Journal List > J Nutr Health > v.46(5) > 1081308

J Nutr Health. 2013 Oct;46(5):418-426. Korean.
Published online October 31, 2013.
© 2013 The Korean Nutrition Society
Association between picky eating behaviors and growth in preschool children
Jae Eun Shim,1 Ji Hyun Yoon,2,3 Kijoon Kim,2,4 and Hee Young Paik2,3
1Department of Food and Nutrition, Daejeon University, Daejeon 300-716, Korea.
2Department of Food and Nutrition, Seoul National University, Seoul 151-742, Korea.
3Research Institute of Human Ecology, Seoul National University, Seoul 151-742, Korea.
4BOM Research Institute, Seoul National University, Seoul 151-742, Korea.

To whom correspondence should be addressed. (Email: )
Received August 20, 2013; Revised September 09, 2013; Accepted October 08, 2013.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


This study was conducted in order to investigate the association between picky eating behaviors of preschool children and growth outcomes. In this study, picky eating behaviors were defined as containing four constructs of 'eating a small amount (ES),' 'neophoic behavior (NB),' 'refusal of specific food groups (RF),' and 'preference for specific food-preparation methods (PP).' A 7-point scale was used for the multi-item questionnaire, which consisted of 21 items (three items for ES, two items for NB, nine items for RF, and seven items for PP), in order to evaluate picky eating behaviors of children. Subjects were recruited among visitors at a medical clinic in Seoul. A total of 150 self-administered survey responses from parents of preschool children were analyzed in order to investigate the association between picky eating behaviors of preschool children and growth outcomes. Height for age (HFA) and weight for height (WFH) z-scores were used for assessment of preschool children's growth. The prevalence of ES, NB, RF, and PP was 44%, 57%, 73%, and 53%, respectively. Children with ES had lower HFA (p < 0.05) and WFH (p < 0.0001) than those without ES, while children with NB, RF, or PP had HFA and WFH were similar to their counterparts. The mean HFA z-score of children with ES was less than 0 (p < 0.05) and the mean WFH z-scores of children with ES, NB, RF, or PP were less than 0 (p < 0.05). According to the study results, related growth outcome differed depending on constructs of picky eating behaviors. In particular, picky eating of ES showed a risk of faltering height growth in preschool children. Further comprehensive studies on the reason for ES and intervention approach is warranted.

Keywords: picky eating; preschool children; growth faltering


Table 1
Concept and constructs of picky eating behavior and questions used to measure each construct
Click for larger image

Table 2
Selected characteristics of subjects (n = 150)
Click for larger image

Table 3
Mean scores of picky eating constructs and prevalence of picky eaters (n = 150)
Click for larger image

Table 4
Comparison of growth status between picky eaters and non-picky eaters (n = 150)
Click for larger image


This research was supported by a grant of Daejeon University in 2012.

1. WHO Multicentre Growth Reference Study Group. Assessment of differences in linear growth among populations in the WHO Multicentre Growth Reference Study. Acta Paediatr Suppl 2006;450:56–65.
2. Nicklas TA, Farris RP, Smoak CG, Frank GC, Srinivasan SR, Webber LS, Berenson GS. Dietary factors relate to cardiovascular risk factors in early life. Bogalusa Heart Study. Arteriosclerosis 1988;8(2):193–199.
3. Randall E, Marshall JR, Brasure J, Graham S. Dietary patterns and colon cancer in western New York. Nutr Cancer 1992;18(3):265–276.
4. Kelder SH, Perry CL, Klepp KI, Lytle LL. Longitudinal tracking of adolescent smoking, physical activity, and food choice behaviors. Am J Public Health 1994;84(7):1121–1126.
5. Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 1998;338(23):1650–1656.
6. Lichtenstein AH, Kennedy E, Barrier P, Danford D, Ernst ND, Grundy SM, Leveille GA, Van Horn L, Williams CL, Booth SL. Dietary fat consumption and health. Nutr Rev 1998;56(5 Pt 2):S3–S19.
7. Lien N, Lytle LA, Klepp KI. Stability in consumption of fruit, vegetables, and sugary foods in a cohort from age 14 to age 21. Prev Med 2001;33(3):217–226.
8. Skinner JD, Carruth BR, Bounds W, Ziegler PJ. Children's food preferences: a longitudinal analysis. J Am Diet Assoc 2002;102(11):1638–1647.
9. Anzman SL, Rollins BY, Birch LL. Parental influence on children's early eating environments and obesity risk: implications for prevention. Int J Obes (Lond) 2010;34(7):1116–1124.
10. Carruth BR, Ziegler PJ, Gordon A, Barr SI. Prevalence of picky eaters among infants and toddlers and their caregivers' decisions about offering a new food. J Am Diet Assoc 2004;104 1 Suppl 1:s57–s64.
11. Jacobi C, Schmitz G, Agras WS. Is picky eating an eating disorder? Int J Eat Disord 2008;41(7):626–634.
12. Carruth BR, Skinner J, Houck K, Moran J 3rd, Coletta F, Ott D. The phenomenon of "picky eater": a behavioral marker in eating patterns of toddlers. J Am Coll Nutr 1998;17(2):180–186.
13. Carruth BR, Skinner JD. Revisiting the picky eater phenomenon: neophobic behaviors of young children. J Am Coll Nutr 2000;19(6):771–780.
14. Lewinsohn PM, Holm-Denoma JM, Gau JM, Joiner TE Jr, Striegel-Moore R, Bear P, Lamoureux B. Problematic eating and feeding behaviors of 36-month-old children. Int J Eat Disord 2005;38(3):208–219.
15. Wardle J, Guthrie CA, Sanderson S, Rapoport L. Development of the children's eating behaviour questionnaire. J Child Psychol Psychiatry 2001;42(7):963–970.
16. Cooke L, Wardle J, Gibson EL. Relationship between parental report of food neophobia and everyday food consumption in 2-6-year-old children. Appetite 2003;41(2):205–206.
17. Steyn NP, Nel JH, 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(5):644–650.
18. Wright CM, Parkinson KN, Shipton D, Drewett RF. How do toddler eating problems relate to their eating behavior, food preferences, and growth? Pediatrics 2007;120(4):e1069–e1075.
19. Davies WH, Ackerman LK, Davies CM, Vannatta K, Noll RB. About your child's eating: factor structure and psychometric properties of a feeding relationship measure. Eat Behav 2007;8(4):457–463.
20. Shim JE, Kim J, Mathai RA. STRONG Kids Research Team. Associations of infant feeding practices and picky eating behaviors of preschool children. J Am Diet Assoc 2011;111(9):1363–1368.
21. Goulet O. Growth faltering: setting the scene. Eur J Clin Nutr 2010;64 Suppl 1:S2–S4.
22. Corvalán C, Kain J, Weisstaub G, Uauy R. Impact of growth patterns and early diet on obesity and cardiovascular risk factors in young children from developing countries. Proc Nutr Soc 2009;68(3):327–337.
23. Dubois L, Farmer AP, Girard M, Peterson K. Preschool children's eating behaviours are related to dietary adequacy and body weight. Eur J Clin Nutr 2007;61(7):846–855.
24. Galloway AT, Fiorito L, Lee Y, Birch LL. Parental pressure, dietary patterns, and weight status among girls who are "picky eaters". J Am Diet Assoc 2005;105(4):541–548.
25. Oh YJ, Chang YK. Children's unbalanced diet and parents' attitudes. Korean J Nutr 2006;39(2):184–191.
26. Kim Y, Han YS, Chung SJ, Lee Y, Lee SI, Choi H. Characteristics of infants' temperaments and eating behaviors, mothers' eating behaviors and feeding practices in poor eating infants. Korean J Community Nutr 2006;11(4):449–458.
27. Galloway AT, Fiorito LM, Francis LA, Birch LL. 'Finish your soup': counterproductive effects of pressuring children to eat on intake and affect. Appetite 2006;46(3):318–323.
28. Ogden J, Reynolds R, Smith A. Expanding the concept of parental control: a role for overt and covert control in children's snacking behaviour? Appetite 2006;47(1):100–106.
29. Newman J, Taylor A. Effect of a means-end contingency on young children's food preferences. J Exp Child Psychol 1992;53(2):200–216.
30. Birch LL, Marlin DW, Rotter J. Eating as the "means" activity in a contingency: effects on young children's food preference. Child Dev 1984;55(2):431–439.
31. Birch LL, Marlin DW. I don't like it; I never tried it: effects of exposure on two-year-old children's food preferences. Appetite 1982;3(4):353–360.
32. Bante H, Elliott M, Harrod A, Haire-Joshu D. The use of inappropriate feeding practices by rural parents and their effect on preschoolers' fruit and vegetable preferences and intake. J Nutr Educ Behav 2008;40(1):28–33.
33. Dovey TM, Staples PA, Gibson EL, Halford JC. Food neophobia and 'picky/fussy' eating in children: a review. Appetite 2008;50(2-3):181–193.