Very few parents I see describe their children as great, or even good, eaters. Most parents, in fact, perceive their children — especially their preschoolers and young school age kids — as “picky”, “limited”, or “terrible” eaters. Despite showing parents their kids’ consistently good growth on their growth charts, I still get skeptical looks when I advise them to use these words: “If you don’t want it, don’t eat it.”
When does the typical picky eater (a generally healthy child who is growing and developing normally and, who, with time and patience, can be expected to broaden his or her palate) become atypical? In other words, when is being “picky” — what for many is a normal part of development for up to 20% of toddlers and preschoolers — an actual “selective eating disorder?” A fascinating new study, published in this month’s Pediatrics, tries to answer that question. James McIntosh spoke with the lead author:
“These are children whose eating has become so limited or selective that it’s starting to cause problems,” [Nancy] 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.”
McIntosh reviewed the data:
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.
The researchers hypothesize that the link between moderate and severe selective eating habits and psychological diagnoses may be due to extreme sensory sensitivities in these children: Eating can be an intense sensory experience for some children and so they attempt to regulate the intensity by limiting choices and seeking “sameness” in food. The striking results showing an association between moderate and severe selective eating habits and psychological disorders are prompting the authors to suggest reclassifying this clinical problem:
Such eating patterns thus may be better characterized using the diagnostic category of avoidant/restrictive food intake disorder (ARFID), an eating disorder new to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
The vast majority of “picky eaters” do not, and will not, earn this DSM-V diagnosis. Most are just picky, and fighting with them about it will only make things worse! But this study should make parents pause and pediatricians redouble their efforts to either reassure anxious parents or intervene with appropriate therapies.