Selective Eating in Toddlers: Cause for Concern?

Recently, an article published by our colleague Dr. Nancy Zucker at Duke University, received a lot of media attention. The study, titled Psychological and Psychosocial Impairments in Preschoolers with Selective Eating1, highlighted the correlation between selective (picky) preschoolers and the development of mental health problems such as anxiety, depression, and attention deficit hyperactivity disorder. The study, which sampled just over 900 children ages 2-6, found that even moderate pickiness could suggest mental health concerns later in life. And for those with severe selective eating and aversion, the likelihood of developing social anxiety disorder, defined as an excessive fear of social situations and anxiety related to being judged, was seven times higher than in the general population.

If you are a parent like I am, this information probably concerned you. I’ve spent hours sneaking vegetables into baked goods in an attempt to nourish my picky eater…all to little or no avail. After hearing about this study, I couldn’t help but wonder if my child’s picky eating was indicative of a much larger problem. And if so, could I change the course by making my child eat a larger variety of foods?

Dr. Zucker was quick to calm worried parents, and the last thing she wanted was for this study to make parents worry about absolutely normal developmental phenomena. It is critical to remember that correlation does not equal causation. That is to say, picky or selective eating does not cause mental health problems. Nor are parents to blame for their children’s food aversions. Parents cannot cause psychiatric disorders by not encouraging their children to eat new foods.

Zucker and her colleagues highlight the following discussion points in their study:

  • Selective eating is a normative developmental stage for many children. In fact, almost 15% of children demonstrate selective eating until late childhood.
  • Children with severe selective eating and food aversion are more likely than children without selective eating to already have a concurrent psychiatric diagnosis

So what exactly is a parent to think if their preschooler’s diet consists solely of cheese and applesauce? Dr. Zucker’s article suggests that if a child demonstrates severe food aversions, intervention may be necessary to determine if the child has an eating disorder such as avoidant and restrictive food intake disorder (ARFID). According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, ARFID is described as: An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs2.

But, a picky eater might just be a sensitive child who perhaps needs some monitoring and encouragement. For more information on ARFID, see our blog on Just a Picky Eater.


  1. Zucker, N., Copeland, W., Franz, L., Carpenter, K., Keeling, L., Angold, A., & Egger, H. (2015). Psychological and psychosocial impairment in preschoolers with selective eating. Pediatrics. doi:10.1542
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: American Psychiatric Association, 2013.