(CNN) — So your young children won’t eat Brussels sprouts, broccoli or beans?
Maybe it’s just a phase, and they’ll grow out of it. Maybe they’re tired of you bossing them around and this is one place where they can push back. Maybe, many parents say, you should just let your picky eaters go hungry if they choose not to eat. They’ll eat when they’re really hungry, right?
While most young picky eaters grow out of their selective eating habits, a new study found that moderate and severe picky eating are associated with psychological issues such as anxiety, depression and attention-deficit/hyperactive disorder that may require intervention.
More than 20% of children ages 2 to 6 were found to be selective eaters in a Duke University study published Monday in the journal Pediatrics. The study authors conducted in-home assessments with 917 children and followed up with 187 children over two years.
“These are not children who don’t like broccoli and won’t touch a tomato,” said psychologist Nancy Zucker, the study’s lead author and director of the Duke Center for Eating Disorders. “These are not children who just defy authority, who are not eating what you want them to eat just because. These children are going through a lot of (psychological) issues.”
About 18% were found to be “moderately picky,” which means they only ate from a narrow range of food items. They often ate a separate dinner at home and brought their own food to dinners outside the home. The remaining 3% were severely selective in their eating, which limited their ability to eat outside the home.
Children with moderate or selective eating were nearly twice as likely to have increased anxiety over the study’s two-year follow up period.
“This shows that for some kids, it’s more than being picky,” said Dr. Jennifer Shu, an Atlanta pediatrician and co-author of “Food Fights: Winning the Nutritional Challenges of Parenthood Armed With Insight, Humor, and a Bottle of Ketchup.”
“The mental health component might make parents a little more understanding rather than force-feeding your kids,” she said.
Parents, who are often trying to make their children eat, also reported feeling judged for their picky eaters, Zucker, the psychologist, said.
Rather than treating picky eating as a single problem, picky eating could be a helpful clue of these other health concerns, Zucker said. Spotting a picky eater is easier than spotting mental health issues, which is why the study’s connection between eating and psychological issues is a good issue to raise with your pediatrician.
Parents who are concerned about their children’s eating can start a food diary to see if their children are picky everywhere, Shu said. Notice if they eat better at daycare or school or other people’s homes. They might notice that their children are filling up on drinks or snacks right before dinner. All of it — and your family’s mental health history — is fodder to share with your pediatrician.
It’s normal for young children to sometimes need to be reintroduced to food, sometimes as many as 10 times before finally liking the food, said Dr. Lisa Thebner, a Manhattan pediatrician.
“Identifying those children who are moderate to severely selective eaters as possibly having mood or sensory issues as well can aid pediatricians in identifying those at-risk children,” Thebner told CNN.
“In doing so, then we can be better able to make the appropriate referrals to any or all of the following: nutritionists, feeding therapists who can help with sensory issues to food, and specialists in pediatric behavior and development, who can help aid the child and the family working with the child.”