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About 3 percent of kids suffer from severe selective eating, to the extent that they can't eat out at a restaurant, said lead researcher Nancy Zucker, an eating disorders specialist at Duke University Medical Center in Durham, N.C.
These kids are more than twice as likely to be diagnosed with depression or social anxiety, when compared with kids who'll eat anything, according to findings published online Aug. 3 in the journal Pediatrics.
Even kids who are moderate picky eaters -- for example, they only have 10 foods they will reliably eat -- are at increased risk for symptoms of anxiety and attention deficit hyperactivity disorder, although not to the extent that they can be diagnosed with a disorder, Zucker added.
The researchers discovered that kids who eat selectively are unusually sensitive, and that this sensitivity affects their eating and their emotional health.
"They have a stronger sensitivity to the world outside and to how their body feels," Zucker said. "That sets them up to have more vivid experiences -- more intense food experiences, more intense emotional experiences. None of that is pathological, but it could be a vulnerability for later problems."
These findings should take some of the blame off of the parents, since it's not just a matter of controlling an unruly child, Zucker said.
In this study, researchers looked at more than 3,400 children ages 2 to nearly 6 who were treated at one of Duke's pediatric primary care clinics. Of those, over 900 kids were screened by an in-home evaluation, and their parents filled out psychiatric assessment forms and reported on their eating patterns.
About 20 percent of the kids who were screened had some form of selective eating, researchers found. Of those, 3 percent exhibited signs of severe selective eating and 17 percent were moderately picky eaters.
Children who ate within the normal range of childhood likes and dislikes weren't considered picky eaters. "Kids who disliked broccoli were considered normal," Zucker said.
For severe picky eaters, eating out is too challenging, Zucker said.
"Their sensitivities to smell and other foods are so extreme that eating around other people and all the different smells at a restaurant are too overwhelming," she said.
On the other hand, moderate picky eaters have a limited list of foods they like, but they can manage eating out. "He might not be able to order off the menu, but he's still fine being around food," Zucker said.
The researchers found that selective eaters also are hypersensitive to smell, noise, visual cues and oral textures. They are more likely to avoid food and to have problems swallowing.
Dr. Andrew Adesman is chief of developmental and behavioral pediatrics at Cohen Children's Medical Center of New York in New Hyde Park. He said this study raises important questions about the possibility that "picky eaters may have a different sensory experience of tastes. Further research into variations in sensory experience is warranted."
Parents of a severely selective eater should seek out professional help for their child, based on these findings, Zucker said. "That child might not be struggling only with eating that's causing impairment, but also with other psychiatric diagnoses," she said.
However, there aren't many kids who fit this category, Zucker and Adesman noted.
Most of the 17 percent of kids who are moderately picky eaters can be expected to grow out of it, although parents should take steps to help manage their kids' struggle with food, Zucker said.
For example, to ensure that dinnertime remains a pleasant experience, serve foods that are palatable to the picky eater, and introduce new foods at other times of the day, she recommended.
Also, ignore anyone who advises you your kid will eat whatever you serve once they're hungry enough, she said.
"None of us who are hungry become more adventurous," Zucker said. "We become more rigid and set in our ways if we are hungry."
Finally, don't be alarmed if your kids tend to choose processed foods over healthier options.
"Processed foods are easier to chew, and they're very predictable in terms of what they taste like," Zucker said.
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