Preschoolers who are extremely picky eaters may also be more prone to mental health problems, a study suggests.

Children with severely selective eating habits were more than twice as likely to be diagnosed with depression or social anxiety than kids who consumed a wide variety of foods, the study found.

Even moderately selective eating was linked to some psychological difficulties. These kids were more likely to have symptoms of depression, anxiety and attention-deficit/hyperactivity disorder than children with more varied diets.

“This is not a simple story of indulgent parents or bratty kids,” said lead author Nancy Zucker, director of the center for eating disorders at Duke University. “These are children who are profoundly sensitive to their internal and external world – so things smell stronger and they may have more intense feelings.”

It’s normal for young children to go through a period when they are wary of unfamiliar foods or refuse to consume more than a handful of different items, though most kids outgrow this during elementary school. It isn’t necessarily harmful as long as the children maintain a healthy weight for their height, pediatricians say.

For the current study, Zucker and colleagues questioned caregivers of 917 children aged two through five.

Selective eating was common, with up to about 20 percent of parents reporting their preschoolers exhibit this behavior much or all of the time, the researchers report in the journal Pediatrics.

Among the kids with selective eating, 185 had moderate aversions to foods that led to a restricted diet, and another 37 had severely restricted eating habits that limited their ability to eat with others.

Levels of selective eating were linked to aversion to food and reduced growth, as well as heightened sensitivity to the texture, smell and appearance of food.

About two years after the first interviews, the researchers checked back with 187 children and their parents and found that kids with selective eating were 1.7 times more likely to have increased symptoms of generalized anxiety levels.

One limitation of the study is that it relied on parents to accurately report how their children ate and approached food, the researchers acknowledge.

Even so, the study adds to a growing body of evidence linking picky eating to sensory processing difficulties, said Helen Coulthard, a psychology researcher at De Montfort University in Leicester, U.K. who wasn’t involved in the study.

Some amount of pickiness is normal, and parents should be careful not to become overly anxious about how their kids eat as long as children grow and gain weight at a normal pace, Coulthard said by email.

She urges that the study by interpreted cautiously and says it’s important not to frighten parents about their children’s eating behavior. “Many children who are selective/picky from childhood gradually widen the repertoire of food they accept, especially when confronted with social situations where their behavior is frowned upon,” she said.

Still, parents should also recognize that picky eating can have a real psychological impact even in early childhood, Myles Faith, a nutrition researcher at Gillings School of Public Health at the University of North Carolina, Chapel Hill, said by email.

Avoiding mealtime battles is key when working to help picky eaters expand their diet, said Faith, who wasn’t involved in the study.

“The more frustrated parents get, the more they might try to control,” he said. “Tensions surrounding feeding, if sustained over years, could promote child anxiety or depression.”

This article first appeared on ‘Yahoo!‘ on 5 August 2015.