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Table 4 Characteristics of original qualitative studies synthesised in this review

From: Childhood fussy/picky eating behaviours: a systematic review and synthesis of qualitative studies

StudyCountry and Author DisciplinesAge Group TargetedSample/PopulationAims/ObjectivesData Collection, Analysis, & Summary of Interview GuideQuality AppraisalaKey Findings Reported by Primary Study Authors
Study A
Rubio et al. 2017 [29]
18–38 months
38 parents (35 mothers, 3 fathers)
General community sample
Low-moderate income
Recruited through day care centres
To explore parental concerns about their toddler’s pickiness and its consequences for parent-child relationship and family meals.
To understand parental attributions of food pickiness and to investigate how parents manage their children’s food refusals.
Focus groups
Thematic analysis
Interview guide: Onset of child’s eating difficulties, parental perceptions and beliefs, parental strategies and food practices.
ModerateThe majority of parents report changes in food behaviours. Parents feel responsible. Picky eating causes parental anxiety and guilt. Attributions include opposition. Variety of different practices including repeated exposure, modelling and rewards for eating.
Study B
Goodell et al., 2017 [55]
Nutrition Sciences; Pediatrics; Human Development
3–5 years
111 primary caregivers (104 female, 6 male, 1 chose not to answer)
Low-income African American and Hispanic parents
Recruited from Head Start Centers
To determine parent feeding strategies used to influence child acceptance of previously rejected foods.Focus groups
Thematic analysis
Interview guide: Several topics relating to child feeding and mealtimes including: what strategies do parents use to influence their children to like previously rejected foods?
HighParents often do not serve previously rejected foods. Parents value their child eating over liking a food. Parents rarely use the same feeding strategy more than once for a previously rejected food. Parents wish to reduce waste, save time, and ensure children eat enough for adequate growth.
Study C
Jarman et al., 2015 [56]
Lifecourse Epidemiology; Nutrition Biomedical Research; Psychology; Musculoskeletal Biomedical Research
18 months – 5 years
29 mothers
Socially deprived area
Purposive sampling
To explore mothers’ use of overt and covert control practices (and relationship with neophobia). Specifically, what do mothers say about controlling their children’s eating habits?Mixed method
Focus groups
Thematic analysis
Interview guide: Not provided
HighFeeding young children is stressful. Parent control is often relinquished to reduce conflict at mealtimes.
Study D
Harris et al., 2018 [50]
Children’s Health; Exercise & Nutrition Science; Social Science
1–4 years
6 parents of children > 1 year (5 female, 1 male)
General sample, mix of low and high socio-economic status
To characterise parents’ presentation of fussy eating and mealtime interactions at a point of crisis.Calls to a help-line
Inductive thematic analysis
Interview guide: n/a
ModerateParents of toddlers present emotional accounts of feeding, portrayed their child’s eating behaviours as a battle and child agency over intake/variety as ‘bad’ or ‘wrong’. Escalating concern evoked non-responsive feeding practices.
Study E
Russell et al., 2013 [33]
Exercise & Nutrition Sciences
2–5 years
57 parents (49 female, 8 male)
General community sample recruited from a range of SES background
Purposefully selected from survey participants
To describe parents’ beliefs (attributions and self-efficacy) about the origins of children’s food preferences that may influence parental feeding behaviours. To examine differences between parents of children with healthy preferences, unhealthy preferences and neophobia.Interview
Content analysis
Interview guide: describe child’s likes and dislikes, influences of preferences, how much preferences change over time, how much influence parents have over child preferences.
ModerateAttributions of food preferences include child characteristics, sensory attributions, and socialisation experiences. Beliefs (and self-efficacy) differ between parents of children with healthy preferences, unhealthy preferences, and neophobia supporting the idea of causal links between parent beliefs, behaviours, and child characteristics.
Study F
Russell et al., 2015 [57]
Health; Exercise & Nutrition Sciences
Pre-schoolers 2–5 years57 parents (49 female, 8 male)
General community sample recruited from a range of SES background
Purposefully selected from survey participants
To describe behaviours used by parents to influence children’s food preferences. To examine differences between parents of children with healthy preferences, unhealthy preferences and neophobia.Interview
Content analysis
Interview guide: behaviours used to influence children’s preferences (likes and dislikes), whether methods were effective and why.
ModerateParents used diverse behaviours to influence their child’s food preferences. Parents of children with healthy preferences appeared to use more effective feeding behaviours. Parents of children with unhealthy and neophobic preferences appeared to use more ineffective behaviours.
Study G
Norton et al., 2016 [58]
Pre-schoolers 1–2.5 years24 parents (23 female, 1 male)
General community sample recruited from range of socio-economic areas
Snowball sampling and purposeful selection
To explore primary caregivers’ awareness of food neophobia and how food preferences develop in young children.Interview and projective technique drawings
Cross case analysis
Interview guide: history of child’s eating, foods that should be provided to a child on an everyday basis, other foods. Drawings of crying child in a trolley and child making a mess in a highchair.
ModeratePrimary caregivers are unaware of food neophobia and food preference development in young children.
Study H
Boquin et al., 2014 [35]
Food Science & Human Nutrition; Market Research
Children 18 months – 21 years19 parents (14 female, 5 male)
General sample
To investigate perceptions of picky eating. To determine the most predictive elements that people use to describe a picky eater.Mixed method
Focus groups
Analysis method described but not specified
Interview guide: describe mealtimes, picky eating perceptions, definitions and characterisations.
ModerateFussy eaters display before mealtime behaviours (being uninterested or avoidant), during mealtime behaviours (being disengaged, uninvolved, distracted, carefully inspecting food, having strong physical reactions to foods), general mealtime preferences, and food sensory-dependent preferences. Top two perceptions of picky eating: 1) unwilling to try new things, 2) consuming limited type and amount of food.
Study I
Trofholz et al., 2017 [34]
Family Medicine & Community Health
Children 2–18 years88 parents (83 female, 5 male)
Racially and ethnically diverse
Low-income sample
Recruited from previous study
How do parents describe child picky eating?
How do parents perceive picky eating to impact the family meal?
How do parents report responding to picky eating in the family meal?
Content analysis
Interview guide: what kind of eater child is, how eating impacts meal, how picky eating affects the family, what happens if child doesn’t want to eat what is prepared, how parents influence what child eats.
HighChildren are frequently described as picky eaters, parents define picky eating in a variety of ways, picky eating impacts the family meal (stress, meal preparation), parents respond in a variety of ways.
Study J
Berge et al., 2016 [36]
Family Medicine & Community Health; Human Development & Family Studies; Epidemiology & Community Health
Target children 6–12 years
Siblings 2–18 years
88 parents (83 female, 5 male)
Racially and ethnically diverse
Low-income sample
Recruited from previous study
How do parents describe their approach to feeding siblings? Do parents engage in different feeding practices based on child-specific characteristics (weight, picky eating, age, sex, temperament)?Interview
Content analysis
Interview guide: what it is like to be a parent of two (or more), how you decide what to feed your children, how do you feed them (similarly and differently), role as a parent during mealtimes, how you influence what siblings eat (child characteristics)?
HighFood preferences, in-the-moment decisions and planned meals influence decisions about what to feed siblings. Picky eating is managed by making one meal or by giving leeway to siblings about having other food options. Parents used different feeding practices.
  1. aJBI Critical Appraisal Checklist. Assessment is based on 10 items regarding congruity between authors’ philosophical perspective, methodology, methods, research question and data analysis, the interpretation of results, the influence of the researcher on the research, adequate representation of participant’s voices, ethics, and conclusions drawn from the analysis. Moderate indicates a score of 5–7. High indicates a score of 8–10