Toddler Development and the feeding challenges it can create

The development of food preferences goes through three stages; the first stage is a time of relatively easy acceptance, the second stage is one of rejection based on the way that foods look, the third stage is one of rejection based on what the child thinks about the food. Toddler eating behaviour is therefore the result of an interaction between these three developmental stages and the eating environment to which the child is exposed.

Stage 1
In the first stage, which occurs in the first year of life, the infant should be exposed to foods that are being eaten by their family. Infants are born with a liking for a sweet taste, but all other taste preferences, sour, salt, bitter, and their combinations, have to be learned¹. The bitter taste is the most difficult taste to get the infant to accept, because this taste is usually associated with toxicity. There is also a genetic difference in the extent to which we can taste a bitter food; this starts in childhood, some infants will react more strongly to the bitter taste than others².

The infant only learns a preference for foods because those are the foods that are given. Wherever the infant is born, whatever foods are available in that culture, the infant can learn to like them³. There is no evidence to suggest that infants prefer bland tasting foods. They might accept rice mixed with milk but that is because they are used to the taste of milk! And they might make funny faces when new stronger tastes are introduced, but they usually get used to these tastes with continued exposure. The more different tastes that are given during the period of early introduction, the more likely an infant is to try new foods when they are offered ⁴. Therefore, the more home-prepared fruit and vegetables that an infant is offered, then the more fruit and vegetables s/he will eat in later childhood⁵.

Firstly, infants get used to tastes and later in the first year, they get used to different textures. By the end of the first year, they have learned to recognize the food that they are usually given: the taste, the smell, the texture, and most importantly the way that the food looks⁶. This first stage of food acceptance is one of learning to like what is available, or made available, by means of exposure.

This stage is completed by the end of the first year. By the end of the second year, children’s food preferences become relatively fixed. They tend not to change their food preferences between the ages of 2 and 8 years⁷.

How can this part of the process go wrong?

• Instead of giving the foods that they want their children to eat when they are older, parents might restrict their children to a diet of specially prepared baby food and nothing else.

• If parents want their children to eat vegetables for example, when they are older, then they need to start to introduce these in the first year, so that the infant gets used to the taste and the way that they look. If parents leave these foods and try to introduce them into the toddler diet later, then this will be difficult. This will be especially difficult when the food is an unusual colour (few foods that we give to infants are green) and an unusual taste (few foods that we give to children are bitter - and yet some very good vegetables like broccoli are both green and bitter).

• Infants might miss out on the sensitive periods for the introduction of tastes and more solid textures. Different tastes need to be introduced by at least 6 months, or as soon as possible thereafter. Solid finger foods need to be introduced from 7 months, so that the infant experiences different textures in the first year. When introducing the more solid foods, infants are more able to cope with bite and dissolve texture to begin with –lumpy foods that break down in the saliva. They can then gradually progress to more difficult textures that need moving around in the mouth, or chewing.

Infants that are delayed will have missed out on a period of relatively easy acceptance. The later that solid foods are introduced then, in general, the more difficult it becomes, and the more problems the infant will have in learning the tongue movements necessary to control the food in the mouth ^{8, 9}.


Action points:
Get a good range of tastes in from the introduction of the first foods.
Encourage parents to introduce a range of different coloured foods - green, red, yellow.
Encourage parents to let their children experiment with food of different textures, both to hold and feed themselves with.
Make sure that parents know infants have to get used to the taste of new foods and may be wary at first.

Stage 2
The second stage begins at around 12 months. At this age, the neophobic response begins (fear of new foods)¹⁰. This stage of relative food refusal is thought to have evolutionary benefit: as the child becomes mobile, then they are less likely to put non-foods or poisonous foods in their mouths. The child knows which foods are strange or new because they don’t match the child’s visual image of the foods that they have learned to like. Foods that the child doesn’t recognize will begin to provoke a disgust response, which in some children can be very strong.

The neophobic response strengthens over this period and tends to peak at around 18 months. Parents will observe that children after this age will refuse foods on sight, and reject them without even tasting them. This response again, would be of evolutionary benefit, to aid survival. It is better to reject a food that could possibly be poisonous, on sight, and without tasting it. Those children who tasted new things more readily would have died out quite quickly!

Around about this age, children will reject foods if they are not an exact match for their image of a food that they know. They may also reject foods that they ate before if they are not an exact match to the way they expect them to be. So, biscuits will be rejected if they are broken and chips will be rejected if they are brown at the ends. It might seem that the child is being ‘fussy’, or flexing their ‘no’ muscles, but in fact they are just responding to a cognitive developmental stage. Each child has a group of accepted foods that they recognize and know that they have had before. Anything else is a non-food and will provoke a disgust response.

Of course, children do take new foods after this period, but they rely on slightly different rules to make choices and decisions. Food must be safe if others are eating it, so children will eat new foods if they see other people eat them.

They will copy adults in the first 18 months, and then, after this they increasingly copy the behaviour of other, slightly older, children¹¹.

Children also start to get verbal labels for foods and to make generalizations at this age. That is, they begin to accept food that is slightly different in the way it looks from the food that they originally ate. At 18 months a chocolate biscuit might have to be a chocolate digestive, whereas by 30 months, a chocolate chip cookie will do just as well!

Action points:

Encourage parents to eat healthily too! Their children will copy their eating patterns, so they need to set a good example.

Remember, each fruit or vegetable has to be introduced one at a time, so parents need to be reassured about this. A child won’t necessarily like one vegetable because they eat another, or like one presentation of a vegetable (mashed potato) because they eat it in another form (chips).

Stage 3
The third stage is one of showing disgust responses, and about showing rather odd and sudden rejections of food. Very little research has been carried out into why children suddenly refuse a previously accepted food, but we can come up with some ideas about why they might do it.

Many suggest that children refuse previously accepted foods to ‘challenge’ their parents, to establish autonomy and their right to choose, and this is likely to be a small part of the problem. But when we watch and listen to children as they refuse food, then we seem to get other reasons for the refusal.

Quite often the previously accepted food looks different at subsequent servings and parents say that the most frequently rejected foods are fruit and vegetables and mixed recipes (spaghetti bolognaise for example) – these foods are all likely to change in the way that they look from day-to day.

As children make and remake categories of accepted foods, so they also learn about how those foods relate to the world around them. They learn about which substances are disgusting and not meant to be eaten. And sometimes children see similarities between substances that disgust them and the food that they are eating. Pasta becomes “slimy”, and scrambled egg has “funny bits in”.

Children who are ‘sensory sensitive’ tend to make more of these judgements about food 12 and tend to have very strong disgust responses. This means that we can end up with a child that will eat nothing that is in a sauce, or that has mushrooms in it, or has eggs that are too runny, or fish that “smells horrible”. Parent’s strategies in dealing with these problems may not help. We know that parents need to support children in eating a wide range of foods, but if parents force children to eat a ‘disgust’ food then the disgust response will worsen.

Parents at this stage have to tread a fine line between modelling good eating to the child, and prompting good eating, but never forcing or coercing their child to eat a food that they don’t like. Similarly putting a food that the child doesn’t like on the plate next to a liked food means that the liked food becomes ‘contaminated’ by the other, and is likely to be rejected as well.

What can go wrong at this stage?

• Some children tend to be more ‘sensory sensitive’ than others. These children are more aware of differences in the way that food looks, tastes and smells. They also dislike getting their hands and face dirty and may have worries about changes in routine. They are more anxious children and such children will always be more difficult to wean onto a wide-ranging diet. This sensory sensitivity may appear when solid foods are first introduced - these children will have more difficulties with lumpy textured foods. Or the problem may first appear at around 18 months - the child’s diet might narrow and the child will insist on eating relatively few foods. The child might gag or vomit at the sight or smell of ‘disgust’ foods.

• Very rarely, and mainly with boys, a child’s diet will narrow at this time until only a few foods are accepted. Because the child is very sensory sensitive, and has problems making generalizations about food, the diet will remain very rigidly adhered to until late childhood¹³.

• Parents may try and force or coax a child to eat and make the problem of refusal worse.

Action points:
Remind parents never to force feed a child.
Reassure parents that some children are more neophobic and more sensory-sensitive than others. For these children getting enough calories in should be more important than a well-balanced diet, at this difficult toddler stage. If a child finds a food disgusting, give parents permission not to keep trying it Encourage parents not to keep giving the child disliked foods. This makes a child anxious and less likely to eat.
Encourage parents to let their children get messy from an early age when eating. Sensory sensitive children need messy play.

Some good tips for you to give to parents

‘To do’s’ for parents:

• Tell parents that foods that they want their child to eat should be introduced in the first year, and don’t have to be bland in taste.

• Parents should not totally rely on commercial baby food; they should get some home prepared food in when they can; parents will then be able to carry on with home prepared foods into the second year. Of course when home prepared foods are not routinely offered, or are unsuitable (pureed chips or pureed sweets have been offered by parents), then commercial baby food is a far better option.

• When giving finger foods suggest that the parents let the child handle, and hopefully try, different fruits and vegetables in their more or less complete form. Suggest whole strawberries, sprigs of broccoli, slices of tomato, and chunks of peach. In this way the child gets used to the texture of each food, and associates it with the colour of the food. To begin with, some textures might be easier than others, strawberries are a single texture, and tomatoes are a mix of textures. Suggest the single textured bright coloured foods to start with, try with the multiple textures when these are accepted.

Remind parents:

• To get different colours and different textures into the diet as soon as possible. To get different tastes in by at least six months, get the more solid textures in by at least nine months.

• That meals for toddlers should be small, mealtimes short, but frequent.

• Children copy adults, so parents must be eating a healthy diet too.

• Children will usually (but not always) widen their diet by copying other children who eat well, so suggest that parents take their children to playgroups and nurseries or to eat with relatives.

For parents of food refusers:

• Reassure parents that children are different, and some will be more reluctant to try new foods and more likely to reject known foods, than are others.

• Reassure parents at this stage that growth is more important than dietary balance. That the children are eating something is more important than what they eat.

• Reassure parents that very fussy eaters usually grow well, usually remain healthy, and get less fussy as they are older.

• Remind parents that these children are less likely to imitate other children eating and change their diet in that way, so nurseries and playgroups might not help here.

• Suggest the child is given frequent small meals. This reduces anxiety in child and parent. Leaving the child to get hungry in order to make them eat doesn’t work and may make the child lose weight.

• Prompt the child to eat, give them attention when they do eat, but remind parents not to force children to eat foods that they don’t want.

• Remind parents not to spend long periods trying to coax them to eat, mealtimes should be no longer than 20 minutes or so14.

• Suggest that parents don’t put disliked food on the plate next to liked food, it won’t work!

• Don’t encourage parents to waste time with a fussy child in food preparation, if they won’t eat it plain, they won’t eat it made into a clown’s face!

For more information visit:
The Infant and Toddler Forum website
www.littlepeoplespates.co.uk

References
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