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Approximately 30% to 60% of children experience a behavioral health problem such as picky eating, toileting, or sleep difficulties; however, less than half of those individuals receive the necessary services to improve their symptoms and functioning. Examining the pathway through which children access behavioral health care is crucial to understanding the gap between the need for services and actual service use. Help-seeking process models suggest that for a child to receive care, caregivers must go through a series of linear stages: problem recognition, decision to seek help, and service selection. This help-seeking process has not been previously examined for sleep, picky eating, and toileting challenges, which leaves a gap in our knowledge about how children receive access to important behavioral health care. The current study aimed to fill gaps in the literature regarding help-seeking for behavioral health concerns. Survey data was collected through Amazon’s Mechanical Turk. Participants were 151 caregivers of children ages 5 to 10 years who provided information about help-seeking and child behavioral health symptoms. Rates of caregiver problem recognition for children who exhibited clinically significant concerns were 39% for sleep, 70% for picky eating, and 52% for toileting. When caregivers identified a problem, rates of help-seeking ranged from 53% (sleep) to 69% (toileting). The severity of the child’s problem predicted caregiver problem identification and help-seeking across all concerns. Caregiver past experience with mental health predicted problem identification and help-seeking for sleep and for picky eating. Family disorganization also predicted identification of picky eating problems. Caregivers demonstrated low knowledge of treatment options for behavioral health, and specialty behavioral health services were underutilized across problem areas with 69% to 75% of caregivers in the sample indicating that they had or would seek help from a pediatrician and only 11% to 19% indicating that they had or would seek help from a therapist or psychologist. Caregivers also reported low rates of pediatrician screening for these behavioral health concerns, and results suggest that caregivers are not fully satisfied with how pediatricians address their concerns. Overall, results support and add to the findings in the literature that suggest child behavioral health problems are under- recognized and under-treated. Future research is needed to close the gap between the need for services and service use.

Although vegetables provide many beneficial nutrients and have been shown to help reduce the risk of dietary related chronic diseases, children in the United States are not meeting the national recommendations of vegetable servings. The overall goal of this research was to study the relationship between children’s vegetable acceptance and the following children’s characteristics: food neophobia (FN), vegetable neophobia (VN), picky eating (PE), 6-n-propylthiouracil (PROP) sensitivity, Mouth Behavior (MB). The specific objectives were to: (1) develop a novel method for evaluating children’s MB, (2) assess the FN, VN, PE, PROP sensitivity, and MB levels in children in San Luis Obispo County, (3) examine the relationship between FN, VN, PE, PROP sensitivity, and MB, (4) determine exposure and willingness to try familiar and unfamiliar vegetables of the two levels of each of the children’s characteristics, (5) to determine acceptability of familiar and unfamiliar vegetables of each level of each of the children’s characteristics, and (6) determine if the preference between two levels of each children’s characteristic differed. Children’s acceptability of familiar and unfamiliar vegetables was conducted with 43 child and parent pairs. Parents completed five questionnaires: demographics, the Child Food Neophobic Scale, the Fruit and Vegetable Neophobia Instrument (vegetable subscale), the Child-Feeding Questionnaire (pickiness subscale), and the JBMB® typing tool. Children participated in consumer acceptance testing of red carrots (stick, sliver, and puree) and broccoli (floret, sliver, and puree). Sensory attributes were measured using a 5-point facial hedonic scale. The children’s PROP sensitivity was determined by having the children place a control taste strip on their tongue for approximately ten seconds and report what they tasted. This procedure was repeated with a PROP taste strip. The children’s MB was determined through a guided discussion about their eating behaviors and food preferences with their parents. Of the children in the study, there were 46.51% FN, 32.56% PE, 34.8% PROP sensitive, 44.19% VN, 60.47% chewers, 27.91% crunchers, 6.98% smooshers, and 4.65% suckers. From likelihood ratio chi-square analysis, the following characteristics were related: FN and VN (p This study indicates there are possible trends between FN, PE, MB, and vegetable acceptance. Another trend that appeared was that the sensory attributes of the non-bitter, unfamiliar red carrots were often rated higher than the sensory attributes of the bitter, familiar broccoli. It may be possible to determine child’s MB through discussions with the child and their parent. In conclusion, knowledge of a children’s MB and understanding how their eating behaviors are associated with the acceptability of familiar and unfamiliar vegetables served in different product forms may be able to help increase children’s vegetable consumption.

Eating and feeding are skills learned in early childhood that are important to human survival. These activities are complex and require physical, sensory, cognitive, and behavioral skills. Understanding the nature of picky eating and addressing it in this essential developmental period is critical to establishing healthy eating habits that persist into adulthood. Educating and equipping parents and caregivers with the tools they need to support their child will create healthy, sustainable eating habits. Picky eating is a concern for parents of children at all developmental stages that is frequently associated with parent stress and mealtime disruptions. Researchers often refer to picky eating as a passing childhood phase; however, clinical studies and longitudinal results indicate that picky eating could persist into adulthood and cause obesity, cardiovascular disease, metabolic disorders, and respiratory problems. Three main factors cause picky eating: the child, the caregiver, and the mealtime climate. Together in Every Bite is a virtual hands-on parent education program that aims to educate parents and caregivers to establish healthy habits around mealtime and decrease picky eating behavior in children in their early developmental stages (6-24 months) and decrease mealtime stress and anxiety. Caregivers will engage in problem-solving and plan-building activities coinciding with the learned material, developing their self-efficacy and confidence while reducing stress and anxiety. The program director will also distribute valuable information provided through this platform to health professionals who work with parents of infants. This paper outlines the relevant literature and theory, and the evaluation, funding, and dissemination plans for Together in Every Bite.

Although restrictive eating behaviors are very common during early childhood, their precise nature and clinical correlates remain unclear. Especially, there is little evidence on restrictive eating behaviors in older children and their associations with children's shape concern. The present population-based study sought to delineate subgroups of restrictive eating patterns in N = 799 7-14 year old children. Using Latent Class Analysis, children were classified based on six restrictive eating behaviors (for example, picky eating, food neophobia, and eating-related anxiety) and shape concern, separately in three age groups. For cluster validation, sociodemographic and objective anthropometric data, parental feeding practices, and general and eating disorder psychopathology were used. The results showed a 3-cluster solution across all age groups: an asymptomatic class (Cluster 1), a class with restrictive eating behaviors without shape concern (Cluster 2), and a class showing restrictive eating behaviors with prominent shape concern (Cluster 3). The clusters differed in all variables used for validation. Particularly, the proportion of children with symptoms of avoidant/restrictive food intake disorder was greater in Cluster 2 than Clusters 1 and 3. The study underlined the importance of considering shape concern to distinguish between different phenotypes of children's restrictive eating patterns. Longitudinal data are needed to evaluate the clusters' predictive effects on children's growth and development of clinical eating disorders.

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