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PURPOSE: Picky eating is related to the lack of consumption in food variety by children when shown different foods (Wolstenholme et al., 2020). A 2015 study reported that almost half of children experience a period of picky eating at some point during early childhood, including almost 15% of children for whom picky eating does not resolve by age 6 (Cardona et al., 2015). The purpose of this systematic review is to identify interventions within the scope of occupational therapy that increase food acceptance in children under the age of seven years who demonstrate picky eating characteristics and who have no underlying health conditions.
DESIGN: This systematic review included articles relevant to children under the age of 7 with no underlying health conditions, addressed unfamiliar food introductions or picky eating interventions, and assessed food consumption and variety. Level I evidence published in 2012 to 2023 in peer-reviewed journals was included.
METHOD: We reviewed the title and abstract of 738 articles from four different literature databases; each title and abstract was reviewed by two researchers to build consensus about which articles would be considered for full-text review. Then we reviewed the full text of 102 articles that appeared to meet or might meet the study’s inclusion criteria, all of which were reviewed by at least two researchers. Twelve articles met the inclusion criteria of this study. We used the U.S. Preventive Services Task Force levels of certainty and grade definition to describe the strength of evidence across these 12 studies.
RESULTS: We categorized articles into three different themes: taste exposure, nutrition education, and flavor change. Nine articles provided strong support for occupation-based interventions involving taste exposure for improving food acceptance and variety. These interventions consisted of screen-based modeling, offering unfamiliar food at snack times, making the foods into small pieces to eat, and using rewards or praise. There was moderate evidence supporting nutrition education and flavor change; these interventions included picture books, school based nutritional education, flavor change of vegetables, and changing the form of vegetables, respectively.
CONCLUSION: Overall, this systematic review identifies several strategies within the scope of occupational therapy practice that may improve food consumption and variety in picky eaters aged seven and under. Eating is a chief activity of daily living and essential to life, and occupational therapy services can address picky eating by using interventions tailored to the individual. Occupational therapy practitioners can use taste exposure to effectively increase food consumption. Since there is moderate evidence to support interventions involving nutrition education and flavor change, practitioners should consider recommending these interventions on a routine basis. Future research could refine protocols’ intervention activities, frequency, and duration.
Cardona Cano, S., Tiemeier, H., Van Hoeken, D., Tharner, A., Jaddoe, V. W., Hofman, A., Verhulst, F. C., & Hoek, H. W. (2015). Trajectories of picky eating during childhood: A general population study. The International Journal of Eating Disorders, 48(6), 570–579. https://doi.org/10.1002/eat.22384
Wolstenholme, H., Kelly, C., Hennessy, M., & Heary, C. (2020). Childhood fussy/picky eating behaviours: A systematic review and synthesis of qualitative studies. International Journal of Behavioral Nutrition and Physical Activity, 17(2), p.1-2. [CJ1] [JL2] https://doi.org/10.1186/s12966-019-0899-x
Picky eating, children, food acceptance, occupational therapy
Jacobsen, Savannah L.; Cox, Josie; Bos, Alli; Ferguson, Cherokee; Smallfield, Stacey; and Whitlow, Molly, "Effective Occupational Therapy Interventions to Decrease Picky Eating in Children: A Systematic Review" (2022). Student Systematic Reviews: Occupational Therapy. 5.