It’s common for young children to be fussy about the foods they eat. Children’s appetites are affected by their growth cycles and it’s not unusual for children to be very hungry one day and picky or less hungry the next.

Some children may only want to eat foods such as chicken nuggets, toast, and bread, but won’t eat fruits or vegetables. Or they may only want to eat or drink from a certain bowl, cup, or drink bottle and have difficulty consuming food or drink in different environments.

Furthermore, if your child is frequently coughing, gagging, or choking with different foods and drinks, or has immature chewing skills or self-feeding skills, you should seek a medical opinion as soon as possible.

Some children with fussy eating may meet the criteria for Paediatric Feeding Disorder (PFD). PFD is impaired oral intake that is not age-appropriate and is associated with one or more of the following: medical, nutritional, feeding skill, and/or psychosocial dysfunctions.

This may be shown through things such as:

• Vomiting
• Stress, worry or fear during meals
• Never seeming hungry
• Refusal to eat, drink, or swallow certain food textures
• Discomfort when eating or drinking
• Needs for distraction (such as screen time) to eat
• Constipation
• Inability to eat in new or unfamiliar situations
• Limited dietary diversity for their age (e.g., not eating vegetables)
• Needs for special foods, strategies, positioning, or equipment
• Excessively long or short mealtimes
• Avoidance behaviours during meals

Other children may have difficulty moving or coordinating the muscles needed for eating and drinking safely and which may be indicative of swallowing difficulties, which we refer to as dysphagia. Sometimes children may not have developed their eating and drinking skills, or due to the types of food they eat or what they drink out of, they haven’t had the opportunity to develop and coordinate the eating and drinking skills needed to consume different textures of food and to drink from different vessels.

Not surprisingly some children have a combination of both Paediatric Feeding Disorder and dysphagia necessitating individualised support to address the dysfunction as well as develop the skills they need to manage their food and fluid safely.

It is also worth noting that there are other diagnoses that relate to fussy eating in children, for example, Avoidant/Restrictive Food Intake Disorder (ARFID). ARFID is a persistent and disturbed pattern of feeding/eating that leads to a failure to meet nutritional requirements and needs medical attention promptly.

If you believe your child might be suffering from one of the conditions outlined above, you should seek assistance from a qualified Speech Pathologist. Once an assessment takes place, a plan can be put in place to improve their ongoing relationship with food, and help facilitate safe and positive eating and drinking moving forward.

Old fashioned approaches such as force feeding a fussy eater may have appeared to work in the short term, but the evidence shows it can be counter-productive, leading to long term problems with appetite awareness, interest in food and potentially create an intense dislike of the food or the food groups that the child was forced to eat.

Whilst medical assessment and intervention is necessary in cases of PFD, dysphagia and ARFID, parents should not underestimate the role they can play to help children develop a positive relationship with food andthe skills they will need for the future. Health professionals highly recommend that parents get children involved in activities such as;

• Grocery shopping (giving them a list of items they need to get)
• Helping to wash fruits and vegetables
• Helping to put groceries away
• Stirring and mixing during cooking
• Cutting with kid-safe knives and supervision
• Getting them to help read and follow recipes (once old enough)

In addition, having shared mealtimes, and modeling the behaviour you want to see, is incredibly valuable to children growing up.