Many a parent will have despaired at trying to convince their children to “eat their greens,” but at what point does picky eating represent more than just misbehavior? New research suggests that selective eating in children is often associated with underlying issues that require intervention.

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Selective eating can lead to poor nutrition in children and conflict within families.

In particular, researchers from Duke Medicine in Durham, NC, found that both moderate and severe levels of selective eating were associated with psychological problems such as anxiety, depression and attention-deficit hyperactivity disorder (ADHD).

The findings of the study are published in the journal Pediatrics.

Eating problems are so prevalent that many clinicians and researchers consider them a normal part of development for preschool-aged children. According to the study authors, between 14-20% of parents report that young children aged 2-5 years are selective eaters.

“The question for many parents and physicians is: when is picky eating truly a problem?” asks lead author Nancy Zucker, director of the Duke Center for Eating Disorders. “The children we’re talking about are not just misbehaving kids who refuse to eat their broccoli.”

Although selective eating is quite prevalent, previous research has also associated it with emotional, social and physical domains. As a result, it is important for both researchers and clinicians to understand at what level of severity that selective eating causes such impairment in order to determine when intervention is required.

To investigate, the researchers analyzed a group of 917 children aged between 24-71 months. The children’s caregivers were interviewed on the children’s eating habits, functioning, possible psychiatric symptoms and home environment variables.

The researchers were interested in finding out whether selective eating at either moderate or severe levels could predict the development of psychological impairment.

“These are children whose eating has become so limited or selective that it’s starting to cause problems,” Zucker explains. “Impairment can take many different forms. It can affect the child’s health, growth, social functioning and the parent-child relationship. The child can feel like no one believes them, and parents can feel blamed for the problem.”

Children with moderate or severe selective eating habits were found to be nearly twice as likely to have increased symptoms of anxiety than children who were not picky with food. Both moderate and severe selective eating habits were also associated with raised symptoms of depression, social anxiety and generalized anxiety.

The researchers found that while children with moderate selective eating habits did not appear more likely to be diagnosed with a psychiatric disorder, severely selective eaters were more than twice as likely to be diagnosed with depression.

Conflict between parents and children about selective eating does not necessarily result in the children changing their eating habits, Zucker said, indicating that both doctors and families require new tools to address the problem:

Because these children are seeing impairment in their health and wellbeing now, we need to start developing ways to help these parents and doctors know when and how to intervene.”

Selective eating in children could be attributed to bad experiences with certain foods, leading to anxiety developing when being forced to eat the food, or try new foods. Some children may also have heightened senses that cause the tastes and textures of certain foods to become overwhelming.

While traditional forms of therapy could help and stop certain foods from producing anxiety in selective eaters, these will not work in children with heightened senses. Zucker says that new interventions are necessary to help these children improve their eating habits.

The researchers conclude that selective eating that results in impairment of function should now be diagnosed as avoidant/restrictive food intake disorder (ARFID) – a new diagnosis that has been included in the latest Diagnostic and Statistical Manual of Mental Disorders.

Previously, Medical News Today reported on a study revealing that children with ADHD are more likely than other children to have loss of control eating syndrome. The findings suggest the two conditions could share a common biological mechanism.