Picky eating can be sign of deeper troubles

Katherine K. Dahlsgaard, Ph.D., lead psychologist of the Anxiety Behaviors Clinic at Children's Hospital of Philadelphia, wrote this for the "Healthy Kids" blog, www.philly.com/healthykids.

Picky eating is relatively common in young children, but that doesn't make it harmless, conclude the authors of a study published online last week in Pediatrics.

"Eating problems among preschool-aged children are so pervasive that clinicians and researchers often treat them as developmentally normal," lament the authors of the study, who presented results suggesting the problems were anything but.

The children in their research identified as having moderate or severe picky eating behavior were also more likely to show elevated symptoms of anxiety and depression, as well as sensory sensitivities to the taste and texture of foods. Moreover, the problems persisted: When they received follow-up exams about two years later, these children were 1.7 times as likely as children without selective eating habits to show increased symptoms of anxiety, even when their original levels of anxiety were taken into account.

In the study, more than 900 children were recruited from pediatricians' offices, and their parents were interviewed about their eating habits and a wide variety of other problems. More than 17 percent of the children were identified as displaying moderate picky eating behavior, meaning they ate within only a range of certain preferred foods. An additional 3 percent had severe picky eating behavior, in which eating outside the home was challenging because of the extremely limited range of foods they would accept. Children with severe picky eating behavior were also found to have oral-motor problems that made swallowing more difficult.

Parents of picky eaters often feel blamed by health-care professionals for not presenting a wide enough variety of foods or giving in too easily when their children refuse a newly introduced food. But, the authors note, their finding that moderate and severe picky eating were associated with a three- to fivefold increase in family conflicts around food suggests these parents were hardly just accommodating their children's demands.

The results suggest that children with even moderate levels of picky eating behavior are at risk for other problems in childhood and that the "just relax" or "wait and see" approach is not enough and a new treatment approach is indicated. "We need to develop interventions that don't just focus on the anxiety piece, but that incorporate the sensory sensitivity and the disgust aspects of the condition," said Nancy Zucker, director of the Duke Center for Eating Disorders and lead author of the study.

Proper recognition of the problem by health-care professionals is a crucial first step. Problematic picky eating is a diagnosable condition, Avoidant/Restrictive Food Intake Disorder, but a recent study involving about 2,500 Canadian pediatricians found 63 percent – nearly two-thirds – were not familiar with the diagnosis.

The good news is that the disorder has been receiving so much media attention lately that better recognition of the problem and effective treatments for it will likely result. Stay tuned.