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Many parents of children who are extreme picky eaters describe their kids as "difficult" in other areas of life, from choosing clothes to controlling emotions. Not surprisingly, research that looked into the connection between extremely picky, or selective, eating and anxiety found a link between the two seemingly unrelated conditions. The new study, published this month in the journal Pediatrics, reports that different levels of selective eating may indicate that a child is at a risk for psychiatric problems such as anxiety, depression, or ADHD and urged doctors to give parents of even moderate selective eaters more guidance.

The study analyzed two sets of interviews with parents of over 900 children aged 2-5. Researchers identified two groups: children with moderate selective eating and those with severe selective eating. They then compared them to non-picky eaters.

The researchers found that:

  • All selective eaters were more likely to show signs of depression and anxiety, but those with severe selective eating symptoms were more likely to have current psychiatric diagnoses of depression or social anxiety as well as oral-motor problems affecting eating.
  • All selective eaters were at a risk for growth issues, food aversions, and heightened sensitivity to food texture, sight, and smell.
  • While mothers of moderate selective eaters were more likely to seek psychiatric treatment for themselves or have a history of drug abuse, mothers of all selective eaters had elevated anxiety.
  • There were more mealtime conflicts in families of all selective eaters.
  • Alarmingly, at a two-year follow up children with both levels of selective eating were nearly two times more likely to have increased symptoms of generalized anxiety disorder.

The researchers conclude that pediatricians and other health care providers should offer more guidance and support to parents when children exhibit even moderate levels of selective eating.

Frequently though, parents of preschoolers are advised by their doctors to "wait and see." And without support, parents often end up using controlling strategies to "get" their child to eat. Jenny McGlothlin, a pediatric speech language pathologist and a co-author of Helping Your Child with Extreme Picky Eating, says: "A vicious cycle can begin where the child has a feeding challenge, the parents get anxious and pressure, they ask for help and possibly get bad advice, they pressure more because nothing is improving, and the child pushes back."

In fact, few doctors are trained in developmentally appropriate feeding strategies and in screening for selective eating. Dr. Katja Rowell, aka the "Feeding Doctor", and a coauthor of Helping Your Child with Extreme Picky Eating, agrees that pediatricians should offer more guidance. "Reassurance is a critical role of the clinician," says Rowell, "but they have to ask a few more questions and reassure parents only after problems have been ruled out and if the picky eating is truly more typical than extreme."

So what should parents do if they have a moderate to severe picky eater at the table?

  1. Even if your concern about your child's eating is dismissed by your primary child care provider, trust your instincts and keep looking for help. Here are the signs that your child's eating problems are more serious than a typical fussy eating phase.
  2. Share these recent guidelines for screening for feeding problems with your health care provider.
  3. Get your child evaluated for underlying issues that may be impairing his eating, such as oral motor and sensory issues, food allergies and gastrointestinal problems.
  4. Get help with your child's, and possibly your, anxiety. For stress-free mealtimes, use evidence-based feeding strategies based on authoritative feeding that have been shown to reduce mealtime anxiety and help everyone eat better. Here are some steps to consider:
    - Learn about the Division of Responsibility in feeding. It is a concise formula coined by Ellyn Satter who has been doing groundbreaking work in feeding for a few decades.
    - Read Helping Your Child with Extreme Picky Eating to get specific strategies for a child with sensory challenges and oral motor problems while reducing anxiety, minimizing family conflict and enjoying meals with your child. (Find an interview with the authors here.)

Natalia Stasenko MS, RD, CDN is a pediatric dietitian based in London and New York. She offers an online, one-on-one support program for parents of picky eaters called Feeding Bytes, and is the mother of three. Natalia is the cowriter of the cookbook Real Baby Food, and when not writing, teaching online feeding classes or consulting, she is in the kitchen cooking and eating with her family. Follow Natalia on Twitter, read more of her stories on feedingbytes.com and download her guide on Smart Snacks That Help Kids Eat Dinner here.

Image: Picky Eater via Shutterstock