By age four, children could be established picky eaters, a new study suggests. And the more parents try to control and restrict children's diets, the more finicky they may become, according to findings published in Pediatrics.

"Picky eating is common during childhood and parents often hear that their children will eventually 'grow out of it.' But that's not always the case," says senior author Megan Pesch, M.D., a developmental behavioral pediatrician at Michigan Medicine C.S. Mott Children's Hospital.

But there's a silver lining for worried parents -- while fussy eaters have a lower body mass index, most are still in the healthy range and not underweight, researchers found. They may also be less likely to be overweight or experience obesity than peers.

"We still want parents to encourage varied diets at young ages, but our study suggests that they can take a less controlling approach," Pesch says. That being said "we need more research to better understand how children's limited food choices impact healthy weight gain and growth long term."

The study followed 317 mother-child pairs from low-income homes over a four-year period. Families reported on children's eating habits and mothers' behaviors and attitudes about feeding when children were four, five, six, eight and nine.

Picky eating was stable from preschool to school-age, indicating that any attempts to expand food preferences may need to occur in toddler or preschool years to be most effective. High picky eating was associated with lower BMIs and low picky eating was associated with higher BMIs.

The pickiest eaters also were often associated with increased pressure to eat and restriction on certain types of foods. This reinforces previous Mott-led research suggesting that pressuring children to eat foods they dislike won't lead to a well-rounded diet later in life or encourage better health or development.

Certain child characteristics, including sex, birth order, and socioeconomic status, also have been associated with persistence of picky eating.

"We found that children who were pickier had mothers who reported more restriction of unhealthy foods and sweets," Pesch says. "These mothers of picky eaters may be trying to shape their children's preferences for more palatable and selective diets to be more healthful. But it may not always have the desired effect."

It is unknown if children who are picky eaters would have become even more selective if they did not receive higher levels of controlling feeding behaviors, Pesch says. She says future studies should investigate interventions around maternal feeding and child picky eating.

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Materials provided by Michigan Medicine - University of Michigan. Note: Content may be edited for style and length.