Childhood picky eating habits persist into adulthood, impacting dietary choices

Picky eating is a common though unwanted behavior among children. However, little is known about its impact on long-term eating patterns and growth in later life. A new study published in the journal Appetite looked at these aspects using associations over time.

Study: Association of picky eating around age 4 with dietary intake and weight status in early adulthood: A 14-year follow-up based on the KOALA birth cohort study. Image Credit: kwanchai.c / Shutterstock


Children’s healthy development depends on their proper nutrition. It promotes appropriate weight gain and immunological development, preventing several chronic diseases.

Picky eating is a common childhood challenge that prevents good nutrition. Also called fussy eating, it is characterized by refusing to eat certain foods at any time, sticking to a limited food repertoire, unwillingness to try new foods (“food neophobia”), slow eating, experiencing lower pleasure from the act of eating, and greater satiety for a given level of food intake.

The causes or underlying factors range from those which are inherent to the child or parent or which pertain to their interactions. However, the impact of picky eating is seen in food intake, especially concerning lower levels of fruits, vegetables, whole grains, and proteins. Snacks usually form a more significant proportion of the diet compared to good eaters.

Deficiencies in minerals and vitamins, or constipation, are some of the effects of such restrictions in food intake. Fortunately, while over a quarter of two-year-olds are fussy eaters, this reduces by half at age six. Those who continue to be picky about their food are termed persistent picky eaters.

Some toddlers will be picky eaters only for a brief period of time, while others will persist as fussy eaters or become fussy later on in life. Some studies have shown remote impacts of picky eating in early childhood, such as a poorer diet, lower weight, and less growth in height, during adolescence.

The current study seeks to assess the long-term effects of picky eating on food intake and body mass index (BMI), in young adulthood.

The researchers used data from the Dutch KOALA Birth Cohort, a prospective longitudinal cohort study. KOALA represents the Dutch acronym for Child, Parents, and Health, Attention to Lifestyle, and Predisposition.

Parents in the study completed a questionnaire on the children’s health and behavior. The presence of picky eating at about four years of age (the range of assessment being 3-6 years) was confirmed from these questionnaires. The study included over 800 participants.

A follow-up questionnaire was sent out when the children were around 18 years old. This aimed to assess the frequency of food intake, weight, and height. The scientists then analyzed the data to identify associations between these factors and picky eating in early childhood.

What did the study show?

Most participants were female, more than 90% were Dutch, and more than 60% had a good educational background. At 4-5 years old, the study found an average picky eating score of 2.24. The score was based on three questions about picky eating, with the mean score for the highest-scoring question being 2.85.

Fried food intake was the lowest, at a mean of less than one day a week. Conversely, cooked vegetable intake scored almost five days a week. All snacks put together had a mean intake of over eight days a week or more than once a day.

With a one-point increase in the score, the individuals were found to eat less raw vegetables, or fruit, by 0.14 days less per week, as adults. Reduced intake of cooked vegetables was also associated with a one-point increase in the score by 0.21 days per week and dairy products by 0.23 days per week. Fish intake was reduced by 0.07 days per week.

The intake of other foods, including snacks, meat, eggs, and sweet drinks, did not show a significant association with picky eating as a four-year-old. This was also the case with the BMI as an adult.

What are the implications?

This is the first large prospective cohort study to look into the relationship between picky eating in young children and the frequency of intake of selected foods by the same cohort in young adulthood. Unlike earlier studies, it has a long follow-up period.

The study results indicate that long-term eating patterns are related to picky eating in young children. It thus extends the findings of a prior long-term study that showed such impacts on the intake of fruit, vegetables, and meat at 13 years, carrying observations forward to young adult life.

However, it did not confirm the earlier study in finding an association between meat intake in young adults and picky eating as children while observing new associations with reduced intake frequencies (days/week) of fish and dairy products.

Of course, food availability and choices vary between countries and cultures, accounting for discrepancies between cross-sectional studies. Measurement methods also differ between studies. Standardized data collection norms are required to ensure comparability in this research area.

More research is also necessary to identify associations with gross variations in BMI of adults who were picky eaters as children.

Despite the preliminary nature of these findings, the researchers emphasize the need to correct picky eating behavior early in life, as far as possible, to promote healthy nutrition throughout childhood and adulthood.

Such interventions should address not only the child’s eating behavior but also parental eating problems, which often underlie similar issues in children. They should also embrace support for parents who struggle with feeding picky eaters.

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