Picky eating in early childhood is far more common—and potentially more consequential—than many parents realize, according to new research. 

A large international study analyzing data from more than 35,000 children aged 3 to 8 uncovered compelling evidence that avoidant/restrictive food intake (ARFI), an extreme form of picky eating, is both widespread and closely associated with developmental challenges. 

The study, which drew on data from the Norwegian Mother, Father and Child Cohort, estimates that between 6 and 18 percent of children fall into patterns of eating so limited that they meet criteria for ARFI symptoms.  

And in two to three percent of kids, these patterns become clinically significant, meaning their restricted diets lead to nutritional deficiencies or failure to meet energy needs. 

Researchers say these findings highlight the importance of distinguishing everyday picky eating—a common frustration for parents—from severe, persistent avoidance that crosses into disorder territory. 

The team found that children with persistent ARFI were significantly more likely to have developmental difficulties compared to those with typical eating habits. These challenges spanned emotional, cognitive and social domains, consistent with earlier work linking restricted eating with conditions such as anxiety, attention problems and autism. 

Kids with clinically significant ARFI were also more likely to exhibit physical complaints, including gastrointestinal problems—patterns that mirror what clinicians see in practice. 

The study identified two genome-wide significant genetic loci associated with ARFI. Notably, a strong association was found with ADCY3, a gene involved in appetite regulation and previously linked to obesity and feeding behaviors.  

Estimates of heritability ranged from eight to 16 percent—small but meaningful genetic contributions suggesting biology plays a measurable role. 

Researchers also found small to moderate genetic correlations between ARFI and a range of other traits, including mental health conditions, cognitive abilities, anthropometric traits and gastrointestinal disorders. That overlap may help explain why children with ARFI so often experience broader developmental challenges. 

ARFI was formally recognized in the DSM-5 only a decade ago, and until recently, data on how often it occurs—and how it unfolds over childhood—has been limited. Previous estimates varied widely, from 1.5 percent to more than 60 percent, depending on how the disorder was defined and the populations studied. 

This new research, one of the largest longitudinal efforts to date, helps narrow those estimates and provides clearer evidence that extreme picky eating is not just a phase for many children.  

The authors emphasize that understanding who is most at risk—and why—is critical for informing public health guidelines, screening practices, and early interventions. 

The study concludes with a call for “broad support interventions,” noting that many children with ARFI do not receive timely help because symptoms can appear to be typical childhood behavior. Yet early intervention could help families prevent nutritional deficiencies and address developmental concerns before they escalate. 

The researchers also argue that better understanding of genetic contributions may ultimately support more targeted treatments and help reduce stigma for families navigating feeding challenges. 

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Reference

Bjørndal, L. D., Corfield, E. C., Hannigan, L. J., Ayorech, Z., Bulik, C. M., Watson, H. J., Dinkler, L., Chawner, S. J. R. A., Johansson, S., Andreassen, O. A., Ask, H., & Havdahl, A. (2025). Prevalence, Characteristics, and Genetic Architecture of Avoidant/Restrictive Food Intake Phenotypes. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2025.4786