Picky eating – its connection to anxiety and depression in children

This article –  Picky eating linked to psychiatric problems in kids study finds

 
Bet you can’t guess what I will say about this……
I think it is fantastic that researchers are looking into possible connections between a personality trait and a condition, such as biological reasons behind picky eating.  And I am even happier that mainstream news outlets are covering the stories that offer more information to their readers than the usual, “How to get your picky eater to eat more.”  However, I do think news outlets that cover medical research are missing the big boat here and in my opinion, the reason is to play on the drama surrounding psychiatric conditions.  I would like to know who doesn’t have some variation of anxiety, stress, depression, or something else?  That’s right, no one.
Issues arise when anxiety or depression does not go away, or when daily life is greatly impacted.  While I understand what the post on Today.com is sharing and appreciate the research article that this post is referring to, I do not see the need to use a dramatic title, nor the reason to post an article with such little depth.  What Today.com failed to look into, are the more detailed explanations for the connection between kids who are picky eaters and common psychiatric conditions.  As a mom of three children, as a medical writer and as someone who has worked in the medical field for years, it is my opinion that the title of the article on Today.com is potentially reckless and can cause unnecessary angst.  Why create drama for parents who already worry enough about their child barely eating enough food?  By using such a strong title and including little more in depth details, the article gives off the strong statement that a picky eater isn’t just picky, he/she actually has a serious mental illness instead.  Personally, I do not know one parent who would not begin to worry and possibly even seek professional help for a diagnosis.  Hence, why I felt as though this article provides little help for parents.
This post by Today.com also failed to mention various evidenced-based theories of why kids who are picky eaters are more prone to anxiety and depression – ie. the missing link. The cause. The underlying condition that is more than likely the genetic connection between both issues.  
If similar articles refer to research findings associated with adults, the dramatic title and the lack of deep content, would not bother me.  On the other hand, when we are discussing medical research that has to do with children who are picky eaters and a possible link to mental illnesses, I think the media needs to do its due diligence and dive in more.  Offering readers and listeners, especially parents, additional content, resources and information with the stories that they cover, would go a long way.
Here are a few ideas:
– Dig deeper into the research.
– Ask questions that the article does not cover, such as the actual missing link between why picky eating is linked to anxiety and depression, not just that it is link. Dig deeper into research and ask questions.
– Probe to find answers for the questions that fall outside of the mainstream medical box.
– Provide reputable resources for parents – not just hysteria.
The truth is, there is so much more to picky eating than just being “picky.”  Even Today.com quotes Nancy Zucker, study co-author and associate professor of psychology at Duke University stating, “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.”  
It IS way more complicated that we think.
Maybe proposing a question such as the one I just stated above, versus playing to what will get people to pay the most attention, would offer the help, guidance and education that parents need.  With more information, parents would be able to decipher information appropriately for their child’s personal case of pickiness, versus facing the sudden fear that their picky eater has a serious psychiatric condition that has gone undiagnosed.
Trust me… for many of us who were (are) picky eaters, there’s so much more to the story than having anxiety and/or depression (I used to get the number of peas for whatever month it was and swallow them like pills).  I mention anxiety and depression, not to disclude other serious mental illnesses, but because those are the conditions named in this article.
Here are a few more thoughts:
How about Sensory Processing Disorder (SPD)?  This article states, “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.” Sounds like SPD to me.
What is SPD linked to?  SPD is linked to Ehlers-Danlos Syndrome (EDS) (and other connective tissue disorders), which is linked to mast cell activation disorders, which are linked to food allergies.  And….systemic allergic reactions do not always present like the traditional anaphylaxis we are told about; there are different stages of anaphylactic reactions, including GI upset. See graphs to left and to the right below.
 
 
 
 
 
 
So, what are mast cell activation disorders?  Mast Cell Activation Disorders are when you have either too many mast cells, or your mast cells are overly reactive.  Overly reactive and having too many mast cells can lead to various levels of anaphylaxis. 
 
 
Where are our connective tissues?  Our connective tissues are all over our bodies – connective tissue even lines our entire GI tracts from the mouth to the anus.  That is a lot of square footage of connective tissue in just the GI tract!  Our bodies are made of 7 types of connective tissue.  According to Wikipedia, connective tissue can be described as:

“one of the four types of biological tissue that supports, connects, or separates different types of tissues and organs in the body. The other three types are epithelial, muscle, and nervous tissue. Connective tissue is found in between other tissues everywhere in the body, including the central nervous system. The outer membranes, the meninges, that cover the brain and spinal cord are composed of connective tissue.
All connective tissue apart from blood and lymph consists of three main components: fibers (elastic and collagenous fibers),[1] ground substance and cells. (Not all authorities include blood[2] or lymph as connective tissue.) Blood and lymph lack the fiber component. All are immersed in the body water.
The cells of connective tissue include fibroblasts, adipocytes, macrophages, mast cells and leucocytes.” 
 
 
 
 
 
 

Where are our mast cells?  Mast cells are made in our bone marrow and only travel in our peripheral blood when they are on the way to whichever type of connective tissue where they will live out their life cycle.  When a lot of mast cells are found in the blood, it can be suggested of a more serious problem.  For this reason, mast cell activation disorders seem to overlap so much with connective tissue disorders, like Ehlers-Danlos syndrome.  Mast Cell Activation Disorders are also considered bone marrow/blood conditions, because our blood has components of connective tissue in it. As mentioned above, not everyone in the medical community considers blood a type of connective tissue, because it lacks the fiber component that other types of connective tissues possess.  Below is a graphic of mast cells within connective tissue (adipose connective tissue), including the other necessary components that help provide structure and integrity.

Go here for a fantastic graphic on what mast cells really look like.  Graphic developed with the help of Dr. Theo – considered the mast cell master.  Additional graphics on Mast Cell Activation Disorders are below.

I’m not suggesting that since this article alludes to research showing a bigger, more serious connection to picky eating, that we should now give in to picky eaters all of the time.  In fact, I disagree that wholeheartedly.  My hope is to point out that various issues can stem from biological reasons, and that there is a lot more involved than a simple connection between picky eating and psychiatric conditions.  Kids do not always have the words to state what they are feeling in a way that adults can understand.  Most of the time, a child really has no idea what or why they are feeling the way they are, but they just are.  It could be the smell, the texture, the way a food crunches or doesn’t when eaten, the way it feels when it hits the stomach… it could be anything.  And when a child feels crummy, one of the only ways they know how to express it, is to say that they do not like the food or that they do not feel like eating.  I really cannot see why that would be bad thing.  Haven’t we also told them to not stuff themselves too much, or they will feel sick?  So, why state that a child is “picky,” if he/she is just expressing an opinion on a certain food?   Children are entitled to have opinions and if we constantly squash them and dismiss what they are trying to communicate, we can create a lifetime of issues.
 
How about wondering if that is where the psychiatric conditions actually stem from?  The fact that kids are made to feel bad and forced to eat food that many times makes them feel ill over and over again, can cause enormous stress, anxiety and even depression.  Even worse, PTSD.  We are only creating a more definitive link to developing a serious mental condition, when we make a huge deal about being picky.  What we are essentially doing is blaming children for the way they were born from the beginning.  I would argue that many kids develop the more severe aversions, when they are forced to eat something that does not make them feel well over and over again.  I don’t think that was part of the study parameters though.  One would think that it would be important to analyze the severity of the aversion and the related anxiety or depression, with how often a child was repeatedly made to eat something that they did not like.  Additionally, I would argue that some kids are probably going through some form of anaphylaxis when eating certain foods.  However, it is easy to overlook because it is not the typical anaphalaxis reaction.
My opinion is not that all picky eaters have EDS, a mast cell activation disorder, or that all picky eaters are having some level of anaphylaxis when they eat a food that they do not like.  The purpose in writing this post is to reiterate that kids are much more in tune with their bodies than we give them credit for.  Sometimes, we need to listen, be open to signs that may not always have an easy explanation, and even ones that most healthcare professionals are not aware of.
A personal example – my youngest told us that she did not want to eat tomato sauce anymore, because she felt that it caused this rash she kept getting.
Because we had no other explanation, we listened, even though it seemed silly and her suggestion came out of no where.
So, we stopped putting tomato sauce on her pasta, but she can still eat pizza.
She was right, no more rash. Gone. Done. No more. 
She is also a very sensitive and overly dramatic child (this isn’t just a girl thing, I have a son who is similar, but not as overly dramatic).
She has bouts of extreme nervousness/worry and gets sad very easily.  She hates to sleep alone. Sleeping along causes her a tremendous amount of stress, but her fear started only about a year ago.  Up until then, she slept in her room, by herself since she was 6 months old, but that’s just one example. I know many kids are similar, but her fear isn’t subsiding just yet.
She also is hypermobile and bruises very easily.
My point?  We already know that many kids are picky eaters, and about the same percentage seem to be predisposed to anxiety and feelings of sadness.  We also know that EDS is not that uncommon and either are mast cell activation disorders.  Additionally, we know that EDS and MCAD are both linked to each other, various psychiatric conditions, sensory processing disorders and food allergies.  And finally, we now know that sensory issues and psychiatric conditions are very common in kids who are picky eaters.
These inherent personality traits are not uncommon at all, just under recognized, under diagnosed and very much linked to an underlying genetic, multi-systemic condition for so many picky eaters.
Does that mean every parent of a picky eater needs to seek a diagnosis to rule out these misunderstood, multi-systemic genetic conditions?
No, not unless symptoms are severe enough to warrant medical attention. However, the choice is really a personal one, but considering aprox. 95% of those with EDS do not seek a diagnosis, I do not believe we need to create more hysteria.  Many kids grow out of their extreme pickiness and grow-up as adults with specific preferences.   I know that I’m certainly one of them. 
My hope is that we all concentrate on listening a bit more to our kids and the message that they are trying to share with us.  A little give and take goes pretty far.  It also helps to diffuse potential life-long issues the could stem from repeatedly pushing our kids to eat things that they have clear aversions to.
An excerpt from the article on Today.com is below, as well as are links to additional resources and information.

“That untouched plate andlook 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.
Picky eaters may have psychological problems, according to health study.
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.
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.
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.” 

 
 
 
 
 
To read the full post on today.com, go to: http://www.today.com/health/picky-eating-linked-psychiatric-problems-kids-study-finds-t35961
Additional Resources: 
– Mast Cell in GI Disorders
– Disordered mast cells, and the clues to food allergy
– Common comorbidities with Ehlers-Danlos Syndrome
– When else to suspect Ehlers-Danlos Syndrome
– Ehlers-Danlos Syndrome, Hypermobility Type: An Underdiagnosed Hereditary Connective Tissue Disorder with Mucocutaneous, Articular, and Systemic Manifestations
– Postural Tachycardia Syndrome: A Heterogeneous and Multifactorial Disorder
– Some tell-tale signs of mast cell activation disorders
– Top 10 nutritional tips and resources for optimal health with Ehlers-Danlos Syndrome