This study attempts to provide an overview of picky eating and feeding difficulties among children aged 1 to 10
years in Singapore and the impact on the children’s parents or caregivers. The study was conducted as a questionnaire survey among a representative sample of the Singapore population.
The spontaneous caregiver-reported prevalence of picky eating in this study was 49.2%, which is similar to that of 50% reported by Carruth et al in their cross-sectional survey [10
]. Other studies have found rates ranging from 17% in China to 29% in Canada [11
]. When exploring typical behaviours, 49.6% of respondents’ children exhibited at least one ‘picky eating’ or ‘feeding difficulty’ behaviour ‘all the time’.
The most common behaviours occurring ‘all the time’ were eating slowly or holding food in the mouth; refusing food, particularly fruit and vegetables; eating sweets and fatty foods instead of healthy foods; food neophobia; eating snacks instead of meals and accepting only a few types of food. Wright et al found that eating a limited variety and preferring drinks to food were the most prevalent problem behaviours [3
], while Jacobi et al. reported that picky eaters ate fewer foods and were more likely to avoid vegetables [5
]. Mascola et al found that picky eaters were more likely to consume a limited variety of foods, required food prepared in specific ways, expressed stronger likes and dislikes for food, and had tantrums when denied foods [2
]. Interestingly, in this study, respondents who reported that the child was not a picky eater were more likely to report picky eating behaviours of 'eating slowly' or 'eating sweets instead of healthy foods' (occurring 'all the time' and 'sometimes'). This possibly reflects greater cultural acceptance of these picky eating behaviours as normal in Singapore, thus overlooking potential consequences.
Although some studies have shown that picky eating does not affect health or weight gain [11
], two studies found that children with eating problems gained less weight than children without eating problems [3
]. Reduced intakes of energy, carbohydrate, fat and protein have been found to be evident among children with picky eating and feeding difficulties [15
], although most children with problem eating achieve normal growth [3
]. There was no evidence that the children in this study were smaller than expected for their age, but further study is needed to ascertain the impact of eating problems on childhood development.
In this study, the older age groups were more likely to be picky eaters. The mean duration of picky eating by age suggests that picky eating may be a persistent and chronic problem in childhood, as reported in the study by Mascola et al. [2
Picky eating caused the respondents considerable concern with nearly half being ‘very much concerned’; the concerns were predominantly about the child’s physical and mental health. This is in agreement with the study by Mascola et al that found that picky eating is of considerable parental concern [2
]. It is interesting to note that some of the respondents’ attitudes and perceptions towards child feeding (deciding what the child will eat, raising the voice, threatening the child and making the child eat even when not hungry) were significantly associated with the reported prevalence of ‘feeding difficulty’ behaviours. However, it is not clear whether the associations noted are the cause or the result of the mealtime behaviours.
One-third of respondents had other family members who were picky eaters, and those who perceived the child to be picky eaters tended to have a family history of picky eating. Most ‘picky eating’ and all ‘feeding difficulty’ behaviours appear to be significantly associated with respondents’ stress when feeding the child and with a negative impact on family relationships.
The respondents used a variety of coping strategies, including modifying the texture to make food easy to eat, allowing television viewing at mealtimes and presenting food in an age-appropriate manner (use of coloured cups or bottles). Other strategies cited involved consulting a doctor about the child’s eating habits, allowing a maid/caregiver to feed the child and giving the child milk in a bottle. Nearly one-third of respondents (29.2%) consulted a doctor about the problem of picky eating/feeding difficulty. Thus, clinic visits provide an opportunity for clinicians to assess the problem, provide support and guidance to parents, exclude any underlying pathology, and initiate appropriate management.
Study limitations and future research recommendations
While this study provides insight into the attitudes of parents with children who are picky eaters in Singapore, the study investigated their perceptions of picky eating and it’s impact on the child’s health and family relationships. All data were caregiver-reported, with no independent measurement of the children’s mealtime behaviours or caregivers’ stress. Further studies are needed to fully understand the regional and ethnic variations in attitudes and coping strategies, as well as the impact on the child, caregiver and other family members.