Picky Eating in Children Linked to Anxiety, Depression and ADHD

For the last several months, my 3-year-old daughter Annika has been on a steady diet of waffles, yogurt sticks and milk. Before that, she ate mainly hot dogs and milk. And for many months before that, she ate almost nothing but fruit-and-yogurt squeezers and, you guessed it, milk. While I haven’t exactly been thrilled with her eating habits, I recognize that in life, and in parenting, we need to pick our battles. And the food battle is one I had chosen not to fight in full force. I had purposefully avoided putting too much pressure on Annika to eat a wider variety of foods because I thought that might backfire and make things worse. I also figured she would branch out eventually, as my older daughter had. But a new study, published in the journal Pediatrics, made me wonder if I should rethink my strategy.

The research, which includes a sample of 917 children ages 2 to 6, found that even moderate selective eating (a.k.a. picky eating) is associated with symptoms of psychological disorders such as anxiety, depression and attention deficit hyperactivity disorder. As for children with severe selective eating — meaning children whose aversions are so intense, they are often unable to eat outside the home — they were seven times more likely to have social anxiety and twice as likely to have a diagnosis of depression compared to children without selective eating habits.

In other words, picky eating, which affects an estimated 20 percent of children, may not merely be a benign phase for some of those children, but an indicator of other problems.

The study findings, which were based on parent interviews over the course of three years, immediately made me wonder: Had I picked the wrong battle to concede? And more important, if I were to increase my efforts to expand my daughter’s palate, would I be able to minimize her chances of longer-term issues?

Unlikely, said Nancy Zucker, lead author of the study and associate professor of psychiatry and behavioral science at Duke University School of Medicine. She noted that the research doesn’t show that picky eating causes psychological issues or vice versa; it only shows a correlation between the two.

“I don’t want to raise panic among parents,” Ms. Zucker said. “I’m hoping this research will make all of us realize that the story is more complicated than we appreciated.”

The story, as she tells it based on this study, is that picky eaters are not simply stubborn or tyrannical children whose parents have given in to their culinary whims. Rather, the research reveals that picky eaters have a heightened sensitivity to the world that is innate. “Their sensory experience is more intense in the areas of taste, texture and visual cues. And their internal experience may be more intense, so they have stronger feelings,” said Dr. Zucker, who is also director of the Duke Center for Eating Disorders. “They’re sensitive kids who may be anxious or a little depressed; so cutting up fruits into funny shapes is not going to do the trick for these kids.”

What should parents do? For one thing, they should lose the guilt. “In some ways, this research exonerates parents who have reported that they’ve felt very blamed, and that they’re not doing enough or presenting enough foods to their kids,” said Dr. Zucker.

Parents may also begin to shift their thinking in light of this study. “It is a reminder that food is not a stand-alone issue and that it plays a role in the big picture of development,” said Dr. Laura Jana, pediatrician at the University of Nebraska Medical Center and co-author of “Food Fights: Winning the nutritional challenges of parenthood armed with insight, humor, and a bottle of ketchup.” “How kids behave around food relates to how they interact with the world in general. It doesn’t surprise me that some kids who are really tentative around food might be really tentative in life.”

Picky eating may also serve as a visible marker to identify children who are at high risk for anxiety and depression, which can be hard for parents and physicians to spot. This could allow more children to get help earlier.

Dr. Zucker acknowledged, however, that it remains unclear which children will grow out of their finicky ways and which children won’t. “We don’t know enough about who will persist in their picky eating or for whom this is only a phase,” she said. “That’s part of the challenge.” Another challenge for clinicians is to come up with more interventions that can address children’s varied issues related to selective eating.

So, what does this mean for Annika and her waffles — and every other child who subsists solely on chicken nuggets, white foods or cereal? In each case, only time will tell. The best you can do, according to Dr. Jana, is to be a good role model in your own eating habits in your home. “It is the parent’s job to put healthy food in front of the children and it’s the children’s job to choose whether to eat it or not.” And try not to make family meals a battleground. “Positive experiences around family meals have at least as much impact on healthy outcomes as the actual foods you serve,” Dr. Jana said.

Dr. Zucker, too, emphasized the idea that family mealtimes should be more about family, and less about food. “Mealtimes are such a sacred space for families to share time together, to eat together and to share their day,” she said. “It should be a peaceful and calm time.” So save the adventures with new foods for snack time, and focus on making family meals happy.

One waffle, coming up.

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