Parents around the world are frustrated by kids who are fussy about their food, often left bemoaning uneaten broccoli and waiting impatiently for them to grow out of it. Now, research suggests that paying closer attention to picky eating may be about more than making sure kids get enough fruits and veggies.
A Duke University study involving hundreds of young children found that even moderate picky eating often coincides with psychological health issues, including depression, anxiety, attention-deficit disorder and hyperactivity. And as the pickiness got more extreme, the associated psychological problems tended to get worse.
“We're talking about kids whose picky eating went beyond having a non-preference for certain foods like broccoli,” says co-author William Copeland, a clinical psychologist at Duke. “Their eating was so restrictive that it required their parents to make separate meals for them apart from the rest of the family.”
As they report this week in Pediatrics, the scientists conducted in-home assessments for 917 kids that were 2 to 6 years old, using the Preschool Aged Psychiatric Assessment. They also interviewed the children's caregivers to collect information on eating habits and psychiatric symptoms. The results showed that about one in five of the participants are picky eaters—often or always selective with their food. Of those, almost 18 percent were moderately picky, while about 3 percent were severely selective, meaning their pickiness limits their ability to eat with others.
The team found that kids showing both moderate and severe selective eating were significantly more likely to show symptoms of social anxiety, depression and other mental conditions. Moderately picky kids were also more likely to suffer symptoms of separation anxiety and ADHD, though those correlations weren't seen among the study's relatively small number of severely picky eaters. And while some kids do grow out of picky eating, the psychological problems among the severe picky eaters tended to grow worse. The team conducted annual follow-ups for two years with 187 of the participants, and they found that selective eaters were twice as likely to show increased symptoms of general anxiety.
“It was surprising to me that when we followed up with these kids two years down the road, we saw that these problems predicted increased levels of anxiety,” Copeland says. “It certainly isn't the case for everybody. But it does mean that selective eating isn't something that should just be disregarded. Pediatricians and parents should be paying attention over time and seeing if a child shows some type of vulnerability to these emotional problems."
Parents regularly fight their picky eaters on food, but as many will attest that conflict doesn't always result in eating. It may even compound kids' psychological issues or lead to more family strife. While it's not the parents' fault when one of their kids is a picky eater, Copeland notes, young kids are so influenced by their parents that it's necessary to look at the family mealtime dynamic as a whole when assessing problematic eating.
“I think this absolutely could be related to certain dynamics that the kids have with their parents,” he says. “It's certainly the case that certain ways of responding with certain kids can make these things worse.”
Part of the problem is that there are many possible reasons why Junior won't eat his Brussels sprouts. Scientists have previously identified several likely triggers for picky eating, from genes to in utero exposure to reward systems in the brain. For instance, heightened senses make smell, taste or texture overwhelming for some. And bad experiences with foods—including being forced to eat food they don't like—can play a role in generating anxiety. Finding out which one is behind a child's pickiness can be key to successful intervention.
Another possible cause hinted at in the study data is a link with parents' own anxieties. “One of the things we saw in this study is that parents who have emotional problems themselves may be more likely to have kids that are picky about these things, and that's also going to affect how they respond to the kids,” Copeland notes. "So these things can be very synergistic.”
Copeland cited a common example of parents who see that a child isn't responding well to a food and then become concerned about why the kid has a poor response. “They'll ask if the child is feeling sick or the food is hurting their tummy,” he explains. “And that can send a message to the child that there is something to be worried about that can contribute to the child's refusal to have that kind of food.”
Pediatricians can help parents plan better responses to their individual picky eaters, he adds, so that these associated problems don't become more significant. This proactive approach can also help ease stress on the rest of the family—particularly on parents who are pressed to prepare alternative meals or engage in regular food fights.
“Most pediatricians would be comfortable assessing anxiety and depressive symptoms,” Copeland says. “So [picky eating is] really a trigger for them to ask more questions about those things.”