Picky eaters? I’m not worried.
I have twin seven year-old girls. One girl eats – or will at least taste – most foods. She’s a pastanista, loves hot dogs, and happily munches on broccoli. My other girl is much more picky. She has just recently expanded her repertoire of whole wheat waffles or pancakes with jam to include whole wheat bread and jam. She loves mac and cheese, chicken nuggets, hot dogs, certain yogurts, couscous, and milk. That pretty much sums it up. Is she on a path that leads to clinical anxiety and depression? New research says possibly. But I’m not worried.
I’ve never bothered much with any of my kid’s eating habits except to ask “Do you want to try some?” when I’m eating cassoulet. I’ve taken a firm stance to never take a firm stance as far as food goes. I spent many miserable evenings at my Aunt and Uncle’s house where he made me eat everything on my plate, no matter how horrible I thought it was. Children everywhere grow up to be normally eating adults and I have just never understood the “Dammit! I put it on your plate and now you’re going to eat it!” mentality. I’ve always thought that kids will eat when they are hungry and I simply refuse to fight about it. While my feelings are entirely anecdotal, Dr. Nancy Zucker, of Duke University, has recently published research (here) that says that I’m missing an important nuance. While generally upholding my sense that picky eating is normal, she finds that, for a small group of children, this picky or selective eating (SE) can lead to more serious behavioral concerns.
She defines selective eaters as children who:
- Restrict eating of certain food
- Have strong food preferences
- Are unwilling to try new foods
- Eat a limited amount
If you think this describes you or your child, then you’ve noted one question I have about her findings. The definition is too broad. But she adds that selective eaters can have difficulty in eating with others. Not because they don’t get along with others but because they eat such a limited menu. In more extreme cases, selective eaters find it difficult to remain at the table with certain foods, so strong is their repulsion.
She begins her assessment with a group of over 900 children, aged 24-71 months, screened out of a population of about 4,500 who attend the Duke Children’s Pediatric Primary Care Clinics. After initial selection, a questionnaire for each child was completed and then followed by in-home parent interview. Children were scored according to their level of voluntary selective eating. Children with no restricted intake, other than foods like broccoli that almost all children hate, were coded with a “0”. Those who only ate foods ‘within the range of his/her preferred foods’ scored a “1”. And those for whom ‘eating with others was difficult because of the extreme limited range’ [of food preference] were scored a “2”. “0” correlates to normal, “1” to having moderate SE, “2” to severe SE. Truth be told, I’ve met about three kids in my life who didn’t care about what they ate. Moderate SE seems much more normal to me. If not normal, then certainly common.
About 20% of the children screened exhibited moderate SE. Only 3% showed severe SE. Parental behaviors were noted as well: mothers of children with moderate SE were more likely to have sought psychiatric treatment for themselves than mothers of children with severe SE. Both moderate and severe SE children had mothers with ‘high maternal anxiety’. Children with moderate SE were more likely to have mothers with a history of drug use and children with severe SE were more likely to be female. Children exhibiting either moderate or severe SE had a higher correlation with depression, anxiety, and ADHD than normal eaters. There is statistical evidence that many kids with moderate or severe SE will grow out of it as part of normal eating and growth patterns.
Parents of these children are often accused by friends, and even by health officials, of being overly accommodating to their children’s petulant demands but Zucker argues that this isn’t a power play on the part of the child. She writes that, while causative links between SE and anxiety disorders are unknown, it’s possible that there is a correlation between a heightened food or taste awareness and a heightened awareness of surroundings causing anxiety. This anxiety about surroundings could exhibit in a child’s desire to control the sameness of their environment to whatever extent possible. Follow-up studies show that children with moderate or severe SE are 1.7 times likely to exhibit anxiety disorders as they age. Zucker suggests that we should drop the dismissive label of a child as a picky eater and recognize that food avoidance can be a true physiological disorder.
I have my normal concerns over this research just as I do about anything from the social sciences¹. The numbers tend to be fuzzy. The results would be difficult to reproduce and generally impossible to falsify. The old research saw that, if humans are involved, then you’ve got a problem, is a concern. But Zucker makes a strong case and the statistics show clear significance. She is not investigating causal mechanisms but, per the abstract, is hoping to understand SE enough ‘to guide health care providers to recognize when SE is a problem worthy of intervention’. She argues well that further investigation can be warranted for both child and family when food choices block normal development and normal interactions.
Should you force your kids to eat those tomatoes? No. The number of children who exhibit severe SE is low – three percent of those observed in this study. Most children are food averse to some degree and most grow out of it as they grow up, hang out with friends, and change physically. But her research argues that, for a few children for whom eating is a true challenge, then early behavioral intervention might very well be helpful. So if your four year-old can’t even be in the same room as a sliced tomato it might be time to consider talking to someone.
What do you think? Do you have experience with picky eaters? Do you have hint to help other parents cope?
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Note 1: NYT: Many Psychology Findings Not As Strong As Claimed (To be fair, I must say that this paper has come under heavy scrutiny and criticism. In a case of the pot calling the kettle black, Harvard University, cited as writing erroneous papers, reviewed the Psychology Findings meta-paper and found that the writers made several egregious errors themselves. I will only say it again: any time that you have human researchers working with human subjects, you have the potential for a bonfire of error.)
Nancy Zucker, PhD, webpage at Duke Medicine here. A recommended source for research regarding eating and health.
Selective Eating: The Role of Sensitivity, Gut Feelings, and Disgust. A presentation by N. Zucker, 2014.
Picky Eating in Children Linked to Anxiety, Depression, and A.D.H.D. Nice write up at the NYT from Rachel Rabkin Peachman (Interesting that Dr. Daniel Amen, of the Amen Clinics, a brain health center, is convinced that these brain issues are linked to nutrition.)
Are humans subjects being used by human researchers? Be wary of goofiness. Read here.