group of Avoidant/Restrictive Food Intake (ARFID) disorders, which belong to a wider group, i.e. sensory food aversions [1, 3, 7, 8]. The essence of neophobic behaviour is a clear, persistent reluctance, and some-times even fear of tasting new food and lack of openness to accept different than before tastes or unknown consistency and/or colour of food. This rejection may also apply to products previously eaten, which only look new when served in a different form than usual [1, 4–7]. The strong emotional reactions caused by exposure to unknown food and the fact that the treatment of these disorders is based on familiarization with the object causing anxiety confirm that food neophobia may be classified into a group of phobias [3, 7, 8].
Pickiness or fussiness (also referred to as a picky/fussy attitude) is an approach to eating that means rejecting food products not only when they are tasted for the first time, but also when they have been already known and accepted. In fussy children, more often not only the range of foods is much more limited, but also the amount of food consumed in general than in those that manifest neophobic behaviour [1, 3, 6, 7, 9–12]. Picky/fussy behaviour is most often temporary and is characteristic for children aged about 2–3 years. This phenomenon is a natural stage of development of children seeking a way to manifest their autonomy [1, 5–7, 9–11, 13]. The Pelchat and Pliner study indicated that neophobic behaviour may be partially contained in the picky/fussy attitude, whereas pickiness is not consid-ered a component of food neophobia, due to the fact that fussy children are not so resistant to learning new tastes, but are only generally reluctant to eat specific food [14].

Presumed pathomechanism of developing neophobic behaviours towards food

The mechanism determining the occurrence of food neophobia has not yet been fully recognised. This phenomenon is determined by the interaction of many complex factors, the most important of which are biological, psychological and environmental factors [2–7, 9, 11, 15–20].
Neophobic behaviour used to have an important adaptive function in the past. The tendency to avoid unknown products was a natural protection of omnivorous species against consuming poisonous food [1, 3, 7, 16, 21]. Negative experiences gained during exposure to new food products may be the cause of the strengthening of the inborn neophobic attitude. In children with high levels of food neophobia, a higher tendency to reject new kinds of food is often observed only on the basis of individual sensory perception of food-related stimuli - mainly by sight and smell, and to a lesser extent by touch – without an attempt to taste the food [4, 18, 22–27]. Then, a personal vision of how food products considered safe should look and smell is formed. Any deviation from this pattern results in an unwillingness to eat a given food [2–4, 7, 16, 18, 22–27]. This correlation has been confirmed in studies indicating that green veg-etables, due to their colour, are much more frequently rejected by children than orange or red fruits [28–30]. If the food is assessed as acceptable, it is possible to try it, and the experience gained in this way (perceived by the individual as positive or negative) shapes the attitude towards a particular product in the future [2–4, 7, 16, 27, 31].

Food neophobia determinants

On the basis of many scientific analyses, it can be assumed that food neophobia is a genetically determined condition. Numerous studies have also confirmed that a high level of neophobia in the mother was correlated with a higher neophobia of children, especially daughters [1, 3–6, 15, 32, 33]. However, in the majority of studies conducted so far, no differences in the prevalence of food neophobia diagnosis according to gender were observed [1, 7, 15].
The incidence of food neophobia is determined by age, and its development is considered the highest at 2–6 years of age [4, 7, 15, 34]. During puberty and adulthood, the risk of developing this attitude towards food significantly decreases, while in older age it increases again, which is explained by the fact that neophobic behaviours may potentially protect the weakened organism from possible poisoning due to old age [1, 7, 15]. The Kozioł-Kozakowska, Jagielski and Schlegel-Zawadzka studies analysing the prevalence of food neophobia in the population of Polish children at preschool age showed that this attitude is observed in one in ten children [35].
Another factor conditioning the attitude towards eating is personality. Numerous studies have shown a positive correlation be-tween high levels of food neophobia and low openness to experience, anxiety and neuroticism. It has been also observed, that there is a positive correlation between shyness and emotional instability in children and the intensity of neophobic behaviours towards food [1, 4, 7, 36].
One of the early mechanisms for adapting to human living conditions is an innate predilection for sweet and salty tastes and aversion to bitter and sour substances, which are perceived as a warning against potential poisoning. Sensitivity to bitter taste is genet-ically determined, and the intensity of its perception depends on the number of taste buds on the tongue. The level of acceptance of new food products in which this taste is predominant may therefore be to some extent determined by the individual degree of sensitivity to bitterness. This may potentially contribute to shaping the neophobic attitude towards specific types of food, especially those with a distinctly bitter taste [1, 4, 11, 18, 21, 32]. Many analyses have shown that vegetables are the most frequently rejected group of prod-ucts due to hypersensitivity to bitter taste [3, 7, 11, 32, 37].
Early taste experiments, both fetal and neonatal, may significantly affect later individual taste preferences. During the con-sumption of breast milk, the infant has the possibility to feel various tastes, depending on the type of food chosen by the mother. This contributes to a greater acceptance of new products introduced into the diet, especially in relation to food products that the mother regu-larly consumed during pregnancy and lactation. Children fed with modified milk tend to get used to a constant, specific taste of the mix-ture and, as a consequence, more often show reduced tolerance or even aversion during exposure to new types of food [4, 7, 11, 16, 20, 21, 27, 38–41]. One study by Mennella, Jagnoew and Beauchamp found that children whose mothers consumed carrot juice in the third trimester of pregnancy and/or during breastfeeding were more likely to eat carrot puree when it was being introduced into the diet in infancy compared to children of mothers who did not drink carrot juice during pregnancy and/or lactation [42]. Similar conclusions were presented in the Hepper [43] and Schaal, Marlier and Soussignan [44] studies. Attitude towards food depends on a child’s level of knowledge of a given product. Many studies have confirmed that children are much more likely to choose food in the future that they have ever had contact with and that they are familiar with to some extent [38–42]. In the Pliner and Stallberg-White study, it was ob-served that the addition of a favourite sauce to a new dish contributed to the fact that children tasted it more willingly than the same un-known dish without sauce [45].
The child’s reluctance to eat certain food products may also be conditioned by the late introduction of new products into the di-et. Openness to taste unknown flavours is highest in infants up to 12 months of age and decreases with age [7, 18, 20, 40, 46, 47]. Moreover, too fast resignation from continuing exposure to the new product after the initial negative reaction of the child may result in the necessity to eliminate this food from the daily diet. Many studies have shown that only about 10–15 positive experiences gained through numerous patient exposures to specific products may result in the acceptance of the product [16, 20, 32, 46, 47]. Many analyses also emphasized the role of sensory perception of new food as a method supporting the familiarization with the look, consistency and texture of unknown products, which in consequence may weaken the reluctance to eat them in future life [1, 7, 22, 23, 48–51].
The important role of caregivers in shaping proper eating habits in children has been confirmed in many scientific analyses [1–7, 11, 16, 17, 20, 31, 47, 52–67]. Children’s eating attitudes are shaped by observation and imitation of behaviours and reactions of the surrounding people [1, 3, 4, 7, 11, 13, 17, 20, 21, 31, 52]. Harper and Sanders’s study showed that children were much more likely to try an unknown food when at the same time their mothers also ate the product and reacted enthusiastically to it. This effect was stronger than in the case when the parent only verbally encouraged the child to try the food [53]. Similar conclusions were also drawn in other studies [54–57]. Van der Horst’s analysis showed, however, that the involvement of children in the meal preparation process can reduce the intensity of neophobic behaviors and contribute to building positive experiences with food [58]. In a study conducted among older children, it was also observed that the nutritional choices of children may be significantly influenced by their peers [32, 59–62].
Parent pressure, as well as forcing children to eat disliked foods and punishing them if they refuse to eat can result in increased reluctance to food. Many studies have confirmed that the more authoritative the parents are towards the child during a meal, the more often the child rejects the offered products [17, 32, 33, 52, 63–65]. It has been shown that when children are forced to eat food that they do not want, they start to feel anxiety and tension and their disgust with the product increases. This contributes to the development of negative associations related to the consumption of meals and leads to the exacerbation of neophobic behaviours [3, 4, 7, 11, 20, 31–33, 52, 57, 63–65]. This is consistent with the conclusions of the Rigal et al. study, which found that the difficulty of feeding children aged 20–36 months was mainly due to parents’ overauthoritarian coercive practices aimed at forcing the child to consume the rejected food. Interestingly, the authors also pointed out that a permissive feeding style in which the parents satisfy all the child’s wishes to avoid food conflicts does not increase the child’s willingness to try the product. However, it was emphasized, that it is not possible to indicate the occurrence of a cause and effect relationship in this area, because it is difficult to clearly define whether the parental style determines the child’s reaction during feeding, or whether the rejection of food by the child influences the occurrence of a specific behaviour in the parent [66].
It is also a common mistake for parents to impose their own taste preferences on their children, which manifests itself in re-fraining from giving children products that their caregivers do not like. This prevents the child from learning about various types of food and developing individual dietary preferences [3, 4, 7, 11, 17, 31, 40, 47, 52, 62, 67].

The potential impact of food neophobia on health

Neophobic behaviours significantly determine children’s eating habits, which has a significant impact on the quality of their diet in future life [1, 3, 6, 9, 10, 15, 19]. The health consequences of food neophobia are mainly related to the potentially lost benefits due to an imbalanced diet and reducing the consumption of groups of products rich in valuable nutrients [1, 3, 7, 9, 10, 19]. Proper nutrition in early childhood determines the optimal physical and mental development of children and contributes to the reduction of the risk of the occurrence of serious diet-related diseases in the future [1–3, 9, 16, 19].
The occurrence of neophobic behaviours in children with allergies, food intolerances, diabetes mellitus and other diseases re-quiring special dietary recommendations is also an important nutritional problem. The reluctance to try new products, which are an es-sential element of treatment, may exacerbate the course of the disease [1, 3].
On the basis of the analyses conducted so far, it is not possible to clearly determine the influence of food neophobia on the state of nutrition of children, however, in most studies there is no correlation between the occurrence of food neophobia and reduced body weight in children [68]. It is necessary to conduct further studies in this area in order to determine unambiguously the long-term effects of childhood food neophobia on human health in future life [7, 68].

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