This is further compounded by a lack of longitudinal observational data, with most studies using only cross-sectional data. The causes and consequences of picky eating are not well understood because of these inconsistencies and because of heterogeneity in study designs. To add further complication, there are a variety of tools used for the assessment of picky eating and consequently, there is a wide range of prevalence reported ( Reference Taylor, Wernimont and Northstone 2 ). There is no agreement on a formal definition of picky eating, although it is generally accepted to include rejection or restriction of familiar foods and unfamiliar foods, and thus including an element of neophobia ( Reference Dovey, Staples and Gibson 3 ). It is largely a phenomenon of developed countries and involves a complex set of interactions between parents/carers and children centred around food selection and consumption ( Reference Dovey, Staples and Gibson 3 ). It can cause considerable stress to parents/caregivers and have a negative impact on family relationships ( Reference Goh and Jacob 1 ), but it generally resolves with minimal or no intervention by healthcare providers ( Reference Taylor, Wernimont and Northstone 2 ). Picky eating (alternatively known as fussy, faddy, choosy or selective eating) is a common behaviour in early childhood. Strategies for avoiding or ameliorating picky eating include repeated exposures to unfamiliar foods, parental modelling of eating fruit and vegetables and unfamiliar foods, and the creation of positive social experiences around mealtimes. There may be a small subgroup of children in whom picky eating does not resolve who might be at risk of thinness during adolescence, or of developing an eating disorder or adult picky eating: these children need to be identified at an early age to enable support, monitoring and advice to be offered to parents. There is little evidence, however, for a consistent effect of being a picky eater on growth trajectories. There may be developmental difficulties in some children with persistent picky eating. Low intakes of dietary fibre, as a result of low intakes of fruit and vegetables, are associated with constipation in picky eaters. The consequences for the child's diet include poor dietary variety and a possible distortion of nutrient intakes, with low intakes of iron and zinc (associated with low intakes of meat, and fruit and vegetables) being of particular concern. Causes of picky eating include early feeding difficulties, late introduction of lumpy foods at weaning, pressure to eat and early choosiness, especially if the mother is worried by this protective factors include the provision of fresh foods and eating the same meal as the child. There is neither a universally accepted definition of picky eating, nor is there agreement on the best tool to identify it. Picky eating is a common behaviour in early childhood.
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