Psychological and Psychosocial Impairment in Preschoolers With Selective Eating

Abstract

OBJECTIVE: We examined the clinical significance of moderate and severe selective eating (SE).Two levels of SE were examined in relation to concurrent psychiatric symptoms and as a risk factor for the emergence of later psychiatric symptoms. Findings are intended to guide health care providers to recognize when SE is a problem worthy of intervention.METHODS: A population cohort sample of 917 children aged 24 to 71 months and designated caregivers were recruited via primary care practices at a major medical center in the Southeast as part of an epidemiologic study of preschool anxiety. Caregivers were administered structured diagnostic interviews (the Preschool Age Psychiatric Assessment) regarding the child's eating and related selfregulatory capacities, psychiatric symptoms, functioning, and home environment variables. A subset of 188 dyads were assessed a second time ∼24.7 months from the initial assessment.RESULTS: Both moderate and severe levels of SE were associated with psychopathological symptoms (anxiety, depression, attention-deficit/hyperactivity disorder) both concurrently and prospectively. However, the severity of psychopathological symptoms worsened as SE became more severe. Impairment in family functioning was reported at both levels of SE, as was sensory sensitivity in domains outside of food and the experience of food aversion.

Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment

“…Selective eating (though not necessarily ARFID) in childhood has been identified as a risk factor for future psychiatric symptoms. 17 While picky eating (accepting a food one day but eschewing it the next, or systematically avoiding some non-preferred foods, such as broccoli) is common in youth—particularly in preschoolers—children typically expand their diets as they mature. However, there are no data evaluating spontaneous remission rates among individuals with frank ARFID, which differs from developmentally normative picky eating in that individuals with ARFID may not reincorporate previously dropped foods, or may avoid entire categories of food (e.g., all vegetables).…”

Adult picky eaters with symptoms of avoidant/restrictive food intake disorder: comparable distress and comorbidity but different eating behaviors compared to those with disordered eating symptoms

“…Picky eating appears to be quite common across the lifespan, although prevalence estimates vary widely (e.g., 5.6–56 %), likely because of the lack of a standardized, widely used instrument to measure picky eating behavior [32]. Although in most cases, picky eating does not interfere with weight status, growth, or psychosocial functioning, severe picky eating can lead to symptoms of avoidant restrictive food intake disorder (ARFID; [2, 36]). ARFID can be diagnosed in individuals of any age or developmental level whose restrictive eating leads to weight loss, nutritional deficiencies, dependence on nutritional supplementation or enteral feeding, or psychosocial impairment, and cannot be attributed entirely to shape and weight concerns or medical comorbidity [2].…”

“…In childhood, picky eating has been concurrently and prospectively associated with internalizing psychopathology [17, 22, 32, 36]. Adult picky eaters score higher than peers on measures of depression and obsessive compulsive disorder symptom severity, and report lower eating-related quality of life [18, 34].…”

Variants in Chemosensory Genes Are Associated with Picky Eating Behavior in Preschool-Age Children

“…Picky eating may influence the risk of both underweight and overweight [3,4], development of functional gastrointestinal distress [5] and eating disorders later in childhood [6]. In addition, picky eating in children is associated with emotional and behavioral problems, such as depression, anxiety, and somatic complaints [7,8]. …”