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Could picky eating be a sign of anxiety and depression?

Pittsburgh Post-Gazette (PA)
Aug 03, 2015

Aug. 03--Young Ella McKnight is a picky eater, and her mother knows why. Jeria Quesenberry ate the same way as a child and only expanded her menu a bit as an adult.

Nearly 4, Ella lives on diet of white carbs and fruit. Sometimes she pushes the envelope with a waffle, chicken noodle soup, yogurt or peanut butter. Once she ate baked beans.

Most lunches consist of white rice and half of a hamburger bun. Because Ella's diet matches her own as a child, Ms. Quesenberry isn't panicking.

"I haven't had too much concern," said Ms. Quesenberry, 37, whose family recently sold their Squirrel Hill home. "I try to get any nutrition into her that I can, and if she eats white rice for dinner, I'd rather that than try to force her to eat vegetables. At the end of the day, I'm picking my battles and feel that I was that way as a child, and I turned out OK."

But now a new Duke University study, published online today in the journal Pediatrics, suggests that selective eating -- what most parents call picky eating -- could signal depression, anxiety or even attention deficit hyperactivity disorder.

While every child has culinary likes and dislikes, those with moderate or severe selectivity could meet the definition of an eating disorder. They rely on a narrow list of food choices often with devotion to a single brand of favorite food.

Picky eaters also share hypersensitivity to smells, textures and tastes, resulting in a diet of bland foods that don't overwhelm their taste buds or senses. Another common denominator is aversion or outright disgust to new foods.

"The important finding is that with picky eaters, parents identify the problem and know when it is impairing them," said Nancy Zucker, director of the Duke Center for Eating Disorders. She led the new study, which focuses on psychological and psychosocial impairments in preschoolers related to selective eating.

"It is one way to get an indication that a child has a problem, and we're developing a tool kit for preventive interventions to arm parents for success," she said.

But don't call 911 or barrel into the streets with panic even if your kid won't eat breaded zucchini or spinach tortellini or refuses even to taste your pineapple chili. The study helps parents and physicians decide if and when to call a doctor, Ms. Zucker said, with the goal of developing an intervention strategy.

Parents often battle their children to eat healthy foods. So suggesting that picky eating might indicate that the child has avoidant-restrictive food-intake disorder might lead to some overreaction.

"My biggest fear is that this will ring terror across the country," said Ms. Zucker, an eating disorder specialist with a Ph.D. in clinical psychology.

The study involved 180 preschoolers ages 2 to just shy of 6 years and selected from 3,433 who were initially screened. Parents and health care providers cannot expect moderate or severe picky eaters to grow out of it and begin eating a wider variety of foods, it states.

About 20 percent of the children were found to be selective eaters. Of those, 18 percent had moderate levels of disorder with about 3 percent showing a severe condition.

Whether moderate or severe, the children also showed symptoms of anxiety and other mental conditions, but without any increased likelihood of a formal psychiatric diagnosis. Yet, they were twice as likely to have a diagnosis of depression.

At a basic level, the disorder leads to poor nutrition with negative impacts on health, growth, social function and relationships with parents, who often react to the problem by blaming themselves.

Ms. Zucker said children with autism spectrum disorder or mental illnesses were not included in the study, although they can share the symptom of hypersensitivity, raising interest in how hypersensory perception may contribute to psychiatric symptoms including ADHD and eating disorders including anorexia.

The study also found that the mothers of children with moderate levels of selective eating can have their own problems with anxiety, mental illness and drug abuse, with the child's eating behavior often leading to family conflict.

One acknowledged weakness in the study was its exclusive use of parental reports on their children's eating habits. But that weakness was mitigated, the study says, by a trained staff who followed diagnostic interviewing methods.

Jennifer E. Wildes, director of eating disorders research at the Western Psychiatric Institute and Clinic of UPMC, said the study "is the most rigorous out there on selective eating in young children."

"Before, many people thought it was just a phase in development," said the clinical psychologist, who has done research with Ms. Zucker. "It is important for health care professionals not to dismiss it and question what the child is eating and how it affects other areas of the child's life."

Ms. Quesenberry said her concerns are tempered by Ella's good health without signs of anxiety, depression or activity problems, although she definitely experiences hypersensitivity. Ella hasn't been diagnosed with an eating disorder.

"I try to be a good parent and encourage her to put food in her mouth and take a bite," she said.

"But she immediately throws a fit. The other day I tried to get her to taste corn and she thought it was candy corn, and tasted it and said: 'Oh, that's disgusting. I don't like that kind of corn.'

"But I never thought about it" being a disorder, she said.

David Templeton: dtempleton@post-gazette.com or 412-263-1578.

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