when do such problems become abnormal and merit a specific psychiatric diagnostic label , remains a question under study with no clear cut answers .
we present a case of a young girl for whom clinical attention was sought for transient eating problems .
a 12-year - old young lady belonging to lower socioeconomic rural background was seen by the psychiatry services when referred for problems of eating since past 2 months .
the patient had a history of delayed development and achieved milestones slower than other siblings .
she would eat what was given to her by her mother , and ask for specific food items occasionally .
around 2 years back , the patient developed generalized tonic clonic seizures during sleep which were followed by myoclonic jerks .
the electroencephalograpm ( eeg ) findings were consistent with a diagnosis of juvenile myoclonic epilepsy ( jme ) .
the episodes of generalized tonic clonic seizures were well controlled with valproate , but myoclonic jerks continued to recur . due to the occurrence of jerks at school , other children would tease her .
she became irritable with her family members quite often , and would hit the siblings when provoked .
she did not have depressive cognitions or change in sleep or appetite then . due to behavioral problems of refusal to go to school and irritability ,
intelligence quotient ( iq ) assessment was done and reported as 57 with a diagnosis of mild mental retardation . since around 2 months prior
she would eat rice at the previous amounts , but would refuse to eat rotis , the staple diet of the family . if persuaded , she would get irritable and start crying and go to sleep without eating anything .
at times she said that she was hungry and would ask for food , and would eat rice but refuse rotis .
she did not have any associated loose stools , abdominal pain , vomiting , or regurgitation .
she would not demand for specific food items like chocolates , etc . ; would not appear sad , withdrawn or fearful , or have any disturbances in sleep . over the period of 1 month
, the weight reduced by about 1 kg . on further exploration , no preoccupation with body image , of previously fussiness of eating was reported by the family members .
the child had a slow to warm up temperament and there was no history suggestive of eating inedible objects , delusions , hallucinations or repetitive behaviors , significant obstinacy , hyperactivity or inattentiveness .
the general physical examination was within normal limits , the height and weight was over the 10 percentile and there were no signs of chronic malnutrition .
rapport could be established with difficulty and the child answered briefly only after urging from the mother and therapist .
when patient returned in 2 weeks , there was no further decrement in weight and the patient started to eat all kinds of food stuffs again and to the previous amounts . even on recovery , she did not elaborate the cause of decreased intake of certain foodstuffs and that of resumption .
multiple possibilities can be entertained in this child while evaluating a child presenting with such eating problems .
the age appropriateness of such behaviors , development level aptness , sociocultural background , parenting style , and medical conditions need to be ascertained before considering whether such a behavior can be assessed as abnormal .
feeding habits in adolescents reveals deficits in calories and proteins in apparently healthy school - going children from relatively well - to - do backgrounds .
with such a premise , is diagnosing the transient problems of eating as a separate disorder in this child a useful and relevant exercise , or whether these problems can be passed off as developmentally appropriate erratic behaviors ? even if a diagnostic label is required , where does the child fit in ? is the diagnosis of mental retardation sufficient to subsume these symptoms or an additional diagnosis is needed ?
since the diagnostic categories of affective , psychotic , and anxiety spectrum disorders do not apply in this case , whether the problems can be better characterized as eating disorder not other specified ( eating disorder nos ) ? however , there was no evidence of body image disturbances
. does feeding disorder of infancy and childhood better characterize this case , though the obvious atypicality being age of presentation and transient symptoms in this case ; or does this case remain a 
many researchers have proposed alternate pragmatic classification systems for characterizing the problems of eating in childhood .
fox and joughin have described a variety of eating problems that are encountered in the childhood and adolescence . among these
, the index case exhibits symptoms closest to food avoidance emotional disorder which occurs in the age range of 5 - 16 years and is characterized by avoidance of food and emotionality in the absence of preoccupation of body weight or body image .
many children who present with behavioral problems of eating can not be pigeonholed into diagnostic class of present nosology , but still benefit with interventions .
hence , we suggest that these disorders should be treated pragmatically after detailed assessment without being excessively concerned about the diagnostic label , at the same time not overlooking the obvious diagnostic possibilities .
 eating problems are commonly encountered in childhood and adolescents , and may be manifestation of a variety of psychiatric disorders when medical causes are excluded . 
 we present the case of a young lady presenting with problems of eating which presented with difficulties of ascribing a diagnostic label for eating problems . 
 the patient , a 12-year - old girl with history suggestive of mild mental retardation and juvenile myoclonic epilepsy presented with selective eating of foodstuffs which improved spontaneously in 2 months . 
 the different diagnostic possibilities entertained for the case are discussed . 