Concerns About Children’s Appetite and Eating Behavior

The appetite and eating behavior of children are among the most common concerns for parents. According to Rosaura Leis, a Pediatrics professor at the University of Santiago de Compostela (USC) and coordinator of the Committee on Nutrition and Breastfeeding of the Spanish Association of Pediatrics (AEP), it is one of the leading causes of consultation with pediatricians. As stated in the 2016 article “Lack of Appetite” published by the Spanish Association of Primary Care Pediatrics (AEPap), “eating well or poorly is a relative concept influenced by social norms, perceptions, and beliefs of different family members… Therefore, appetite and eating behavior of children are often a cause of concern for parents.”

This concern may be due to neophobia, “the rejection that some children present to ingest new foods, especially around the second year, when they are incorporated into the family table,” as described by Leis. The expert affirms that around 20-40% of parents report feeding difficulties with their children, little interest in food, slowness, and selectivity for certain foods. According to dietitian and nutritionist Elena Toledano, neophobia is a common phenomenon that usually constitutes a mild and transitory problem and has much in common with picky eating, which refers to choosy, selective children with little appetite. However, they are not the same.

Understanding Neophobia and Picky Eating

Neophobia, although not having a specific cause, is considered a normal physiological stage that children may go through at some point after weaning, typically peaking between two and six years of age, and diminishing around that age. “There is a very early link between neophobia and breastfeeding,” continues the nutritionist, “which serves as a learning gateway for the acquisition of a wide range of flavors previously ingested by the mother, which means it will help in the subsequent acceptance of new foods and preference for these flavors in weaning foods.”

During these early stages, children most frequently reject fruits, vegetables, and fish. The reason for this lies in the fact that children are predisposed to the sweet taste, while other tastes such as bitter or salty need to be learned, as pointed out by Leis. To teach them, the expert recommends introducing complementary feeding following the pediatrician’s advice, with a variety of foods and textures according to the infant’s development. In case the child rejects the presented flavors, Leis advises repeated exposure to those foods the child initially does not prefer, trying them in small amounts and in a relaxed, enjoyable atmosphere shared with the family: “Some flavors may need to be tried up to 9 or 10 times before they are liked. It’s not about forcing intake, but about having the food on the family table and trying it repeatedly.”

Encouraging Healthy Eating Habits

Toledano also suggests allowing children to experience their own feelings of hunger and fullness and, when possible, letting them eat on their own: “This helps them feel in control of what they are eating. Forcing children to eat foods they reject, as well as banning those we believe are not good, is not the solution in these cases, as the power struggle at the table upsets the child who is demanding when eating.” “Most children love carbohydrate-rich foods like rice, pasta, potatoes… It’s not negative that they love these foods, but that they end up displacing others,” Toledano continues. That’s why the dietitian recommends combining both food groups: “That is, serving vegetables with more energetic and protein-rich foods such as cereals, legumes, meats, fish, and eggs.”

All these ideas and recommendations are aimed at ensuring that nutrition is not solely focused on the idea of ingesting food. “It should be enjoyment and social interaction, and the child must be introduced to it, following the gastronomic and culinary traditions of their area,” explains Leis. “The family, parents and caregivers, and the school, along with the pediatrician, are going to play—and must play—an extremely important role in the acquisition of healthy lifestyles, in which nutrition is fundamental,” she adds.

When Eating Becomes a Disorder

Although neophobia is generally temporary, sometimes it can degenerate into a serious mental health problem. Leis cites the report “Avoidant or Restrictive Food Intake Disorder in Pediatrics: A Novel Diagnosis for a Frequent Entity in Clinical Practice,” published in 2020 in the journal Pediatric Integral, which states that 3% of children continue to have persistent feeding problems beyond the age of 6. “This leads to functional, social, and/or nutritional impact. In these cases, it is considered that the child has Avoidant or Restrictive Food Intake Disorder (ARFID), a disorder that is part of the diagnostic group of eating disorders (EDs),” points out the Pediatrics professor.

This condition poses a risk of nutritional deficiencies and/or low weight and psychosocial impact. “For its diagnosis, they must fail to meet nutritional and/or energy needs, as evidenced by significant weight loss,” Leis continues, “and/or deficiency of a nutrient, and/or need for nutritional supplements or special nutrition and/or interference with psychosocial integration.”