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Patient Information

Selective eating in children

https://kingstonhospital.nhs.uk/information/selective-eating-in-children

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This leaflet offers information for anyone who supports children with selective eating.

Managing selective eating

Selective eating can be worrying when it appears to impact on a child’s health and growth.

Many children experience stages of refusing meals or avoiding certain foods. Children often grow out of this and learn to accept a wider range of foods.

Focusing on your child’s overall weekly intake, rather than their daily intake, may help reassure you. Studies show that young children tend to eat the right balance of nutrients across the week to support healthy growth.

  • Remember there are no quick fixes to getting your child to eat. It is important to be patient and follow regular routines.
  • The more your child feels your own anxiety around eating, the less likely they are to want to eat. Forcing a child to eat does not work and it can be traumatic for them.

Sometimes an underlying issue may be causing a child to eat selectively and further investigations are required.

Contact your GP if you have growth or gastrointestinal concerns about your child, or if your child appears weak or lethargic. 

Measure your child’s growth

It is a good idea to gather recent growth measurements of your child’s weight and height.  Plot these measurements in their red book or on a growth chart.  If you are unsure how to do this, ask your GP or health visitor or nurse to do it for you. These measurements will help to give a clear indication of how your child is growing and whether your GP needs to refer them to a dietitian for nutritional support.

Children who grow and follow their lines on their charts are likely to be getting enough protein and energy overall, even if they have a restricted diet.

Keep a food diary

Keeping a food diary might help you identify what, when, where and how your child will and will not eat certain foods or food groups.

Does your child eat foods from the main food groups?

CarbohydratesTick the box if your child eats these foods
Potatoes, pasta, rice, chips, waffles, couscous, bread, bagels 
Breakfast cereal                                         
Biscuits, cakes, pastries                                                               
Protein
Dairy products (milk, yogurts, cheese, kefir) 
Milk substitutes such as pea or soya or oat milks 
Meat (includes chicken) 
Soya based meat substitutes (e.g., tofu, Quorn) 
Fish                                                                                                                  
Eggs 
Lentils, beans, legumes, hummus 
Nuts and seeds (eg peanut butter, tahini paste, hazelnuts etc.) 
Fats 
Oils, butter 
Cream, cheese, whole dairy products 
Cakes, biscuits, puddings 
Oily fish, avocado, nuts, sesame 
Fried foods 
IronTick if your child eats these foods
Meat, liver, pate, ham, bacon, salami etc.  
Eggs 
Fish, particularly sardines 
Breakfast cereal fortified with iron, or porridge, chapatti 
Lentils, beans, legumes, tofu, soya based products 
Nuts and seeds 
Calcium 
Dairy products (cheese, milk, yogurts, kefir) 
Calcium fortified milk substitutes 
Sardines, mackerel, fish fingers 
Tofu (only if set in E 509 or E 516; always check the packaging) 
Eggs 
Bread or calcium fortified breakfast cereals (always check the packaging) 
Fruit and vegetables 
Fresh, tinned, or frozen fruit or vegetables 
Smoothies 
Soups 
Fluid intake
Water
Milk
Juice
Smoothies
Other

If your child eats foods from each of these groups, they are likely to get most of the nutrients they need from their food.  They will get most of the nutrients they need if they eat either a wide variety or a limited amount within each group.

Vitamin and mineral supplements

If your child only eats specific food groups and small amounts or none of others, you can give them multivitamins and mineral supplements. This will help them to get key micronutrients they may be missing.  (Micronutrients are vitamins and minerals needed by the body in small amounts.)

Multivitamins

If you are concerned your child is not eating a balanced diet, a daily multivitamin will help. There is a huge variety of over the counter supplements to choose from.

Choose one that is appropriate for your child’s age and comes in a form your child is likely to take.  For example, chewable, liquid, capsules, sprinkles. Some are gluten free, vegan, or organic. Some may be more acceptable to your child in terms of flavours or colours. 

Do not choose a chewy or a tablet form if your child is under 3 years. For a child under 3 years, chop a gummy into tiny pieces to prevent any choking hazard.

Iron

If you notice that your child eats few foods containing iron, make sure you choose a supplement that contains iron.  See the table below.

Brand nameType
Boots AtoZChewable
Health4AllKids tabletsChewable
Wellkid rangeChewable or liquid
Feroglobin liquidLiquid
SpatoneLiquid sachets
Nature’s Aid iron mini dropsDrops
VitamixinSprinkles
Nutrigen Ferromixin SachetsSprinkles
Haliborange Iron + Vitamin C SoftiesGummies

Calcium

If you are worried about calcium and your child eats less than 3 dairy or calcium fortified dairy substitute portions per day, you can add a calcium supplement.  See the table below.

Remember that some breads and cereals are fortified with additional calcium, such as Kingsmill 50 50 vitamin boost, Hovis Best of Both (check the packaging).

Brand nameType
Haliborange Calcium & Vitamin DChewable
OsteocareLiquid
Wellkid calciumLiquid
NaturesPlus Animal ParadeChewable

Vitamin D

During the autumn and winter months (October to March), a 10 microgram vitamin D supplement is recommended for the whole population.

Children with darker skin, or those who often play indoors or are covered in sunscreen outdoors, are more at risk of low vitamin D levels.

Brand nameType
Baba West Vitamin DDrops or spray
Boots Baby Vitamin D3Drops
DaliVit Vitamin DDrops
Holland & Barrett Baby Vitamin D3Drops
Nature’s Aid Vitamin D3Drops
Nature & NurtureDrops
Wellbaby Vitamin DDrops
Better You Dlux Infant Vitamin DSpray (comes in various strengths)
BabyD Drops

Strategies for introducing new foods

It may take a lot of tries before your child accepts a new food. Try some of the following strategies to help them to accept a new food.

Food chaining

Take a food that your child already eats and gradually make subtle changes to this food until a new food is accepted.

  • Start off by identifying the things that your child likes about the accepted food. These may be colour, shape, texture, smell or taste. Then think of foods that contain similar properties.
  • You may wish to start off with small changes, such as cutting their food into a different shape such as triangles or squares.
ExampleMethod
Fish fingersYou can try other breaded proteins such as turkey dinosaurs, Quorn, or chicken goujons.
Try removing the breadcrumbs.
Offer the same shaped pieces of plain cod.
MuffinsYou can try adding cinnamon. Then add shredded carrots.
Use pureed carrot and cinnamon for icing on the muffin.
Offer roasted carrots and season with cinnamon.

Take foods out of their packaging and put them in clear food containers
  • This prevents your child becoming fixated on certain packaging.
  • You can also try changing between brands as much as possible.
Encourage your child to play and explore new foods outside mealtimes

For example you can:

  • run a pretend restaurant
  • look through cookery books
  • use carrot sticks as bingo pieces
  • make necklaces out of pasta.

You can also involve your child in food shopping by asking them to choose 2 new foods (for example vegetables or cheeses) to try during the week. 

Try again in a few weeks

If your child refuses a particular food, you can try again in a few weeks. They may want to try it after a few weeks, so do not give up on foods they refuse at first.

Try following these 6 steps gradually:

  • put the new food on the table
  • put the new food on their plate
  • encourage them to touch it
  • encourage them to lick it
  • encourage them to put the food in their mouth (keep a spit bowl nearby)
  • encourage them to swallow the food.

Strategies to prepare for mealtimes

The following strategies may help.

  • Timetables or weekly menus showing the time of the next meal and what will be served. You can stick these on the fridge with magnets.

  • Signpost mealtimes with a pre meal routine to help them change from another activity to a meal. This can help your child manage their moods and anxieties when it is time to move from one activity to the next.
  • For example, 10 minutes before the meal you can tell your child that they need to finish what they are doing. Then ask them to perform an activity such as washing their hands, singing a song, blowing bubbles or setting the table.  Choose an activity that is suitable for their age and interests.

Mealtime strategies to help your child have a better feeding experience

Child eating at table photo
  • Stick to a regular mealtime routine so your child knows when to expect food.
  • Try to eat together at the dinner table so your child can copy your behaviour.
  • Encourage family members to always sit in the same seats. This can reduce the pressure associated with mealtimes and help with routine. 
  • If your child is reliant on screens, start by asking them to sit at the table for 1 minute before getting the screen out. The aim is to gradually increase the time spent at the table with no screen. They may wish to bring a teddy or a toy to the dinner table instead.
  • If your child requires noise, try playing music or the radio in the background.
  • If your child has some sensory issues (such as being sensitive to noise or smells), they may find it easier to eat in a different part of your home.
  • Categorise food. Group foods into those that are accepted always, sometimes and never.  Identify any preferred sensory characteristics, such as mashed, lumpy, crunchy, soft, spicy, salty, beige, red, hot, cold, separates, sauces. Present your child with a food from each food group at mealtimes.
  • Present new foods in a separate bowl or on a separate plate. This is so the new foods don’t touch the ‘safe’ foods your child already eats. Do not introduce too many new foods at once or it will be overwhelming for your child.  Offer 1 or 2 new foods maximum per meal.
  • Serve family style meals. Offer individual meal components in separate serving dishes. Allow your child to choose which foods they want to eat and serve themselves. Try not to prepare ‘rescue meals’ if they do not eat what is served.
  • Do not limit any foods. Avoid limiting certain foods or labelling foods as good, bad, healthy or unhealthy.
  • Avoid using food as a reward. For example try not to offer your child sweets if they sit at the dinner table. Instead, use a sticker chart or offer extra play time or an activity they enjoy.
  • Describe new foods using their physical properties. For example say it is crunchy or sweet (rather than saying ‘It is so good’).
  • Offer a spit bowl. Use a bowl into which they can spit out any new food they try but do not like. This helps reduce the pressure associated with trying new foods.  
  • Let your child feed themselves and make a mess. If you feed your child yourself, it takes control away from them.  This can lead to food refusal.
  • Be realistic with your mealtime expectations. If your child has foods from each food group or you give them vitamin or mineral supplements, this may be the best that you can achieve at this time.
  • A bedtime snack can be a useful addition (before brushing teeth), especially if you think your child is not eating enough at breakfast, lunch or dinner.

Give your child enough fluids

Not drinking enough is a major cause of constipation in children.

Constipation can make children feel full and spoil their appetite.

Make sure your child has easy access to fluids throughout the day, but avoid offering drinks approximately half an hour prior to mealtimes.  (Filling up on fluids just before a meal can make a child feel too full to eat.)

If a young child does not eat some or all of their meal, do not give them milk instead. This can stop them from eating solids and cause low iron levels.

More information

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Information from Infant & Toddler Forum: https://infantandtoddlerforum.org/
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Kingston Hospital Iron Diet Sheet for guidance on iron rich food sources:
https://kingstonhospital.nhs.uk/information/iron-diet-sheet/
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Kingston Hospital information on daily calcium intakes:
https://kingstonhospital.nhs.uk/information/calcium/
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NHS information on children with sensory behavioural feeding difficulties:
https://hrch.nhs.uk/services/search-services/speech-and-language-therapy-children-richmond
Click on link above, go to the Resources and Links tab, then scroll down to ‘Children with sensory-behavioural feeding difficulties’
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Achieving for Children information on the ‘Beyond Fussy Eating’ programme
https://kr.afcinfo.org.uk/pages/local-offer/information-and-advice/parenting-courses/beyond-fussy-eating
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Information on the eatwithsprout app: https://eatwithsprout.com/

Image courtesy Freepik

Selective eating in children - Kingston Hospital Download PDF


Contacts

Paediatrics Dietetics Administrator, Monday to Friday (voicemails are checked daily) 020 8973 5277
khft.dietetics@nhs.net

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