Is picky eating a sign of deeper trouble in children?

Is picky eating a sign of deeper trouble in children?

Is your child picky eating at every meal? Has picky (selective) eating become a mealtime headache? Are you making three different meals each time you sit down to eat? it is reported that this feeding behaviour is a sign of deeper trouble in children.

Clinicians should intervene when preschoolers are extremely picky eaters, as even moderate levels of selective eating (SE) are associated with impaired psychological and psychosocial function, according to a study published online August 3 in Paediatrics.

Clinicians should not view SE as a phase the child will “grow out of,” write Nancy Zucker, PhD, from the Department of Psychiatry and Behavioural Sciences, Duke University School of Medicine, Durham, North Carolina, and colleagues. Rather, SE should be seen as a warning sign for current impairment and “a marker for later psychopathology.” Screening for SE in primary care practices would help identify vulnerable children.

It is not uncommon for young children to turn up their noses at a variety of foods, with up to 20% of parents saying their 2- to 5-year-old children are “sometimes” or “often” selective about what they will eat, Dr Zucker and colleagues write. However, it remains murky as to when food aversion becomes severe enough for clinicians to take action.


As part of a study of preschool anxiety, Dr Zucker and coauthors screened 3433 children aged 2 to 5 years treated at Duke Children’s Paediatric Primary Care clinics for risk of anxiety. They initially enrolled 944 children who screened high and a random sample of 189 of the remaining youths who had not screened high. After in-home assessments for 917 children, the researchers settled on a final sample of 180 participants for follow-up, many of whom had anxiety disorders.

Parents completed an assessment of their child’s psychopathology, including questions that explored the degree of the children’s SE. Eschewing broccoli did not register as a red flag, as preschoolers typically dislike cruciferous vegetables. SE ranked as a “2” if the range of food the child ate was so limited that it made it difficult to have meals with others.

“Children with SE at either moderate or severe levels were more likely to have elevated symptoms of anxiety or depression, to experience hypersensitivity to taste and texture, to have mothers with elevated anxiety, and to have family conflicts around food,” Dr Zucker and colleagues write. “Compared with children with severe SE, children with moderate SE were more likely to endorse externalising symptoms (specifically symptoms of [attention-deficit/hyperactivity disorder]), to have a parent with a substance abuse history, and to have a mother who has sought mental health treatment.”

In addition, diagnosing the eating disorder as “avoidant/restrictive food intake disorder” would leverage a more sensitive diagnostic category that can be used beyond childhood.

“There is much to learn about the management of SE,” Dr Zucker and colleagues conclude. “Findings may help health care providers better understand the complex challenges parents face when their child is a selective eater.”

Financial support for the study was provided by the National Institutes of Health. The authors have disclosed no relevant financial relationships.

Paediatrics. Published online August 3, 2015.

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