OBJECTIVE: We examined the clinical significance of moderate and severe selective eating (SE). Two levels of SE were examined in relation to concurrent psychiatric symptoms and as a risk factor for the emergence of later psychiatric symptoms. Findings are intended to guide health care providers to recognize when SE is a problem worthy of intervention. METHODS: A population cohort sample of 917 children aged 24 to 71 months and designated caregivers were recruited via primary care practices at a major medical center in the Southeast as part of an epidemiologic study of preschool anxiety. Caregivers were administered structured diagnostic interviews (the Preschool Age Psychiatric Assessment) regarding the child’s eating and related self-regulatory capacities, psychiatric symptoms, functioning, and home environment variables. A subset of 188 dyads were assessed a second time ∼24.7 months from the initial assessment. RESULTS: Both moderate and severe levels of SE were associated with psychopathological symptoms (anxiety, depression, attention-deficit/hyperactivity disorder) both concurrently and prospectively. However, the severity of psychopathological symptoms worsened as SE became more severe. Impairment in family functioning was reported at both levels of SE, as was sensory sensitivity in domains outside of food and the experience of food aversion. CONCLUSIONS: Findings suggest that health care providers should intervene at even moderate levels of SE. SE associated with impairment in function should now be diagnosed as avoidant/restrictive food intake disorder, an eating disorder that encapsulates maladaptive food restriction, which is new to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
Dr. Palmeri acknowledges that the day-care experience described its our article was "qualitatively comparable" and "a good surrogate" for that of the home-reared child. He agrees that infant day care "...did not interfere with the maturation and emergence of that important developmental landmark, separation anxiety and protest." He recognizes, as do we, that thought and feeling are interwoven. He expresses concern that the comments offered in our paper "may induce pediatricians to take infant day care lightly...."
One (or more) out of three marriages in the United States ends in divorce, involving numerous children. The result of a broken home by divorce may be similar to the death of the parent, affecting the emotional growth and development of children. Attention is focused here on the confusion in the parents and children, their projection and compensation for guilt feelings, retaliation by the use of the children, feelings of helplessness and magic in the children, their wishes to reunite the parents, the effects of relocation, and the influence of internal realignments on external realities. The initial emotional response is that of separation anxiety; following divorce finalization, there is a mourning reaction. The manifestation of these responses vary according to the child's age, sex, level of psychosexual development, previous history, and current arrangements. Some understanding and definite guidelines to visitation rights, parental dating, and remarriage are considered. If in spite of their own emotional upheaval the parents are alert to the child's anxiety or depression, they may be able to institute prophylactic measures. This requires parental cooperation which may be quite difficult. Here the advice and explanations of an informed and perceptive pediatrician may be of unique value.