Understanding Picky Eating in Children: Insights from Recent Narrative Reviews

A recent narrative review shows persistent picky eating can threaten growth and micronutrient status, reframing it as a substantive pediatric concern rather than a benign developmental phase. When selectivity is persistent or pronounced, it warrants clinical attention.

Prevalence estimates range from 13% to 50% and peak between ages two and six. Much of that spread reflects methodological heterogeneity—sampling, definitions, and measurement tools—so early childhood is the key surveillance window and persistent food selectivity in this period merits systematic assessment.

Evidence separates routine picky eating (limited dietary variety without growth or psychosocial impairment) from feeding disorders such as ARFID, which present with weight faltering, nutrient deficiency, dependence on supplements, or marked psychosocial impact. Escalation signals include downward crossing of growth percentiles, laboratory evidence of micronutrient deficit, marked mealtime avoidance, or coexisting developmental concerns. In practice, pursue further evaluation when intake or growth patterns deviate from expected trajectories.

Family-centered interventions that combine repeated, structured exposures with responsive feeding reliably expand dietary variety and improve intake among selective eaters. Trials and program descriptions support embedding structured exposures within family routines; exposure-based therapy figures as a core component alongside caregiver coaching and noncoercive strategies. Prioritize repeated exposure and consistent responsive mealtime routines to increase acceptance without coercion.

Targeted nutritional risks include shortfalls of iron, zinc, vitamin D, and overall calorie deficits when variety is severely limited, with potential downstream effects on linear growth and developmental progress. Practical triggers for laboratory or dietetic evaluation are slow or downward crossing of growth centiles, clinical signs of deficiency, and extreme restriction that persists beyond the toddler years. Pair behavioral feeding strategies with targeted dietary assessment when risks or growth deviations are present.

Routine growth monitoring combined with family-centered feeding support provides a measurable pathway to reduce downstream nutritional shortfalls and to trigger timely multidisciplinary care for the subset of children at persistent risk.

Key Takeaways:

• Most cases remit, but a defined subset shows persistent selectivity linked to micronutrient shortfalls and growth risk.
• Children aged two to six are most commonly affected; persistent trajectories concentrate in a smaller subgroup with greater nutritional and psychosocial risk.
• Integrate routine growth monitoring with family-centered feeding support and selective nutritional testing to identify children who need multidisciplinary evaluation.