Help for eating issues

The following information has been created by North Tees and Hartlepool NHS Foundation Trust. The information on this page is for children and families that are going through a natural phase of fussy/picky eating.

You have probably arrived on this page because you are concerned about a child’s eating. If this is the case, then the information on this page has been written for you. You may be a parent, carer, family member, concerned friend, or a professional. The information that follows is relevant for children of all ages who have fussy or picky eating right through to those children who persistently avoid the majority of foods. If you are worried and need advice and support, then please do keep reading.

 

 

Fussy or picky eating can often be part of normal development for children. For example, it is particularly common in young children as they become more aware of the taste, colour, smell, and look of different foods. They become suspicious that they may not like the food, and so avoid eating it. This is a natural part of development and most children pass through this phase easily.

A small number of children may move from being fussy/picky to become more avoidant and restrictive with the foods that they are prepared to eat.  

First of all, be reassured that you are not alone. Many parents, families, and professionals will at some point become concerned about a child’s eating. You may have heard other people says things like:

  • My child hasn’t eaten anything all week
  • My child will only eat the same thing at every meal
  • My child becomes really upset when I try to offer food
  • My child will only eat beige foods
  • My child won’t eat any fruit or vegetables
  • I have tried everything and nothing works

It is stressful when a child refuses to eat and it can be difficult to know what to do. There are also some myths out there that can cause greater worry, so let’s deal with those now. 

It is normal and expected that young children may eat more one day and then eat less the next day. The amount of food a young child eats from one day to the next can be influenced by such things as how much sleep the young child has had, how much physical activity/exercise they have had, and whether or not they are feeling well or a bit under the weather. Changes in appetite and the amount of food eaten from day to day is not a concern for young children where they are healthy and continuing to grow and thrive. 

If you think your child is going through a fussy/picky phase of eating, or you are worried that your child is restricting a wide range of foods, then keep reading.

Myth One

My child won’t learn to speak if they don’t eat and chew different foods

Plenty of children pass through a fussy/picky eating phase of development and develop talking/speech without any difficulty at all.

The muscles and parts of the mouth we use for chewing, such as the lips and the tongue, are also used for talking. However, the way we use those muscles and parts of the mouth is different depending on whether we are chewing or talking. So, there is no direct link between refusing to chew and eat foods and developing talking/speech.

Myth Two

If my child does not eat then they will be under weight and unhealthy

Your child could be a fussy/picky eater and still eat enough to grow and be healthy. Children will generally eat what they need to fuel their bodies. How much a child needs to eat may change from one day to the next and this is normal. We all need more food some days than others, and different people need to eat different amounts of food. This is the same for children as it is for adults.

Now we have dealt with the myths, let’s look at some top tips that can help.

Sometimes changes in a child’s eating can feel slow. Don’t give up, and try to use these top tips as consistently as you possibly can at each meal and snack time.

  • Children have smaller stomachs so cannot eat as much as adults. Try not to offer too much food as this may be off-putting for some children. You can use your child’s own hands to work out how much to offer. Guidance on children's food portions:
    • Carbs: 1 fistfull
    • Veggies: 1 cupped hand
    • Protein: 1 palm
    • Fat: 1 thumb
  • Children learn what food is safe to eat by watching other people for their reaction. Try to eat the same foods as your child to show them it is safe and fun
  • Avoid putting pressure on your child to eat as often this will cause them to refuse and eat less. Sometimes we try to help by saying the following things, but often this only results in the child feeling under pressure and eating less.

Just three more pieces.

No dessert if you don’t eat your carrots.

Come on, try to eat some more.

Just try one bite, you will like it.

If you find it hard to stop yourself saying these things, then try to distract yourself by talking about something completely different.

  • Avoid feeding your child yourself unless they ask for help. Sometimes it is tempting to take over and feed your child to make sure they finish their meal or eat a bit quicker. This can feel like too much pressure. If your child has had enough and stops eating then this is probably because they are full.
  • Children are meant to be messy when eating, particularly when they are young. Try not to interrupt their eating by wiping hands, face and mouth – we would find it quite annoying if someone did this to us as we ate! It is good for children to touch and explore foods with their hands, so be prepared to let them get messy!
  • Try not to use food as a reward. Have you heard yourself say, “If you eat your broccoli you can have some cake”. It is important that children learn to eat and enjoy a wide variety of food because they learn to like it, not because they want cake as a reward.
  • Do not trick your child to open their mouth for food, e.g. do not distract them with kisses, toys, or a dummy to get them to open their mouth so you can sneak some food in! This breaks trust and your child will learn to dislike food and mealtimes more and more.
  • Do not force your child to eat. Force-feeding only makes fussy/picky eating worse and last longer. As an adult, your job is to provide food for your child to eat. Your child’s job is to decide for themselves if they want to eat it or not.
  • Try to keep mealtimes short particularly for younger children. A long mealtime can feel like too much pressure for young children especially if they get bored. For many young children, 20 minutes if often the maximum they want to sit and eat for.
  • Try to encourage your child to take part in food activities, e.g. baking, cooking, preparing foods, food shopping.
  • Offer foods that your child likes alongside some new foods. Starting with new foods that are similar is shape, colour, feel, smell, and taste is a good place to start if your child struggles with new foods. Remember though, you might need to offer the new foods lots of time before your child is happy to try it.
  • Try to keep mealtimes relaxed and as positive as possible. This will help your child to feel relaxed and to make sure they feel no pressure at all.
  • Sitting down for a family meal. No pressure to eat, but just to have a fun time together and get used to the routine, even if it's just a for a very short period of time to start with. 
  • It can be difficult because of the busy lives we all lead, but sticking as much as possible to a good routine around mealtimes and snack times can really help children with eating.

The following websites and books can be read to help you further understand fussy/picky eating and offers a wide range of advice and guidance you can use to support your child and family. Have a read through and see which methods work best for you.

Sometimes despite your best efforts, you might find that your child is still struggling.

  • Your child’s fussy/picky eating may be getting worse
  • Your child may be eating less and less food
  • Your child may stop eating foods that previously they really liked
  • Your child’s growth and weight might be slowing, stopping, or falling

If you are worried, in the first instance, it is a good idea to talk to your GP, health visitor or school nurse for some advice and support. Remember, there is no such thing as a silly question, so always ask if you are worried. You can contact them via your normal route.

Specialist support is available and you can access this support yourself or via a referral from another professional such as your GP, health, visitor or school nurse. The following explains the specialist service available and when a referral may be required to this service.

Speech and Language Therapy service

The Speech and Language Therapy Service offers assessment and intervention for children and young people who have difficulties with chewing and/or swallowing food and drink safely.

A referral to the service should be made if a child or young person is unable to chew food effectively and/or the child or young person if experiencing swallowing safety difficulties such as coughing or choking. 

This is an open referral service. Parents can refer their child directly to this service by calling 01429 522717

Further information can be found here.

Occupational Therapy service

The Occupational Therapy service offers assessment and intervention for children and young people who have difficulties with completing daily activities.

A referral to the service should be made if a child or young person is experiencing difficulties with their everyday functioning/ability to complete daily activities and tasks.

Referrals need to be made by another professional, e.g. GP, health visitor or school nurse.

Further information around support and referrals can be found by accessing the following link - children's occupational therapy

Nutrition and Dietetic service

The Nutrition and Dietetic service offers assessment and intervention for children and young people who are struggling to grow, and who are finding it difficult to eat or drink sufficient amounts to remain healthy.

A referral to the service should be made if a child or young person is unable to eat or drink to grow and remain healthy.

Referrals need to be made by another professional, e.g. GP, health visitor or school nurse.

Further information can be found here.

Teesside community eating disorder team

If you feel your child or young person has a fear of food, or their fussy eating is due to a psychological reason, you should request a referral through to your local eating disorder team - Teesside community eating disorder team

This webpage is not designed to meet the needs of children and young people who are diagnosed with ARFID, however there are some links below to some useful resources to support children, young people and families.

The following resources offers advice, information and guidance for children and young people that are avoiding and/or are refusing to eat foods. Please take a look at the information and support that may be suitable for you and your family.

The regional network has been working on some national pages to offer support to patients, families and professionals, please visit the following:

For patients and families (Inc. embedded resources and webinars): Support for Avoidant Restrictive Food Intake Disorder (ARFID) - Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (cntw.nhs.uk)

This following link is a parent education session deliver by Dr Kay Toomey who leads on SOS feeding - SOS approach to feeding

Information to support patients through ARFID can be found here

Support Group for families -  Owl Blue ARFID Friends | Facebook 

An Overview of Psychological Interventions for Avoidant Restrictive Food Intake Disorder (ARFID) - ACAMH is a blog post on the current ARFID evidence base by Dr Emma Wilmott, Senior Clinical Psychologist (GOSH and SLaM) and her longer research paper on the subject can be found here: A scoping review of psychological interventions and outcomes for avoidant and restrictive food intake disorder (ARFID) - PubMed (nih.gov)

Free ARFID webinars for parents/carers available to watch from Aneurin Beavan University Health Board (Wales) Paediatric ARFID Service - Aneurin Bevan University Health Board (nhs.wales)

The following information offers support to children and young people with autism and their eating.

Autism - Eating behaviour

Autism - Supporting autistic people with eating difficulties

Autism - Autism parenting summit