by Anne Eglash MD, IBCLC, FABM
Does breastfeeding prevent childhood picky eating behavior? Intuitively it makes sense that a breastfed infant would accept a wider variety of complementary foods, because many flavors of the foods in mothers’ diet are present in breastmilk. According to authors of The Generation R study, a large study of 4779 Dutch breastfeeding dyads, many small studies have shown a relationship between breastfeeding and higher acceptance of fruits and vegetables, but larger studies with fewer confounders have not found a relationship between breastfeeding and fussy eating.
The Generation R study investigated the relationship between the duration of breastfeeding and food pickiness at 4 years of age. They also studied the effect of age at introduction of complementary foods and food pickiness. The investigators controlled for a wide variety of parental psychiatric, socioeconomic and ethnic factors, as well as several infant health and behavioral factors.
What do you think the authors found regarding the duration of breastfeeding, timing of introduction of complementary foods, and food pickiness at 4 years of age? (choose 1 or more)
- They found no difference in picky eating behavior among 4 year olds who were never-breastfed vs those exclusively breastfed for 6 months.
- Children who were introduced to vegetables before 6 months were less likely to be picky eaters in comparison with children introduced to vegetables after 6 months.
- Infants breastfed for 2 years were much less likely to be picky eaters at 4 years of age compared to infants never breastfed.
- Children introduced to complementary foods at 6 months or beyond were less picky eaters at 4 years of age compared to those given complementary foods before 6 months.
See the Answer
The answers are A and B
Appetite. 2017 Apr 8;114:374-381
Infant feeding and child fussy eating: The Generation R Study
de Barse LM, Jansen PW, Edelson-Fries LR, Jaddoe VWV, Franco OH, Tiemeier H, Steenweg-de Graaff J.
Fussy/picky eating - i.e. consistently avoiding certain foods - is common in childhood and can be worrisome for parents. Repeated exposure to various flavors as occurs in breastmilk and early exposure to complementary feeding may increase food acceptance and thereby decrease fussy eating. This study examines the associations between infant feeding and child fussy eating in 4779 participants of Generation R, a Dutch population-based cohort. Breastfeeding initiation and continuation, and timing of complementary feeding were assessed by questionnaires at 2, 6, and 12 months. The food fussiness scale of the Children's Eating Behaviour Questionnaire was administered at 4 years. Linear regression analyses were performed, adjusted for confounders. Children who were never breastfed did not differ in fussy eating frequency from children breastfed for 6 months or longer. However, children who were breastfed for less than 2 months had a 0.70 points higher food fussiness sum-score (95%CI:0.27; 1.12) than children breastfed for 6 months or longer. An earlier introduction of vegetables was associated with less fussy eating behavior (p-for-trend:0.005). Particularly children who were introduced to vegetables between 4 and 5 months had a 0.60 point lower food fussiness score (95%CI: 1.06;-0.15) than children introduced to vegetables after 6 months. An early introduction to fruits or any solids was not significantly related to fussy eating, although the effect estimates were in the same direction as for introducing vegetables early. Results suggest that breastfeeding does not predict fussy eating. However, introducing vegetables into a child's diet before 5 months might be protective against fussy eating, although future research should account for parents' own fussy eating.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
Well, now I feel validated. My 2 children were breastfed, and they ate a wide variety of nutritious foods until about 2 years of age. Suddenly tofu, whole wheat bread, black beans, shrimp, and sweet potatoes went out the window, while crustless white bread, plain spaghetti noodles, and grated cheese were in demand. Super frustrating! Picky eating is right up there with waking up at night and biting as annoying and stress-inducing behaviors that families in my practice deal with. So why does this happen? The authors in this study surmise that perhaps picky eating is familial, a genetic tendency. They didn’t share any other hypothesis on these findings. I have to admit that I was horrified by any foods with color, other than Cheetos, when I was a little girl.
The other interesting result in this study was the decreased risk of food pickiness at 4 years of age among infants introduced to vegetables at 4-5 months of age, in comparison with vegetable introduction after 6 months of age. The authors discuss an existing theory that there may be a sensitive time for ‘food learning’, particularly for vegetables. Evolutionarily, infants need to learn at an early age what plants are safe to eat. So if introduced later, perhaps it is harder to accept them. Alternatively, perhaps earlier exposure to vegetables means more frequent exposure to vegetables. Some studies have shown that increasing the number of exposures to vegetables increases their acceptance rate.
What to do? Right now the recommendation from most health professional groups and the World Health Organization is to introduce complementary foods at 6 months. Perhaps the lesson here is to not delay solids much past 6 months, get up to speed with 3 meals a day by 7 months, and offer vegetables and fruits at each meal on a daily basis. If that does not work, ask the parents if they were picky eaters when they were little. If so, have them recall their personal journeys to healthier eating, and employ those tactics with their kid. And remind them that their child too will survive!