Diet fortification for mild and moderate picky eating in typically developed children: Opinion review of Middle East consensus

Table 2 Characteristics of different grades of picky eaters

Characteristic	Mild picky eaters	Moderate picky eaters	Severe picky eaters
Definition	Children consume inadequate amounts and variety of foods without evidence of over- or undernutrition or micronutrient deficiencies	Children consume inadequate amounts and variety of foods with evidence of over- or undernutrition or micronutrient deficiencies	Extreme food selectivity and refusal leading to significant nutritional deficiencies, growth impairment, and/or psychosocial issues
Nutritional status	Generally adequate nutritional status	Signs of malnutrition, such as poor growth or micronutrient deficiencies	Severe malnutrition, including faltering growth, severe micronutrient deficiencies, and/or significant weight loss
Impact on growth and development	Minimal impact on growth and development	May experience delayed growth, developmental delays, or cognitive impairments	Severe growth impairment, developmental delays, and cognitive deficits requiring urgent intervention
Behavioral characteristics	Mild food selectivity, reluctance to try new foods, flexible eating habits	Moderate food selectivity, avoidance behaviors, mealtime struggles	Extreme food refusal, sensory sensitivities, intense anxiety around eating
Intervention needs	Dietary counselling, nutritional education, minor dietary modifications	Comprehensive nutritional interventions, behavioral therapy, family support	Intensive multidisciplinary intervention, medical evaluation, feeding therapy, psychological support
Risk factors	Fewer risk factors for severe malnutrition compared to moderate and severe picky eaters	A higher risk of nutritional deficiencies, growth faltering, and health complications	The highest risk of severe malnutrition, developmental delays, and psychosocial issues
Clinical management	Managed with dietary counselling, nutritional monitoring, and reassurance	Coordinated approach involving healthcare professionals, addressing nutritional deficiencies, feeding difficulties, family stressors	Specialized care from a multidisciplinary team, addressing complex feeding issues, nutritional rehabilitation, psychosocial support