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New research gives proven strategies for overcoming fussy eating click to tweet Twitter

Do you know a parent struggling with a fussy eater? New research gives us really solid evidence on strategies that help to promote more enjoyment and less fussiness. It seems that a combination of mealtime structure and responsive feeding practices are the keys to help children enjoy food more and be less fussy about food.

What are responsive feeding practices?

Many people are familiar with the concept introduced by child feeding expert, Ellyn Satter, known as the Division of Responsibility, summed up by the slogan, “Parents Provide, Children Decide.” Basically, what this means is that it is the parent’s job to provide children with a variety of foods. The choice of whether to eat or how much to eat is up to the child.

It’s easy to let a child choose when you have a child who is interested in food and eats well. But it’s tempting to interfere when you have a child who doesn’t seem as interested in food.

When the parent lets the child choose, it allows the child to maintain their internal regulation of hunger and satiety cues. This style of feeding is known as responsive feeding.

What are non-responsive feeding practices?

If the parent interferes by cajoling, coercing, praising, encouraging, restricting or using rewards, it undermines the child’s ability to self-regulate. It shifts the cues around eating away from internal hunger cues and to cues such as a clean plate. It can lead to overeating or undereating—exactly opposite to what the parent is trying to do. These types of practices are known as non-responsive practices, as they are not responding to the child’s hunger and satiety cues.

Addressing nutrition professionals at a recent seminar, Australian researcher Elena Jansen comments that parents use non-responsive feeding practices such as restricting food or rewarding eating with the best of intentions. Parents are hoping to promote healthy eating and balanced intake, but evidence from multiple sources has shown this leads to more fussiness and unhealthy outcomes.3–8 

Four key strategies for responsive feeding practices

A group of researchers in Queensland, Australia has been studying child feeding practices for many years. The NOURISH randomized controlled trial conducted by this group showed that teaching new parents to use four key strategies led to more responsive feeding practices, meaning parents were more able to pay attention to when a child was hungry and to identify when they were full.1 The four key strategies were:

  • Be responsive to a child's hunger and satiety cues. If a child indicates they are full, stop. There is no need to bribe ("If you try your broccoli, you can get dessert"). 
  • Avoid feeding a child for other reasons than hunger (e.g. to distract a child, to appease sadness or to reward good behaviour).
  • Show a neutral response to eating or food refusal. Don't coerce ("Just take one more bite") or praise eating ("You're such a big boy, eating all your peas!").
  • Use structured choice. In other words, you decide what will be available.

Mealtime structure

In addition to the Division of Responsibility, child feeding expert Ellyn Satter talks about the Trust Model. The Trust Model says that as well as the division of responsibility, there needs to be mealtime structure. This includes:

  • Providing a routine in terms of time and place for meals (e.g. be at home for dinner at 6:00).
  • Limiting distractions such as TV or tablets.
  • Having the expectation that the family will eat together at the table.

The presence of structure and consistency is thought to help children pay attention to their hunger and satiety cues. The combination of providing mealtime structure and using responsive feeding practices is thought to promote healthy eating patterns.

New research: Mealtime structure and its effect on eating 

There is very little evidence about the effect of mealtime structure on eating behaviour other than the anecdotal experience of child feeding experts. In new research, the Queensland, Australia researchers looked at the interrelationship between feeding practices and mealtime structure and how that affects the eating behaviour of children.2 Parents of children aged 1–10 were surveyed. Eight practices were measured, representing aspects of mealtime structure and feeding practices including both responsive practices and non-responsive practices such as bribing. Examples of the items used in the questionnaire are:

  • My child eats main meals with the rest of the family.
  • My child sits down when having meals.
  • I decide the times when my child eats his/her meals.
  • I use desserts as a bribe to get my child to eat his/her main course.
  • I praise my child if (s)he eats what I give him/her.

Parents were also asked about how fussy their child was and how much they enjoyed food.

The researchers learned that there was a statistically significant, consistent relationship between mealtime structure and enjoyment of food. The more structure there was at mealtime, the more children enjoyed their food. And further, the less structure at mealtime, the fussier children were.

The researchers concluded, if structured mealtimes lead to less fussiness and more enjoyment of food by the child, this can benefit the whole family since they can all enjoy having their meals together.

Author’s note: I found this to be very powerful research—solid evidence to back up what practitioners have been promoting. In some families, it can take quite a bit of effort to overcome mealtime fussiness and picky eating, so it’s good to know there’s evidence the strategies work. There is a huge pay-off when meals can become pleasurable for everyone. It makes it much easier to continue to have regular family meals…and we know there are huge benefits to eating together more often.

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References
  1. Daniels, LA, Mallan KM, Nicholson JM et al. Outcomes of an early feeding practices intervention to prevent childhood obesity. Pediatrics. 2013; 131: 109-118.

  2. Finnane JM, Jansen E, Mallan K, Daniels L. Mealtime structure and responsive feeding practices are associated with less food fussiness and more food enjoyment in children. J Nutr Educ Behav. 2017; 49: 11-18.

  3. Black, M.M. and Aboud, F.E. Responsive feeding is embedded in a theoretical framework of responsive parenting. J Nutr. 2011; 141: 490–494.

  4. Birch, L.L., Marlin, D.W., and Rotter, J. Eating as the “means” activity in a contingency: effects on young children's food preference. Child Dev. 1984: 431–439.

  5. Carnell, S., Benson, L., Driggin, E., and Kolbe, L. Parent feeding behavior and child appetite: associations depend on feeding style. Int J Eat Disorder. 2014; 47: 705–709.

  6. DiSantis, K., Hodges, E.A., Johnson, S., and Fisher, J.O. The role of responsive feeding in overweight during infancy and toddlerhood: a systematic review. Int J Obes. 2011; 35: 480–492.

  7. Faith, M.S., Scanlon, K.S., Birch, L.L., Francis, L.A., and Sherry, B. Parent–child feeding strategies and their relationships to child eating and weight status. Obes Res. 2004; 12: 1711–1722.

  8. Gregory, J.E., Paxton, S.J., and Brozovic, A.M. Pressure to eat and restriction are associated with child eating behaviours and maternal concern about child weight, but not child body mass index, in 2- to 4-year-old children. Appetite. 2010; 54: 550–556.

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