Neophobia

Neophobia also called cainotophobia or cainophobia, is the fear of anything new, especially a persistent and abnormal fear. In its milder form, neophobia can manifest as the unwillingness to try new things or break from routine. Mild manifestations are often present in young children (who want the small portion of the world that they “know” to remain constant) and elderly people (who often cope using long established habits and don’t want to learn “new tricks”). But neophobia could also be fear of losing what one has e.g., the fear that if anything changes, one might never be happy again. In the context of children the term is generally used to indicate a tendency to reject unknown or novel foods ¹. Food neophobia, as it may be referred to, is an important concern in pediatric psychology ².

In biomedical research, neophobia is often associated with the study of taste.

Food neophobia

Food neophobia refers to the reluctance to eat or the avoidance of new foods, is a term which has gained popularity recently as a tool for understanding difficulty with feeding and eating ². In contrast, ‘picky/fussy’ eaters are usually defined as children who consume an inadequate variety of foods through rejection of a substantial amount of foods that are familiar (as well as unfamiliar) to them ³. Food neophobia is distinguished from picky eating because the fear for someone with food neophobia lies in the items being new or unfamiliar. Someone who is a fussy eater often avoids common foods they are very familiar with ⁴. Many people have narrow food preferences and would rather eat food they know than try something they do not. Food neophobia describes a condition when preferences are overwhelming, phobic and likely to have a social impact (avoiding meals and situations with unfamiliar food) and a dietary impact. Individuals with high food neophobia levels may be indicated as a specific group of consumers ⁵, which can be mainly attributed to their sensory aversions, as well as to the fear of negative consequences that can occur following the consumption of specific food products ⁶. The latter reason may be especially important for patients diagnosed with diet-related diseases, particularly for those who develop food allergies, intolerances, and other adverse reactions to food products, including celiac disease ⁷.

Food neophobia is minimal at infancy and peaks sometime between two and six years ⁸. A lower level at infancy is adaptive to facilitate the introduction of new foods ⁹. The peak in food neophobia occurs when children start to explore their surroundings outside parental guidance, thereby functioning as a protective mechanism when risk of consumption of toxic or poisonous food is high ⁸. Food neophobia may be primary (e.g., never learned to eat a range of food), or it may occur in response to an adverse event (e.g., choking, vomiting, diarrhea). Neophobia is not a permanent dislike for new foods; acceptance can be promoted through repeated exposure to or modelling the consumption of the rejected food(s) ¹⁰. Neophobia overlaps to some extent with the broader concept of ‘picky/fussy’ eating which refers to the rejection of both familiar and unfamiliar foods and may not be as easy to overcome through repeated exposure ¹¹. It is worth noting that measurement of both neophobia and picky/fussy eating by parents reflects parental perceptions of the child’s behavior ². In particular, the rejection of foods a child normally eats (‘fussy eating’) may in fact reflect lack of appetite (i.e., fullness) rather than fussy eating behavior.

In Australia, many children do not meet the recommendations for fruit and vegetable intakes; 61% and 22% of four to eight year olds meet fruit and vegetable guidelines respectively ¹². This warrants concern as children may forgo the potential health benefits of fruits and vegetables, such as protection against chronic diseases ¹³ and adiposity ¹⁴. The development of these eating habits involves a complex interplay between genetic and environmental factors ¹⁵. Current literature suggests that neophobia may be a contributing factor, through hindering the acceptance of new foods differentially. In particular, more neophobic children are found to have lower preferences for and intake of both fruits and vegetables ¹⁶..

In addition to making recommendations regarding the quantity of fruits and vegetables to consume, dietary guidelines encourage children to consume a variety of ‘colors’ from these groups due to the variation in nutrients provided by the different fruits and vegetables ¹⁷. Despite the aforementioned evidence, there has been little research regarding the impact of neophobia on the variety of fruit and vegetables consumed. In a brief review ¹⁸ it was suggested that the decline in fruit and vegetable variety observed during the third year of life ¹⁹ coincides with the emergence of the developmental phase of neophobia. In a study that measured self-reported food variety via a food choice questionnaire vegetable variety was negatively related to food neophobia in a sample of (n = 339) 4–22 year olds ²⁰.

Discretionary food, defined as energy-dense and nutrient-poor foods by the Australia Guide to Healthy Eating, is another food group of concern in children’s diets ¹⁷. In Australia, the proportion of total energy provided by discretionary foods increases with age, ranging from 24% for two to three year olds to 38% for 14 to 16 year olds, exceeding the recommended limit of 5 to 20% in all age groups ²¹. Few studies have explored the relationship between neophobia and discretionary food intake. A study of four to five year olds in the UK found no association between neophobia and intake of snack foods at a test lunch at school ²². Similarly, a study of two to six year olds in the UK found no association between neophobia and intake of sweet/fatty snack foods ²³. Given that discretionary foods have been associated with excess energy intake, and consequently weight gain and obesity ²⁴ there is a need to explore the relationship between neophobia and discretionary foods further.

The potential influence of neophobia on dietary intake may translate into unhealthy weight outcomes in children at both ends of the spectrum, i.e. underweight and obesity. Current literature exploring this relationship presents contradictory results. Of four studies, two found no association ²⁵, one observed overweight/obese children to be more neophobic ²⁶, and another found that significantly more children classified as ‘picky’ were underweight compared with the control group ²⁷. These contradictory results may be attributed to differences in demographic characteristics of the sample (including child age) and recruitment techniques. With inconclusive evidence, more research is required to ascertain if food neophobia is a significant predictor of weight.

A study ²⁸ aimed to examine the cross-sectional relationship between food neophobia at 24 months and the variety of fruits and vegetables consumed, discretionary food intake and child weight. Results indicated that food neophobia was related negatively to fruit and vegetable variety but positively related to discretionary foods intake at 24 months ²⁸. Food neophobia was not related to child weight at 24 months ²⁸.

The key finding is that children with higher levels of neophobia are likely to consume a lower variety of fruit and vegetables. Literature examining the influence of food neophobia on fruit and vegetables has mostly concentrated on preferences for these foods and the quantity eaten. Three of seven and four of seven studies on intake found negative relationships with fruit and vegetables respectively ²⁸. Studies examining preferences also reported a negative relationship with food neophobia ¹⁶. Therefore, it appears that food neophobia is related to not only lower preferences for and lower quantity eaten but also lower variety of fruit and vegetables. Dietary variety is a key characteristic of dietary quality and recent dietary guidelines refer to a choosing a wide variety of foods from each food group.

In the same study the authors showed that discretionary foods contributed a larger proportion of daily energy in more food neophobic children ²⁸. This contradicts findings from other studies, which have found no significant relationship. This may be explained by discretionary foods being defined differently. Cooke et al. ²³ measured frequency of consumption of discretionary foods (‘sweet/fatty snacks’) in 2–6 year olds using a Food Frequency Questionnaire. Discretionary food intake was represented by energy intake from chocolate biscuits and cheese crackers offered at three test meals in another study with 4–5 year olds ²⁹. Neither of these measures may fully capture intake over the full range of discretionary foods. Findings from the cross-sectional study add to the literature by including energy intake from a potentially more comprehensive range of discretionary foods based on actual intake records rather than a predefined ‘list’ of discretionary foods. Hence, this may account for the observed positive relationship found in this, but not in previous studies ²⁸.

A possible explanation for the relationship between food neophobia and variety of fruits and vegetables and discretionary foods is that novel foods are rejected based on the visual domain ⁸. In the hunter-gatherer days, plant foods posed a significant risk of poisoning ³⁰. Hence, novel plant foods may incite a larger fear reaction as they do not ‘look right’ ⁸. An alternative explanation is that choices are made based on food value ³⁰. Children are in a stage of rapid growth hence, acceptance of foods of higher energy or protein values may be more adaptive ³⁰. Coupled with an innate predisposition towards sweet and salty tastes ³¹, and the increasing exposure to discretionary foods at a young age, children may more readily accept discretionary foods because of their higher energy content and sweet or salty flavor.

Taken together, more neophobic children appear to have a poorer eating pattern, with a lower variety of fruits and vegetables and higher energy intake from discretionary foods. It is well-established that high intake of fruits and vegetables can protect against chronic disease and adiposity ¹³. These health benefits can be maximised through consuming a variety of fruits and vegetables ³². On the other hand, discretionary foods have been proposed to displace core foods (which provide essential nutrients for optimal health) and contribute to excess energy intake, weight gain and obesity ³³. Therefore, the present findings warrant concern about the potential relationship between food neophobia and children’s dietary quality.

Food neophobia causes

There is a recognized association between autistic spectrum disorder and food neophobia. Individuals with autistic spectrum disorder commonly struggle with flexibility of thought and can be more resistant to change, therefore initial fears of trying new foods are likely to last longer.

Research has also found that individuals with autistic spectrum disorder are more likely to have rigid preferences for specific food textures, colors and tastes, which could maintain their food neophobia. Genetic factors are also recognized as a cause of food neophobia, together with psychosocial influences: if parents have food neophobia themselves, there is an increased risk of the same condition in their child.

Food neophobia signs and symptoms

Some degree of food neophobia is common and expected in early childhood as part of normal development, particularly ages three to seven. It does follow that food aversions reduce from the ages of eight or nine onwards and it is unusual for them to persist through adolescence and into adulthood. The symptoms and signs of food neophobia include:

• Refusal to eat new foods persisting beyond early childhood into adolescence
• Fear of new foods is overwhelming
• Food neophobia has a social impact: key activities such as parties and school trips are avoided because of the fear of having to eat new food
• There is a psychological impact: the fear of unfamiliar foods causes significant distress and anxiety

Food neophobia diagnosis

A Food Neophobia Scale developed by Pilner and Hobden ³⁴ is used for food neophobia diagnosis: participants answer these statements, grading them numerically (7 strongly agree to 1, strongly disagree) to gain an overall score. The higher the score the more neophobic an individual is. Food Neophobia Scale items were answered using a 7-point Likert scale format with answers ranging from ‘I totally disagree’ (1) to ‘I totally agree’ (7). Respondents’ food neophobia score was computed by summing the answers of the ten items, after reversing the scores of items 1, 4, 6, 9, and 10 (theoretical range 10-70). Items with an asterisk are reverse scored.

1. I am constantly sampling new and different foods. *
2. I don’t trust new foods.
3. If I don’t know what is in a food, I won’t try it.
4. I like foods from different countries. *
5. Ethnic food looks too weird to eat.
6. At dinner parties, I will try a new food. *
7. I am afraid to eat things I have never had before.
8. I am very particular about the foods I will eat.
9. I will eat almost anything. *
10. I like to try new ethnic restaurants.

A specific Child Food Neophobia Scale (CFNS) has also been developed with questions framed for children and answered by their parents.

Food neophobia treatment

Food neophobia treatment can encompass one or more of the following approaches, depending upon individual diagnosis and needs:

• Desensitization through graded exposure to new foods in a supportive way
• Modelling behaviour: parents and other significant family members can model normal eating and positive response to new foods
• Cognitive behavioural therapy and techniques
• Relaxation therapy and techniques

Research has shown that an increased number of food exposures, up to 10 to 15 ³⁵ can transform initial rejection of new foods into acceptance in children of this age group. Studies have found both teacher ³⁶ and parental modelling ³⁷ to promote acceptance of novel food, especially if models are consuming foods of a similar color ¹⁰ and it is done enthusiastically ³⁶. Parents have a high degree of control over exposure to food types and food-related experiences of children aged two years ³⁸. Hence, given the potential association between food neophobia and diet quality suggested by the findings of this study ², there is a need for interventions to target parents to encourage acceptance of novel nutritious foods into their regular diet. Health professionals can play an important role in educating parents on understanding neophobia as a developmentally normal stage but also equipping them with strategies such as repeated neutral exposure and modelling through which they can encourage their child to try (and eventually accept) novel foods. Early intervention would be ideal as eating habits established by five years can persist through adolescence into adulthood ³⁹.

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