Thursday, August 6, 2015

Extremely picky eaters

Clinicians should intervene when preschoolers are extremely picky eaters, as even moderate levels of selective eating (SE) are associated with impaired psychological and psychosocial function, according to a study published online August 3 in Pediatrics. Clinicians should not view SE as a phase the child will "grow out of," write Nancy Zucker, PhD, from the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, and colleagues. Rather, SE should be seen as a warning sign for current impairment and "a marker for later psychopathology." Screening for SE in primary care practices would help identify vulnerable children. 

It is not uncommon for young children to turn up their noses at a variety of foods, with up to 20% of parents saying their 2- to 5-year-old children are "sometimes" or "often" selective about what they will eat, Dr Zucker and colleagues write. However, it remains murky as to when food aversion becomes severe enough for clinicians to take action. 

Nancy Zucker, William Copeland, Lauren Franz, Kimberly Carpenter, Lori Keeling, Adrian Angold, Helen Egger. Psychological and Psychosocial Impairment in Preschoolers With Selective Eating.  Pediatrics. Published online August 3, 2015


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 71months 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.

CONCLUSIONS: Findings suggest that health care providers should intervene at even moderate levels of SE. SE associated with impairment in function should now be diagnosed as avoidant/restrictive food intake disorder, an eating disorder that encapsulates maladaptive food restriction, which is new to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

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