Primary care physicians should consider intervention for toddlers who exhibit even moderate signs of selective eating, as this could be a reliable early sign of avoidant/restrictive food intake disorder and increased predisposition to anxiety, depression, and attention-deficit/hyperactivity disorder, a study published online Aug. 3 says.

“There is a need to develop interventions or provide further guidance to caregivers about the management of [selective eating]. Despite data that some children will seemingly grow out of SE without intervention, the presence of concurrent impairment warrants the development of strategies to intervene in all cases,” says the study, led by Nancy Zucker, Ph.D., of the department of psychiatry and behavioral science at Duke University, Durham, N.C.

The Duke Preschool Anxiety Study enrolled 917 children, aged 24-71 months, through primary care clinics to determine “patterns of psychiatric comorbidity and environmental variables associated with preschool anxiety disorders,” wrote Dr. Zucker and her associates. From that group, 187 children completed baseline and follow-up assessment. Results found that children with moderate selective eating (SE) habits were almost twice as likely to exhibit symptoms of attention-deficit/hyperactivity disorder (ADHD) and separation anxiety, and those with severe SE were more likely to have a concurrent psychiatric diagnosis, such as depression or social anxiety (Pediatrics. 2015 Aug 3. doi:10.1542/peds.2014-2386).

Furthermore, both children with moderate and severe SE showed higher rates of symptoms related to generalized anxiety, social anxiety, and depressive symptoms than children who did not exhibit SE. Researchers also found ties between SE tendencies and parents; specifically, children with either moderate or severe SE were more likely to have mothers with elevated anxiety and to have family conflicts around food.

Dr. Zucker and her associates advise parents not to adopt a “wait and see” approach if they observe SE in their children, saying intervention is critical. “Intervention development should consider unique features of SE: sensory sensitivity and aversion/disgust,” the investigators wrote. They added that the study’s findings highlight not only the need for intervention, but also such interventions should include specifically tailored methods for dealing with each child.

The investigators said their findings should be considered in light of several limitations. For example, measurements of children’s eating were made based on parental report only. In addition, children with pervasive developmental disorders were excluded, which means that the current study’s findings might not be generalizable.

The Duke Preschool Anxiety Study was supported by grants from the National Institute of Mental Health. Dr. Zucker and her coauthors did not report any relevant financial disclosures.