Associations of Infant Feeding Practices and Picky Eating Behaviors of Preschool Children


      Picky eating behaviors are prevalent during childhood and are often linked to nutritional problems. However, information on the determinants of picky eating behaviors during infancy, when food acceptance patterns develop, is scarce. This study was conducted to evaluate the impact of infant feeding practices on the development of picky eating behaviors during preschool years. Baseline survey data from the Synergistic Theory and Research on Obesity and Nutrition Group Kids (STRONG Kids) program were used for this retrospective data analysis. Primary caregiver-child dyads were recruited from child-care centers in Eastern Illinois between February and July of 2009. A total of 129 self-reported responses from mothers of preschool-aged children were analyzed. Logistic regression was used to evaluate the association between infant feeding practices and picky eating behaviors. Children who were introduced to complementary foods before 6 months of age had 2.5 times higher odds of developing food neophobia and limited variety of foods (95% confidence interval [CI]: 1.01 to 5.93 and 1.06 to 5.73, respectively). Children who were breastfed exclusively for 6 months had lower odds of developing a preference for specific food-preparation methods by 78% (95% CI: 19% to 94%), food rejection by 81% (95% CI: 31% to 94%), and food neophobia by 75% (95% CI: 11% to 93%). Breastfeeding and introduction of complementary foods after 6 months of age reduced the odds of picky eating during early childhood. This study documents an association between infant-feeding practices and the development of picky eating behaviors in early childhood.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Carruth B.R.
        • Ziegler P.J.
        • Gordon A.
        • Barr S.I.
        Prevalence of picky eaters among infants and toddlers and their caregivers' decisions about offering a new food.
        J Am Diet Assoc. 2004; 104: S57-S64
        • Carruth B.R.
        • Skinner J.
        • Houck K.
        • Moran 3rd, J.
        • Coletta F.
        • Ott D.
        The phenomenon of “picky eater”: A behavioral marker in eating patterns of toddlers.
        J Am Coll Nutr. 1998; 17: 180-186
        • Jacobi C.
        • Schmitz G.
        • Agras W.S.
        Is picky eating an eating disorder?.
        Int J Eat Disord. 2008; 41: 626-634
        • Dubois L.
        • Farmer A.P.
        • Girard M.
        • Peterson K.
        Preschool children's eating behaviours are related to dietary adequacy and body weight.
        Eur J Clin Nutr. 2007; 61: 846-855
        • Cooke L.
        • Wardle J.
        • Gibson E.L.
        Relationship between parental report of food neophobia and everyday food consumption in 2-6-year-old children.
        Appetite. 2003; 41: 205-206
        • Galloway A.T.
        • Fiorito L.
        • Lee Y.
        • Birch L.L.
        Parental pressure, dietary patterns, and weight status among girls who are “picky eaters.”.
        J Am Diet Assoc. 2005; 105: 541-548
        • Steyn N.P.
        • Nel J.H.
        • Nantel G.
        • Kennedy G.
        • Labadarios D.
        Food variety and dietary diversity scores in children: Are they good indicators of dietary adequacy?.
        Public Health Nutr. 2006; 9: 644-650
        • Wright C.M.
        • Parkinson K.N.
        • Shipton D.
        • Drewett R.F.
        How do toddler eating problems relate to their eating behavior, food preferences, and growth?.
        Pediatrics. 2007; 120: E1069-E1075
        • World Health Organization (WHO)
        Diet, Nutrition and Prevention of Chronic Diseases.
        WHO, Geneva, Switzerland2003 (WHO technical report series 916)
        • Kelder S.H.
        • Perry C.L.
        • Klepp K.I.
        • Lytle L.L.
        Longitudinal tracking of adolescent smoking, physical activity, and food choice behaviors.
        Am J Public Health. 1994; 84: 1121-1126
        • Li R.
        • Fein S.B.
        • Grummer-Strawn L.M.
        Association of breastfeeding intensity and bottle-emptying behaviors at early infancy with infants' risk for excess weight at late infancy.
        Pediatrics. 2008; 122: S77-S84
        • Lien N.
        • Lytle L.A.
        • Klepp K.I.
        Stability in consumption of fruit, vegetables, and sugary foods in a cohort from age 14 to age 21.
        Prev Med. 2001; 33: 217-226
        • Lytle L.A.
        • Seifert S.
        • Greenstein J.
        • McGovern P.
        How do children's eating patterns and food choices change over time?.
        Am J Health Promot. 2000; 14: 222-228
        • Birch L.L.
        Children's preferences for high-fat foods.
        Nutr Rev. 1992; 50: 249-255
        • Birch L.L.
        • McPhee L.
        • Shoba B.C.
        • Pirok E.
        • Steinberg L.
        What kind of exposure reduces children's food neophobia?.
        Appetite. 1987; 9: 171-178
        • Birch L.L.
        • Marlin D.W.
        I don't like it; I never tried it: Effects of exposure on two-year-old children's food preferences.
        Appetite. 1982; 3: 353-360
        • Pliner P.
        The effects of mere exposure on liking for edible substances.
        Appetite. 1982; 3: 283-290
        • Stark L.J.
        • Collins Jr, F.L.
        • Osnes P.G.
        • Stokes T.F.
        Using reinforcement and cueing to increase healthy snack food choices in preschoolers.
        J Appl Behav Anal. 1986; 19: 367-379
        • Kissileff H.R.
        Chance and necessity in ingestive behavior.
        Appetite. 1991; 17: 1-22
        • Scaglioni S.
        • Salvioni M.
        • Galimberti C.
        Influence of parental attitudes in the development of children eating behaviour.
        Br J Nutr. 2008; 99: S22-S25
        • Birch L.L.
        Development of food acceptance patterns in the first years of life.
        Proc Nutr Soc. 1998; 57: 617-624
        • Forestell C.A.
        • Mennella J.A.
        Early determinants of fruit and vegetable acceptance.
        Pediatrics. 2007; 120: 1247-1254
        • Mennella J.A.
        • Griffin C.E.
        • Beauchamp G.K.
        Flavor programming during infancy.
        Pediatrics. 2004; 113: 840-845
        • Mennella J.A.
        • Nicklaus S.
        • Jagolino A.L.
        • Yourshaw L.M.
        Variety is the spice of life: Strategies for promoting fruit and vegetable acceptance during infancy.
        Physiol Behav. 2008; 94: 29-38
        • Nicklas T.A.
        • Baranowski T.
        • Baranowski J.C.
        • Cullen K.
        • Rittenberry L.
        • Olvera N.
        Family and child-care provider influences on preschool children's fruit, juice, and vegetable consumption.
        Nutr Rev. 2001; 59: 224-235
        • Illingworth R.S.
        • Lister J.
        The critical or sensitive period, with special reference to certain feeding problems in infants and children.
        J Pediatr. 1964; 65: 839-848
        • Cashdan E.
        A sensitive period for learning about food.
        Human Nature. 1994; 5: 279-291
        • Mennella J.A.
        • Jagnow C.P.
        • Beauchamp G.K.
        Prenatal and postnatal flavor learning by human infants.
        Pediatrics. 2001; 107: E88
        • Galloway A.T.
        • Lee Y.
        • Birch L.L.
        Predictors and consequences of food neophobia and pickiness in young girls.
        J Am Diet Assoc. 2003; 103: 692-698
        • Cooke L.J.
        • Wardle J.
        • Gibson E.L.
        • Sapochnik M.
        • Sheiham A.
        • Lawson M.
        Demographic, familial and trait predictors of fruit and vegetable consumption by pre-school children.
        Public Health Nutr. 2004; 7: 295-302
        • Skinner J.D.
        • Carruth B.R.
        • Wendy B.
        • Ziegler P.J.
        Children's food preferences: A longitudinal analysis.
        J Am Diet Assoc. 2002; 102: 1638-1647
        • Savage J.S.
        • Fisher J.O.
        • Birch L.L.
        Parental influence on eating behavior: Conception to adolescence.
        J Law Med Ethics. 2007; 35: 22-34
        • Gartner L.M.
        • Morton J.
        • Lawrence R.A.
        • Naylor A.J.
        • O'Hare D.
        • Schanler R.J.
        • Eidelman A.I.
        • American Academy of Pediatrics Section on Breastfeeding
        Breastfeeding and the use of human milk.
        Pediatrics. 2005; 115: 496-506
      1. Breastfeeding Report Card-United States, 2009.
        (Updated September 13, 2010. Accessed March 9, 2011)
        • Grummer-Strawn L.M.
        • Scanlon K.S.
        • Fein S.B.
        Infant feeding and feeding transitions during the first year of life.
        Pediatrics. 2008; 122: S36-S42
        • Dovey T.M.
        • Staples P.A.
        • Gibson E.L.
        • Halford J.C.
        Food neophobia and ‘picky/fussy' eating in children: A review.
        Appetite. 2008; 50: 181-193
        • Rydell A.M.
        • Dahl M.
        • Sundelin C.
        Characteristics of school children who are choosy eaters.
        J Genet Psychol. 1995; 156: 217-229
        • Mennella J.A.
        • Beauchamp G.K.
        Flavor experiences during formula feeding are related to preferences during childhood.
        Early Hum Dev. 2002; 68: 71-82
        • Lewinsohn P.M.
        • Holm-Denoma J.M.
        • Gau J.M.
        • Joiner Jr, T.E.
        • Striegel-Moore R.
        • Bear P.
        • Lamoureux B.
        Problematic eating and feeding behaviors of 36-month-old children.
        Int J Eat Disord. 2005; 38: 208-219
        • Beauchamp G.K.
        • Mennella J.A.
        Early flavor learning and its impact on later feeding behavior.
        J Pediatr Gastroenterol Nutr. 2009; 48: S25-S30
        • Sullivan S.A.
        • Birch L.L.
        Infant dietary experience and acceptance of solid foods.
        Pediatrics. 1994; 93: 271-277
        • Kalat J.W.
        • Rozin P.
        “Learned safety” as a mechanism in long-delay taste-aversion learning in rats.
        J Comp Physiol Psychol. 1973; 83: 198-207
        • Ziol-Guest K.M.
        • Hernandez D.C.
        First- and second-trimester WIC participation is associated with lower rates of breastfeeding and early introduction of cow's milk during infancy.
        J Am Diet Assoc. 2010; 110: 702-709
        • Mattes R.D.
        Learned food aversions: A family study.
        Physiol Behav. 1991; 50: 499-504
        • Fortunato J.E.
        • Scheimann A.O.
        Protein-energy malnutrition and feeding refusal secondary to food allergies.
        Clin Pediatr (Phila). 2008; 47: 496-499
        • Birch L.L.
        Effects of experience on the modification of food acceptance patterns.
        Ann N Y Acad Sci. 1989; 561: 209-216
        • Nicklas T.A.
        • Baranowski T.
        • Baranowski J.C.
        • Cullen K.
        • Rittenberry L.
        • Olvera N.
        Family and child-care provider influences on preschool children's fruit, juice, and vegetable consumption.
        Nutr Rev. 2001; 59: 224-235
        • Birch L.L.
        • Ventura A.K.
        Preventing childhood obesity: What works?.
        Int J Obes (Lond). 2009; 33: S74-S81
        • Butte N.F.
        Impact of infant feeding practices on childhood obesity.
        J Nutr. 2009; 139: 412S-416S
        • Lande B.
        • Andersen L.F.
        • Henriksen T.
        • Baerug A.
        • Johansson L.
        • Trygg K.U.
        • Bjørneboe G.E.
        • Veierød M.B.
        Relations between high ponderal index at birth, feeding practices and body mass index in infancy.
        Eur J Clin Nutr. 2005; 59: 1241-1249
        • Islam M.M.
        • Khatun M.
        • Peerson J.M.
        • Ahmed T.
        • Mollah M.A.
        • Dewey K.G.
        • Brown K.H.
        Effects of energy density and feeding frequency of complementary foods on total daily energy intakes and consumption of breast milk by healthy breastfed Bangladeshi children.
        Am J Clin Nutr. 2008; 88: 84-94


      J. E. Shim is a research assistant professor, Research Institute of Human Ecology, Seoul National University, Seoul, Korea; at the time of the study, she was a visiting scholar at the Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL


      J. Kim is an assistant professor, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign


      R. A. Mathai is a doctoral student, Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Champaign