Does your picky child actually have avoidant/restrictive food intake disorder? Some parents are worried after news reports of a study that associated moderate and severe levels of selective eating with depression, anxiety and ADHD diagnoses. Other parents say it’s a whole lot of hooey.
I had to weigh in, especially after reading the entire study and finding what the news reports missed.
For background, this was actually a far-reaching well-done study of over 3,000 kids ages 2-5 years. From those results, smaller samples were selected for further assessments. The authors did indeed find moderate and high levels of selective eating (SE) were associated (not cause and effect, just association) with depression, anxiety and ADHD. Children with moderate and severe SE were also more likely to “have mothers with elevated anxiety, and to have family conflicts around food.” I’ll discuss the author’s interesting recommendations below.
But first, there was a GIANT piece of the study that wasn’t reported in the articles I read (including NY Times, CNN and more). The interviewers had three categories of SE: 0, 1 or 2. Data was from parent self-report (which has its drawbacks). Here’s what was missing in the articles I’ve read so far (though CNN’s was very well done and interesting–see the link at the bottom of this page).
“Interviewers were instructed not to include restricted dislikes that were typical of many children (eg, cruciferous vegetables, such as broccoli) [italics mine].” And kids got a “0” score if they didn’t have these typical dislikes, or if they had no restricted intake.
The children with “typical dislikes” were not even included in the moderate or severe groups. I’m guessing that’s why many parents were confused about this study–their child with typical dislikes did not fit the pattern of psychological impairment.
The moderate and severe SE were truly those (according to parent self-report, anyway) who ate only a small range of foods, and/or whose parents had difficulty eating with others because of the “extreme limited range” of the severe SE kids.
CNN reported, “spotting a picky eater is easier than spotting mental health issues, which is why the study’s connection between eating and psychological issues is a good issue to raise with your pediatrician.“ This is great advice! The study authors basically recommend that we shouldn’t just assume that moderate/severe SE will grow out of it, that intervention is needed, and that pediatricians may need to think about other psychological issues as they assess these young children.
Most “picky” eaters I have met with have garden-variety pickiness, but there are some who are definitely much more rigid. This study gives me pause to think about those children who have much more restricted and rigid patterns.
But let’s talk about “picky” children in general (not the more severe level). Like adults, kids have their preferences—crusts cut off the bread, food not touching, fruit cut but not whole. As my wise aunt says, this is not necessarily a problem that needs a fix.
Other patterns do need a fix. A child who will only eat breaded, fried chicken nuggets, a child who only wants a Lunchable at school, a child who chooses fruit gummies over fruit, a child who demands PopTarts and Lucky Charms for breakfast and gags at the thought of wheat toast. These are an issue of our backwards food supply. Such products marketed to kids have millions of dollars behind them. Companies have figured out the exact cool vibrant packaging, branding, taste and texture that will hook kids. Most of these also happen to have fake colors and long ingredients lists. A child who wants Hot Cheetos daily (not plain Triscuits) isn’t just picky, he’s hooked just how the company intended.
Here are my five general guidelines for feeding families, including how to deal with garden-variety child preferences:
- Buy foods with a short ingredients list: 5 or Less is Best, More than 10 Think Again.
- Buy foods without fake colors.
- Make one meal and let the children manage within that meal. For help on this, come to my cooking classes!
- Put your efforts into offering good food, and don’t force. Let your child be in charge of the amounts they eat.
- Don’t cook multiple meals.
Overall I really appreciated this thought-provoking study about children with very rigid eating patterns.
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Link to original study: http://pediatrics.aappublications.org/content/early/2015/07/28/peds.2014-2386.abstract