Don't panic if your toddlers and young kids are fussy eaters - but do pay attention. Very selective eating in preschoolers may be an early warning sign that they are at risk for depression or anxiety and need support, a major new study finds.Picky eating in children is common and nearly 20% of the children, aged two to six years old, in the US study were moderately "selective" eaters.Three percent of them were "severely selective" - restricting their ability to eat with others - and they were more than twice as likely to be diagnosed with depression and show symptoms of anxiety."The question for many parents and physicians is: when is picky eating truly a problem?" said lead author Dr Nancy Zucker, director of the Duke University Centre for Eating Disorders.Parents tend to see fussy eating as a normal developmental phase but the research shows that it "often coincides with serious childhood issues such as depression and anxiety that may need intervention".South African psychiatrist Dr David Benn said "this group of children are at risk for emotional, psychological or psychiatric problems but not all of them will end up with anxiety or mood disorders. Many, even the majority, will not develop these disorders."Occupational therapists have developed the concept of "sensory integration disorders" in children whose sense of smell or touch is heightened.Benn said these children were "often highly distressed by what most of us see as ordinary sensations, such as the smells of certain foods as well as the texture of clothes."We often see conditions like ADHD, anxiety disorders such as OCD and depression in this group of children. It is also often associated with learning disabilities."The children who were moderately selective eaters in the Duke study had elevated symptoms of ADHD and separation anxiety.Port Elizabeth dietician Annatjie Smith has researched "tactile defensive children" with "extreme sensitivity in their mouths" and found they were twice as likely to be picky eaters. These children struggled to eat highly textured foods such as raw vegetables as well as low-textured foods such as mashed potatoes.Zucker said some of the children who refused to eat "might have heightened senses, which can make the smell, texture and tastes of certain foods overwhelming, causing aversion and disgust".Others may have had a bad experience with a new food and be anxious about being forced to try it again.The American children who were picky eaters had sensory sensitivity outside of food, experiences of food aversion and frequent family conflicts over food.Zucker advised parents who were often fighting with preschoolers over food to find new tools. Health professionals can diagnose this problem and occupational therapists, trained in sensory integration, can give therapy, suggested Smith at the time her research was released.The study 'Psychological and Psychosocial Impairment in Preschoolers with Selective Eating' was published last week in the journal PediatricsSTOP THE FUSSTIPS TO AVOID FUSSY EATING by Deirdre Randall, author of the bestseller 'Easy Meals for Babies and Toddlers'Never keep sweets, chips, cold drinks and other unhealthy foods in the house which can fill kids up before meals. Children will eat when they're hungry and will make the wrong choices if unhealthy food is available.Find out what healthy foods they will eat and dish them up. They may be unconventional but provide a balanced diet.Confine their choices to three or four items such as yoghurt, cheese, fish and fruit and ask them to choose. Don't ask them what they would like to eat or the answer could be chocolate.Appeal to their self-esteem by involving them in preparation, such as grating or chopping or preparing their own sandwich.Allow them a buffet menu for a change. Just separating food and serving in different containers or in a muffin pan will do the trick.Be creative with food, making it into shapes or designs, or let them cut out shapes.Help them to grow their own vegetables which they can eat. Dried beans under cotton wool is a good start.Make meals a sociable occasion and sit down and talk to them.Lead by example with a healthy plate of food yourself, which they can pick off.Forcing a child to eat will do more harm than the nutritional value is worth. Before she has time to reject her food, start an interesting conversation or remind her of happy events...