Send Orders for Reprints to reprints@benthamscience.net The Open Nutrition Journal, 2014, 8, 13-18 13 1874-2882/14 2014 Bentham Open Open Access Impact of Picky Eating on Level of Family Stress in Healthy Children between the Ages of 3 and 6 Years Rocío Ramos-Paúl a , Barbara J. Marriage b , Roberto Ruiz Debeza c , Liliana Oliveros Leal d , Luis Ros Mar e , Luis Torres Cardona a and Jennifer A. Williams b, * a BIEM Center of Psychology, Madrid, Spain b Abbott Nutrition, Columbus, Ohio, USA c Abbott Nutrition, Abbott Park, Illinois, USA d Hospital Universitario 12 de Octubre, Madrid, Spain e Hospital Universitario Miguel Servet, Zaragoza, Spain Abstract: Objective. One of the goals of this study was to measure the impact of a child’s eating habits on a family’s level of stress related to meal times in the home. Methods. A cross-sectional survey study was conducted on 1,090 children between the ages of three and six years, in Madrid, Spain from 2010 to 2011. Questionnaires about the child’s eating habits, family stress, and medical history, along with a three-day food record were filled out by parents. Results. Levels of family stress related to meal time occasions were statistically higher in the picky eater (PE) group compared to the healthy eater (HE) group (p=0.007). Conclusion. This study demonstrates a possible relationship between picky eating behaviors and family stress in the home. Higher levels of family stress can have long-term negative behavioral consequences or changes on the family dynamic, which may further exacerbate feeding disorders. Key words: Family stress, feeding difficulty, feeding disorder, picky eating. INTRODUCTION Although food intake, for both children and adults, is determined by many factors (market supply, economy, cultural norms, eating behavior, consumer marketing campaigns, etc.), of these factors, the parental role is considered essential for instilling good eating habits during childhood. Parents help shape the development of their child’s acceptance of foods by determining which foods are offered and the social context for eating meals [1]. Parental attitudes toward feeding and mealtime occasions can help determine how a child internalizes his or her attitudes and ensuing behaviors related to eating. If parents exhibit symptoms of anxiety, nervousness, unease or worry during mealtimes, it is more likely that a child may demonstrate similar negative symptomology; and, as a result, the risk for feeding difficulties, acute or chronic, may increase. The routine of eating is one of the first habits a child learns. Developing healthy eating behaviors will not only pave the way for acquiring other habits later on, such as studying in *Address correspondence to the author at the 3300 Stelzer Road, RP3-2, Columbus,Ohio 43219; Tel: (614) 624-3933; Fax: 614-727-3933; E-mail: Jennifer.williams@abbott.com academic subjects, but it may also decrease the likelihood of the child becoming a picky eater (PE). Eating is a behavior of children that parents worry about the most. There are intrinsic ideas related to the physiological act of eating, such as: “If my son doesn’t eat, he will get sick or not grow properly, and I will be the one responsible for this” or “Why can’t my child eat foods that their friends/siblings will eat readily, without argument?” [2]. Because of concerns about proper or healthy eating habits for their child(ren), many parents are accommodating and allow various marginal eating behaviors with their children. An example of this permissive parental behavior would be a seven-year-old child whose diet is limited to a mere ten foods. Additionally, parents may develop strategies for increasing the amount or quality of food consumed; however, if parents are not careful, prodding, rewards or punishment to encourage eating can backfire and exacerbate the picky eating phenomenon [1, 3]. In fact, recent research by Webber, et al. showed distinct differences in maternal strategy within families of children according to differing eating behaviors or related perceptions [4]. This same research found that parents were more likely to be restrictive in meals if a child was more responsive to food cues and were more likely to use pressuring strategies if a child was