Understanding the factors influencing fish consumption among children and adolescents: a comprehensive narrative review based on the socio-ecological model

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Objective This review aimed to examine the factors influencing fish consumption among children and adolescents globally. Background Fish is a rich source of protein and micronutrients, including vitamin D, iodine, and selenium, which are essential for child growth and development. It is also the main dietary source of the long-chain n-3 polyunsaturated fatty acids (LC n-3 PUFA), which contribute to optimal neurodevelopment. Nonetheless, fish consumption among children and adolescents is commonly insufficient in most parts of the world. Methods A systematic search across five databases identified 37 relevant articles. Using the socio-ecological model, factors were categorized across individual, interpersonal, environmental, and policy determinants and were either barriers or enabling factors. Results Enabling factors of fish consumption at the individual level were early (aged 2-6 years) and repeated exposure of children to fish. Mild-flavored fish and cooking methods such as frying were more appealing to children. Interpersonally, a family habit of fish consumption and parents having fish-cooking skills promoted both the varieties and quantities of fish consumed. Appropriate public health messaging, fish-in-schools programs, and nutrition were identified as policy-level enablers. Individual-level barriers included a dislike for the smell and/or texture of fish, especially among “picky eaters.” Interpersonally, misinformation and fear of allergies and contaminants were identified among parents. Cost and limited availability, especially in landlocked regions, were environmental barriers. Conclusions This review summarizes how diverse and interconnected factors across the socio-ecological model shape fish consumption in children and adolescents. Improving consumption, therefore, requires a holistic public health approach that promotes early and repeated exposure to fish, delivers clear, and evidence-based nutrition education for parents, and addresses structural barriers such as high cost and limited availability.