That untouched plate and look of disgust on your child's face at mealtime might be a sign of much bigger issues.
Picky eating, even at moderate levels, is linked with psychiatric problems, including anxiety and symptoms of depression in kids, according to a study published Monday in the journal Pediatrics. It found the mental problems worsened as the picky eating became more severe.
While many parents and doctors take a "wait and see" approach, hoping it's a phase the child will grow out of, the issue is serious enough that health care providers should intervene, the paper concludes.
For parents, the issue can be a nightmare as children skip entire food groups like fruits and vegetables. Some say doctors blame them for not trying harder.
"We need to do a better job of giving advice to these parents," Nancy Zucker, study co-author and associate professor of psychology at Duke University, told NBC News.
"The first take-home message is that you're not to blame. The second take-home message is that it's more complicated than we think."
The study screened more than 1,000 children ages 2 to 5, and found 20 percent were picky eaters. The researchers stress this goes beyond kids who just hate broccoli or have certain dislikes.
More than 17 percent of kids were classified as moderate picky eaters: These children had a very limited range of foods they would eat and they would not try anything else, Zucker said.
About 3 percent were considered severe picky eaters: Their sensitivities to smell or taste were so strong that even eating outside of the home was difficult. As they get older, it could be hard for them to go out with friends or eat at school.
Corey Fader, a 19-year-old student at the University of Pennsylvania, can relate. As a child, he would throw up unless he ate certain foods, including chicken fingers, pasta with butter, macaroni and cheese and pizza, he said. That's still Fader's day-to-day diet as he struggles to tolerate more dishes.
"If I see or if I try a different food, I'll have my cup of water ready, I'll be over by a trash bag or something like that just preparing myself to throw up," Fader said. He yearns for the day when he can order a regular meal at a restaurant when he hangs out with friends.
Picky eaters are more sensitive to the texture and smell of food, and have a stronger sense of disgust than other kids, the study found. This ability to experience the world more intensely may also make it harder for them to get a grip on their emotions or focus, the researchers suggest.
"These are just sensitive kids, they see things more intently, they feel things more deeply and that's both in their own internal experience and the world around them. So they have more vulnerabilities to experience taste more vividly, but also more emotions more strongly," Zucker said.
Children who were either moderate or severe picky eaters were more likely to have symptoms of anxiety or depression the study found. They were also more likely to have mothers with high anxiety and to have family conflicts around food.
Given that picky eating is linked with psychiatric problems, there should be strategies in place for doctors to intervene, especially for kids in the severe category, the study urges.
The researchers also note the term "picky eating" may now be obsolete. They suggest the condition might be better described as avoidant/restrictive food intake disorder (ARFID).
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