Many children are picky eaters, a problem that can lead to nutritional problems and even family conflict. Now a new study reveals that more severe forms of picky eating can also be associated with childhood issues such as anxiety and depression that may warrant intervention.

In a new study published in Pediatrics, researchers from Duke Medicine involved more than 3,400 children and found that over 20 percent of children between 2 and 6 years old are selective eaters, 18 percent of whom are classified as moderately picky and around 3 percent are considered as severely selective. The latter's behavior toward food limited their ability to eat food with others.

Study author Nancy Zucker, from the Duke Center for Eating Disorders, and colleagues have observed that those who have moderate and severe selective eating habits exhibit symptoms of conditions such as anxiety and attention deficit hyperactivity disorder (ADHD). Those with selective eating behaviors were almost twice as likely to have elevated symptoms of anxiety in follow-ups during the study period.

Children with severe selective eating behaviors also have twice the odds of being diagnosed for depression. Zucker said that these are the children whose eating behavior become so selective it has started to cause problems.

She noted that this could have unwanted implications on the child's growth, health, social function and may affect the relationship of the parent and the child. The child, for instance, can feel that no one believes him and parents may blame themselves for the problem.

The researchers said that some of the children who refuse to eat may have heightened sense, which can make the texture, smell and taste of some of their foods overwhelming and cause them to feel aversion and disgust. Some children, on the other hand, may have a bad experience involving a particular food so they develop anxiety when they try the same food again.

Although therapy, such as demystifying the food that causes anxiety through exposure, could benefit some children, traditional methods may not benefit children who have sensitive senses, researchers said. Zucker said that new intervention are needed to help these particularly children.

"These children are seeing impairment in their health and well-being now, we need to start developing ways to help these parents and doctors know when and how to intervene," Zucker said.

Children who exhibit moderate and severe pattern of picky eating may meet the criteria for a new eating disorder known as Avoidant/Restrictive Food Intake Disorder (ARFID), which is included in the most recent Diagnostic and Statistical Manual of Mental Disorders.

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