Original Article Early Predictors of Childhood Restrictive Eating: A Population-Based Study Nadia Micali, MD, MRCPSych, MSc, PhD,*†‡ Charlotte U. Rask, MD, PhD,§\ Else Marie Olsen, MD, PhD,¶** Anne Mette Skovgaard, MD, DM Sci¶†† ABSTRACT: Objective: Childhood eating problems, in particular restrictive eating, are common. Knowledge and understanding of risk mechanisms is still scarce. We aimed to investigate prospective early risk factors for restrictive eating across child, maternal, obstetric, and sociodemographic domains in a population-based sample of Danish 5 to 7 year olds. Method: Data on restrictive eating patterns (picky eating, slow/poor eating, and emotional undereating) collected on 1327 children from the Copenhagen Child Cohort 2000 were linked with registered and routinely collected health nurse data (during the first year of life). Prospective risk factors were investigated in univariable and multivariable regression models. Results: Feeding problems in infancy were prospectively associated with childhood picky eating (odds ratio [OR] 5 2.02, 95% confidence interval [CI], 1.20–3.40) and emotional undereating (OR 5 1.49, 95% CI, 1.05–2.11). A high thriving index in infancy was inversely associated with both picky and slow/poor eating. Having 2 non-Danish-born parents predicted slow/poor eating (OR 5 5.29, 95% CI, 1.16–24.09) in multivariable analyses, as did maternal diagnosis of a psychiatric disorder before child age 5 years in univariable analyses (OR 5 6.08, 95% CI, 1.70–21.72). Conclusions: Feeding problems and poor growth in the first year of life show high continuity into childhood restrictive eating. Maternal psychopathology is an important and modifiable risk factor. These findings confirm that early signs of poor eating and growth are persistent and might be useful in predicting eating problems in mid-childhood. (J Dev Behav Pediatr 37:314–321, 2016) Index terms: restrictive eating, feeding disorders, children, predictors. Childhood eating problems are common and reported by about 20% of parents 1 ; they often cause concern for parents and lead to high treatment seeking in pediatric settings. 2 Eating problems in childhood are multifactorial in etiology and associated with a range of adverse out- comes such as poor growth, overweight and obesity, and high social impairment. 3–5 Nevertheless, there is still a paucity of research that fo- cuses on the whole spectrum of childhood restrictive eating (undereating, selective/picky eating, and avoidant eating). The reason for lack of available evidence is likely to be due to 2 factors: (1) boundaries between “pathological” eating problems versus eating behaviors that do not impact on the child’ s physical, psychological, and social well-being are still unclear; (2) a lack of consensus about clinical definitions and diagnostic thresholds. 6,7 Avoidant and Restrictive Food Intake Disorder (ARFID) was recently introduced in DSM- 5, 8 aimed at (1) capturing clinically impairing disorders of food intake (across ages) that are not explained by medical disorders; (2) improving understanding of feeding disorders that impact on the child’ s life, and (3) unifying clinical definitions of childhood avoidant and restrictive eating problems. ARFID has been the focus of little research; however, the one study so far to investigate ARFID in a population-based sample of children found that ARFID was common, with a prevalence of 3.2%. 9 Eating behaviors show continuities across infancy and childhood. Although evidence shows high continuity of overeating patterns into overweight and obesity, 10,11 limited research is available on longitudinal tracking of poor and selective/picky eating. Studies on picky eating show a high continuity in childhood, and persistence in up to a third of subjects. 12–14 Similarly, investigations of early determinants and predictors of childhood eating problems are few and far From the *Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY; †Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY; ‡Institute of Child Health, Child and Adolescent Mental Health, Palliative Care and Pediatrics, University College London; §Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark; \Child and Adolescent Psychiatric Center, Aarhus University Hospital, Risskov, Denmark; ¶Child and Adolescent Mental Health Center, Mental Health Services, Capital Region, Denmark; **Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; ††Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark. Received September 2015; accepted December 2015. Institute of Social Psychiatry. The main CC5-7 study was supported by The Copenhagen County Research Foundation (now called The Capital Region of Denmark), The Health Insurance Foundation, Mrs C. Hermansens Memorial Fund, Butcher Max Wørzner and wife Inger Wørzner Foundation, The Psychiatric Foundation of 1967, The Tryg Foundation, The Augustinus Foundation, and The Danish Association for Mental Health. Disclosure: The authors declare no conflicts of interest. Address for reprints: Nadia Micali, MD, MRCPSych, MSc, PhD, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY 10029-6574; e-mail: Nadia.micali@mssm.edu. Copyright Ó 2016 Wolters Kluwer Health, Inc. All rights reserved. 314 | www.jdbp.org Journal of Developmental & Behavioral Pediatrics Copyright Ó 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.