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When Picky Eating Is a Sign of Psychological Distress

by Alison Knopf

When picky eating is a sign of psychological distress

Picky eating, the subject of a widely publicized study thanks to a Pediatrics article last summer, is no joke. It can tear families apart, turning what is supposed to be the peaceful, bonding time of the day — family dinnertime — into a battleground. Or, if not a battleground, a labor-intensive grueling effort to prepare something that the picky child will eat.

This isn’t about the child who doesn’t like spinach: it’s about the child who has a long-term aversion to a particular food or foods, perhaps almost all foods. Consider the kindergartner who has never eaten anything but noodles and chicken nuggets and apple juice, for breakfast, lunch, and dinner. It’s not that hard to imagine this child becoming the teenager who eats only soda and pizza — for breakfast, lunch, and dinner. But it may seem like a stretch to think of this picky eater as a depressed or anxious teenager. In fact, that’s what the study shows could happen, and may even be happening to the toddler with the odd appetite.

The study, conducted by researchers from Duke University, found that picky eaters are more likely to have symptoms of anxiety and depression. And the more severe the pickiness (known as selective eating) the more severe the symptoms.

The study also showed that picky eating can predict future anxiety.

This means that teenagers in treatment for anxiety or depression may have been suffering since toddlerhood, with problems first manifest as the sensory problems causing picky eating.

Sensory Problems

Parents of children with possible autism spectrum disorders will pick up on the “sensory” cues: children who are particularly averse to a texture, a smell, or being able to see some flaw in any object, including a banana that has black dots. If you have ever tried to remove all of the seeds from a banana for a picky eater, you will understand.

For children with hypersensitivity issues, the problem isn’t the food — it’s the world. Labels must be removed from shirts, a radio show with a particular theme must be switched off before it starts, but when it comes to food, it can be hard to try to get everyone to fit into the “let’s all be happy and enjoy whatever is on the table.”

The Pediatrics study concluded that health care providers should intervene when there is a picky eater of the type they studied, and that selective eating associated with functional impairment should now be diagnosed as “avoidant/restrictive food intake disorder,” a new disorder introduced in DSM-5.

Normal/Not Normal?

One of the traps here is that because so many children are picky eaters, it is viewed as normal. One-fifth of parents say their preschooler is often or always a picky eater.

But another trap is this: just because something is common doesn’t mean it’s harmless, the researchers write.

Typically, parents are not concerned about the child’s psychology but about the nutritional intake. They consult their pediatricians, who may very well say that it’s normal.

For this study, the researchers focused on psychopathology, using the Duke Preschool Anxiety Study, a population-based cohort. First, children ages two through five were screened from a primary care population; then the parents were interviewed, and then there was a laboratory-based case-control phase. Follow-up neuroimaging was used as well. The total number of children in this study was 180.

One of the key findings was, predictably, that picky eaters were more likely to have family conflicts about food. In addition to the depression and anxiety symptoms in the children, the mothers were more likely to have elevated anxiety.

It can be difficult to separate causation from correlation with these children; it could be that children with intense sensory issues about food have a hard time regulating emotions because of that sensitivity, or because there is a common reason for both. In addition, as in conduct disorder, in which negative parenting can feed into the symptoms, picky eating can lead to parental stress, which only contributes to increased anxiety in the child about food.

Some children are averse to a certain kind of food because they are allergic to it; it is not abnormal for a child who is allergic to peanuts to dislike not only peanut butter but hummus and other legumes. And finally, there are children who grow out of eating disorders.

If you have a picky eater, the best advice is not to make it into a battle. If you do want to get your child to experiment with new foods, do it sometime outside of the family dinner. And try to make it fun.

Basically, only a professional can tell the difference between a “normal” picky eater and one with an eating disorder and/or some additional disorder. All of this confusion, in addition to the possibility that the picky eating could signal a long-term psychological problem, makes it seem like a good idea to consult an expert if a child has a very particular selective eating problem. In any event, picky eater or not, if there are constant family fights at the dinner table, the whole family is going to need help — especially the child.

The study cited is Zucker N, Copeland W, Franz L, et al. "Psychological and psychosocial impairment in preschoolers with selective eating." Pediatrics 2015 Sep; 136(3):e582–e590. doi: 10.1542/peds.2014-2386. Epub 2015 Aug 3.

For more information, go to this U.S. Department of Agriculture webpage: https://fnic.nal.usda.gov/consumers/ages-stages/infants-toddlers.

Alison Knopf is a freelance journalist specializing in mental health and addiction issues. For Wiley, she is the editor of Alcoholism and Drug Abuse Weekly and managing editor of The Brown University Child and Adolescent Psychopharmacology Update and The Brown University Child and Adolescent Behavior Letter.