Experts warn that when dietary variety is limited for extended periods, the risk of essential nutrient deficiencies increases, even in children of a healthy weight.
Parents' concerns about picky eating in childhood are often minimized, as it is interpreted as a temporary phase.
However, experts warn that when this behavior persists or becomes very restrictive, it can develop into a problem with real nutritional impact. Among the less visible signs are mood changes and difficulty concentrating, which may appear before any obvious physical alterations.
Scientific evidence indicates that feeding difficulties can be associated with insufficient intakes of iron, zinc, calcium, essential fatty acids and vitamins, even in children of adequate weight.
“Food selectivity is part of development, especially between the ages of 2 and 3, but when it is prolonged or the variety of foods is significantly limited, it can compromise the supply of essential nutrients,” explained Dr. Irina Kovalskys, a pediatrician, nutrition specialist, and medical director of the Institute of Nutrition and Metabolism for Children and Adolescents (INUMI).
For this reason, experts emphasize that attention should be paid not only to how much the child eats, but especially to what he or she stops eating.
It is estimated that between 251 and 401 healthy children experience some form of feeding difficulty during their growth, with pickiness being the most common. Although in many cases it is transient, it may not be, according to studies published in the Journal of the American Dietetic Association and the International Journal of Eating Disorders.
A diverse diet is associated with adequate levels of micro and macronutrients, stable blood biomarkers, and expected evolution in terms of weight and height; however, weight and height alone do not necessarily reflect internal nutritional status.
Warning signs that indicate you should see a doctor
Distinguishing between a transitory stage and a persistent difficulty is key.
Some warning signs include a duration of pickiness longer than three months, fewer than 10 to 15 accepted foods, systematic rejection due to texture, color or smell, excessive eating times or frequent conflicts at the table, and negative impact on family dynamics.
“Rejection based on sensory characteristics, such as texture or color, can be a sign of greater complexity, even associated with difficulties in sensory processing,” Kovalskys adds.
Up to 201% of children with feeding difficulties do not receive an adequate diagnosis, which reinforces the importance of consulting with a pediatrician or nutritionist to promote early detection and take preventive measures, according to the narrative review published in Archivos Argentinos de Pediatría.
Children with feeding difficulties do not meet established recommendations and are at risk of nutritional deficiencies because they do not incorporate adequate amounts of food and beverages, exclude entire food groups, and maintain low diversity in their diets.
A recent meta-analysis published in BMC Nutrition indicates a significant association between lower dietary diversity and a higher likelihood of anemia in children and adolescents, confirming the relevance of dietary variety as a protective factor.
Strategies and a comprehensive approach to addressing selectivity
Overcoming food selectivity requires a progressive and sustained approach, based on repeated exposure to new foods, the gradual incorporation of changes in already accepted preparations, and the building of clear routines around meals.
“It is also helpful to involve the child in the purchase and preparation of food, and to adapt sensory aspects such as texture or presentation to facilitate acceptance. In cases where the variety of the diet is very limited or there is a risk of nutritional deficiencies, a professional evaluation may indicate the use of nutritional supplements as a support tool, while continuing to work on expanding the diet,” suggests Lucía De Nobili, a licensed nutritionist with a master's degree in Maternal and Child Nutrition and a nutritionist at the Ramón Carrillo Hospital.
Infant feeding involves a combination of biological, behavioral, and emotional factors. The approach requires a holistic perspective: growth assessment, dietary history, observation of behavior during meals, and, if necessary, additional testing.
Recognizing the problem and consulting with professionals allows families to be supported with appropriate strategies and to prevent nutritional deficiencies. In this process, the goal is not for the child to eat 'perfectly,' but to build, step by step, a more varied, sufficient, and healthy relationship with food.
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