Mecanismos de la selectividad alimentaria y la pica en pediatría: Hacia un modelo integrador de factores sensoriales, gastrointestinales, nutricionales y emocionales

Food selectivity, food refusal, and pica were examined because of their clinical heterogeneity and nutritional, functional, and family consequences. This review aimed to analyze associated factors and propose an integrative model distinguishing available evidence from hypothetical mechanisms. A critical narrative review was conducted through targeted web searches of bibliographic records, scientific publications, and professional documents in October 2026. Selection was thematic and included relevant clinical studies, consensus statements, and experimental evidence. The synthesis identified relationships involving sensory processing, feeding skills, emotional experiences, family practices, nutritional status, and gastrointestinal disease. Associations between pica and nutritional alterations did not establish a single causal direction. Functional studies indicated diverse maintaining consequences, while microbiota research required consideration of dietary restriction as a potential explanation for microbial differences. Immunological findings and animal studies provided biological plausibility without demonstrating general mechanisms underlying pediatric food selectivity or pica. A model was proposed that differentiated predisposing, precipitating, and maintaining factors from consequences and generated hypotheses concerning avoidance, learning, family feedback, and intestinal mediation. Nonexhaustive selection and the absence of formal risk-of-bias assessment limited the conclusions. The review concluded that interdisciplinary assessment should characterize each behavior and its consequences, and that the model required longitudinal and experimental validation before use as a clinical tool.