Perhaps one of the most satisfying moments in being a parent is when a young child tucks in to your carefully prepared meal with glee, and perhaps one of the most soul destroying moments is when your child refuses to even try the dish you have thoughtfully prepared. Around a quarter of parents report that their toddler has episodes of food refusal, with less than 5% having significant food refusal.
These young children who are particularly fussy or picky eaters may meet criteria in the new edition of the Diagnostic and Statistical Manual (DSM) for Avoidant/Restrictive Food Intake Disorder (ARFID). To fulfil the diagnostic criteria the child needs to demonstrate an eating or feeding disturbance that leads to significant weight loss, or significant nutritional deficiency, or a dependence on enteral feeding or nutritional supplements, or a marked interference with psychosocial functioning. So unlike the earlier versions of the disorder in the DSM, the requirement for weight loss or failure to gain weight is no longer present and the disorder acknowledges the distress families can go through with a child that is a highly selective eater.
These changes to the diagnostic criteria should facilitate earlier referral of children for assessment and management. A large scale study reported in 2015 that looked at selective eating and psychiatric symptoms found that even a moderate level of eating disturbance was associated with psychopathological symptoms associated with anxiety and depression. They hypothesized that those with anxiety symptoms may have experienced episodes of gagging on a particular food that may lead to the development of phobic like responses to particular food tastes, colours or textures. Another sub-group are those young children that exhibit signs of conduct disorder and their non-compliance with eating is just a manifestation of their behavioural disturbance. In severe cases a comprehensive multidisciplinary assessment should have input from nutritionists, speech pathologists and psychologists, to determine the specific type of eating disturbance.
There is now well developed treatment approaches to addressing fussy eating at an early stage, mainly based around a cognitive behavioural approach that uses graduated exposure and positive rewards. The programs provide a step by step guide for parents to introduce new foods, while training the child to reduce their anxiety. The programs also provide the parents with support to resist the temptation to simply provide foods the child will accept. It is not uncommon for parents to report that their toddler refuses everything except a particular type of yoghurt or milk drink, despite their best efforts to provide a range of foods.
 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington VA: American Psychiatric Publishing.
 Zucker, N., Copeland, W., Franz, L., Carpenter, K., Keeling, L., Angold, A., & Egger, H. (2015). Psychological and Psychosocial Impairment in Preschoolers With Selective Eating. Pediatrics. doi:10.1542/peds.2014-2386