Rena, a charming three-year-old, stares at the carrots, potatoes and chicken on her plate. She tells her mom she doesn’t want any of it. No matter what is served, Rena wants to eat mac and cheese and hotdogs. Her mom is concerned about her nutrition so continues to place the healthy foods in front of Rena.

Rena, like other kids who refuse to eat a variety of foods,  is a picky eater–a child who limits her foods to a selective list. According to studies, about 14-24% of preschoolers are picky eaters at least some of the time.

However, because a behavior like picky eating is common, does not it mean it is harmless.

According to Duke researchers, parents of  moderate to severe picky eaters,need to pay attention. A study published in Pediatrics indicates that picky eating is associated with more than eating habits.

Children that had severe levels of picky eating were twice as likely to be diagnosed with depression and social anxiety than kids who ate a normal range of food. And kids with moderate levels of picky eating were more likely to have symptoms of depression, anxiety and attention-deficit/hyperactivity disorder than the non picky eaters. Over time, picky eaters also had a higher risk of developing anxiety as they aged.

So what can a parent do to help avoid future mental health concerns? Intervene now. Follow these suggestions from my book, Raising Healthy Kids in an Unhealthy World based on the research of Dr. Kolp-Jurss:

1) During a stress free time of day, tell your child the expectation is to eat all 3 meals a day.

2) There will be no special meals. He/she eats what the family eats.

3) According to Dr. Kolp-Jurss, it may take up to 20 mealtimes before your child re-engages so you have to persist with this strategy when the going gets tough.

4) If your child resists, tell him/her that is his/her choice. Inform when the next meal will be. Do not make the child sit at the table for hours until he/she eats. This only becomes a power struggle.

5) Eventually, the child will get hungry and be ready to engage at the next meal. The important part is to not give in during the retraining.