Fussy Eating: When is it an issue?
by Teneille Williams (Registered Psychologist at The Kidd Clinic) and Ingrid Roche (Accredited Practising Dietitian at Advanced Dietitians Group).
All children go through some level of fussy eating at some stage. Studies reveal that between 20-50% of typically developing children experience feeding difficulties during childhood, while the prevalence of feeding challenges is significantly higher for children with developmental disabilities at 70-89% (Benjasuwantep et. al., 2013; Adams, 2022). In fact, eating and feeding difficulties can be the first sign that a child is neurodivergent. So, when does fussy eating become a feeding difficulty? For some parents, feeding is a problem when their child refuses certain foods consistently, whilst, for others, it is when children refuse entire food groups.
Whatever your parental threshold for your fussy eater, here are some ways to figure out where your child may be and some tips to support them.
How many different foods does your child happily eat? Researchers and clinicians suggest:
‘Fussy eaters’ generally eat at least 30 different foods and will eat at least one food from all the food groups. They can eat different textures.
‘Problem feeders’ have a restricted range of foods that is usually less than 20 foods. They may avoid entire food groups, such as meats or vegetables. This can result in nutritional deficiencies and growth problems.
Does your child eat the same food/s over and over? This is called a food jag. Have they done this and then suddenly refused the food? Once they refuse it, have they eventually started that food again or does it never return?
Fussy eaters often have a break from eating certain foods for a few weeks or months and then start eating them again.
Problem feeders will rarely eat that food again after stopping it.
How does your child’s plate compare to their family’s?
Fussy eaters may eat different food from their family but will eat with their family.
Problem feeders need an entirely different meal and may eat separately from their family.
How does your child react to new foods on their plate?
When presented with new foods, fussy eaters are generally able to touch or taste the new food - even if reluctantly!
Problem feeders may cry or melt down when presented with new foods.
How easily do they try new foods?
Fussy eaters will add new foods to their arsenal in 20-25 steps on the Steps to Eating Hierarchy (see below).
Problem feeders can take over 25 steps on the Steps to Eating Hierarchy to add new foods to their repertoire.
In summary, fussy eaters appear to have difficulties with some foods but ultimately can tolerate being offered new foods. They may be able to accept new flavours, textures, and types of food easier than problem feeders. For both groups of young people, it is important to recognise that introducing new foods is not as simple as putting a plate of new food in front of them. In fact, in the Steps to Eating Hierarchy, there are 32 steps between the initial introduction and the final incorporation of the food into one’s repertoire. This diagram shows all the steps leading up to actually swallowing a food – who knew it was so complicated?!
Caregivers can feel concerned about their child’s health and frustrated when their continual efforts to increase volume or variety at mealtimes are not successful. Eating can be an overwhelming sensory experience for our neurodivergent children. They may be offered feeding intervention or therapy services but these can be informed by behavioural principals (rewards and punishments through to mechanical/ physical restraint and forcible feeding). Fortunately, within Australia we have many allied and health practitioners who do not recommend compliance-based techniques in feeding therapy. In contrast, responsive or respectful and safe feeding therapy prioritises personal autonomy, the feeding relationship, internal motivation, individualised care and the child’s sense of competence (Rowell et al., 2020). By developing a warm, trusting relationship, supporting the child’s autonomy and creating an environment that facilitates positive emotional responses to mealtimes, you can support your child with eating in a neuro-affirming way.
Here are TKC’s and ADG’s Do & Dont’s
DO:
ALWAYS have your child’s preferred or favourite foods available. We call these their ‘safe’ foods.
Introduce new foods at a time when energy/resources are higher (new food when energy/ capacity is low can be a recipe for disaster).
Eat together if your child can eat with the family. Please don’t feel like you have failed if there are times where your child cannot tolerate the visual or auditory experience of others eating.
Provide positive verbal feedback if your child is receptive to that.
Model healthy food behaviours (being with; interacting with; smelling; touching; tasting; & enjoying foods).
Don’t call food ‘good’ or ‘bad’. Food is food, all with varying nutritional, holistic health, & emotional value.
Provide options, not pressure.
Use family mealtime to provide gentle exposure opportunities (see ‘What to do at mealtimes’ below).
See your GP and/or talk to your psychologist if you’re concerned about your child’s eating.
See a paediatric dietitian for a nutrition assessment. You may need strategies to meet your child’s energy, protein, vitamin and mineral needs for growth and development while they learn about new foods. If the dietician is Autism/PDA aware and neuro-affirming they will not ask you to force your child to eat foods they cannot tolerate.
DONT’S
Force your child to eat foods or pressure them to eat.
Provide negative consequences for not eating foods.
Police food, e.g., “Don’t eat that, it’s not healthy”. Instead, try: “What can we add to that to make it a more balanced meal?”.
Don’t bribe with sweets/preferred foods.
Dismiss your child’s fussiness for a phase if they are vitamin or mineral deficient, have lost weight or plateaued for a significant period, or are consistently irritable or obsessive about foods. Dietitian input is important if your child displays any of these symptoms.
Be hard on yourself as a parent. Many children struggle with eating, especially neurodivergent children. Feeding difficulties usually have little to do with what the parent has or hasn’t done but are a part of your child’s development or sensory profile. Remember, your job as a parent is to provide a range of nutritious food to your child and set boundaries around when and where food is eaten. It is the child’s job to decide whether they will eat it and how much!
Make comments about body shapes and sizes. Research shows that focusing on body size or weight can harm young people’s self-image. Instead, shift the conversation to holistic health, emphasising nourishment and energy. This approach helps children appreciate their bodies for their abilities, fostering a positive relationship with food and promoting lifelong self-acceptance and well-being.
What to do at Mealtimes
Graded exposure can support your child in exploring new foods in a safe way. We recommend working with a neuro-affirming Psychologist, Occupational Therapist or Dietitian through this process, especially if your child has the profile of a ‘problem feeder.’
To start with, try these tips at mealtimes to expose your child to new foods:
Present all meals as a “deconstructed buffet”. This means you prepare whatever you want for the family meal, as well as one or two of your child’s ‘safe’ foods. Put both safe and new foods in separate bowls or dishes with their own serving tool (whatever you have cooked the food in, a pot or saucepan is fine too, it doesn’t have to be fancy).
Put everything on the table - ask the children to help carry the different buffet items to the table, as this helps expose them too.
Everyone starts with an empty plate or bowl, so everyone is in charge of putting food on their own plate. Can you see how the pressure is already off your child? For some children, when you give them a plate of food, they feel pressure to eat certain things.
Start by serving yourself and saying, “I might try this today”, then place the food on the table in front of the person next to you. Allowing them to choose whether to try it without judgment. You can even say, “You can have some”.
If they decide not to eat it, you can say, “that’s ok, you can have some when you’re ready”. Ask them to pass it on to the next person.
DON’T say, “Do you want some?” or “Just try a bit” – this is pressure!
Make sure you choose some of your child’s ‘safe’ foods for yourself on the deconstructed buffet. All foods on the table are family foods. Otherwise, your child may think their safe foods are just for them, and all the other foods are for everyone else.
You can start this method from a very young age (toddlers).
After a while, once your family is used to eating this way, encourage the children to look at, smell, and stir the food with the serving tool before deciding whether to put any on their plate or not.
The ‘buffet’ or ‘family meals’ method helps children tolerate, interact with, and experience new foods in a low-pressure, sensory-friendly way. They see their parents modelling a healthy relationship with food. Over time, you can help your child become more comfortable with a variety of foods. Remember, playing with food is welcome in this approach, and enjoying meals together is key. To ensure the process is low demand, you can work with your psychologist or dietician to discuss ways to tweak this process. Just google ‘deconstructed buffet for picky eaters’ for ideas.
During the day, you may like to provide your child with a snack or ‘Snackle’ Box
Here are some practical tips for building a snack box:
Include a variety of foods that meet the child’s preferences and sensory tolerances.
Use compartments or containers to separate snacks, which can appeal to kids who prefer order and reduce overwhelm.
Rotate items occasionally to keep things interesting, but always include familiar options.
Allow the child to help choose or pack the snack box to foster engagement and autonomy.
This information serves as a generalised guide and should not replace the work completed with your health professional team. As always, seek medical advice for your individual circumstances and ensure that all fussy or picky eaters have physical check-ups yearly to ensure they are thriving in their growth and development.
What’s next?
If you are interested in determining whether your child is Autistic, Daniela has availability to conduct Autism diagnostic assessments.
If you or your child/teen has recently been diagnosed as Autistic, our post-diagnostic Autism session pack might be helpful.
Please reach out to our client care team for more information admin@kiddclinic.com.au.
