Managing restrictive eating
Last edited: 16/12/2022
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Many children go through phases where they refuse to try new foods or eat foods they have previously enjoyed. This is often referred to as fussy eating, can be common in young children and is a normal part of development.
Accepting new tastes and textures can take time and some foods may need to be offered several times before a child will try them. It can be frustrating for parents and care givers, however, rarely causes any nutritional concerns and is usually outgrown. The important thing is not to let it worry you and to continue to offer regular meals and snacks without giving attention to not eating.
Some children’s eating goes beyond fussy eating. The food refusal and/or unwillingness to try new foods may go on for much longer and/or gradually become more restrictive over time. This is often referred to as restrictive eating and can be common in children with sensory challenges.
Restrictive eating can result in poor growth, nutritional deficiencies, dehydration and constipation.
There are a number of reasons why a child maybe refusing foods, for example:
- they are not hungry
- constipation
- being tired
- new food offered or offered in new way
- previously been given too much attention for not eating
- delayed or disordered sensory development – you can find more support at www.kentcht.nhs.uk/childrens-therapies-the-pod/occupational-therapy/
- problems swallowing.
It can be helpful to keep a food diary to get a clearer picture of what your child is currently eating and to notice any patterns.
Things you can do to help
| Do | Reason |
| Set a consistent time and place for meals. Aim for a routine of three meals and two to three snacks. A visual guide for mealtime routines can sometimes be helpful. | Children don’t eat well if they become over hungry or very tired. A consistent mealtime routine will help to prevent these problems. |
| Try to make sure that mealtimes aren’t more than 30 minutes. | Extended mealtimes are unlikely to result in your child eating much more. It is better to wait for the next snack or meal. |
| Eat with your child and enjoy family meals together as much as possible. | Children learn by copying their parents and other children. |
| Try to limit distractions such as the TV or toys, or use them wisely. | Distractions can make it more difficult to concentrate on eating. However, some children with sensory processing difficulties may find it easier to eat with some appropriate distraction. |
| Try to stay calm and relaxed, even when your child isn’t eating and be led by your child. | Pressure to eat can increase your child’s anxiety can make the problem worse. It’s important to try and reduce stress around mealtimes and make them pleasurable for your child. |
| Praise efforts at eating, however small. | Children respond positively to praise. |
| Ignore misbehaviour, don’t comment on foods not eaten or give attention to food refusal. | Children thrive from attention, whether it’s positive or negative. Excessive attention on food refusal can exacerbate the problem and lead to a ‘battle of wills’. |
| Expose to new food repeatedly – up to 20 times. | It can take a number of ‘exposures’ to a new food before a child will touch, or pick up or taste it. |
| Encourage your child to experience different textures through ‘messy play’ every day. | Many children with restricted diets are very sensitive to touch on the hands and mouth, and will tend to avoid picking up new foods. Regular opportunities for messy play can help them to get used to new and different textures. |
| Encourage to smell and lick new food and give them plenty of praise for touching and eating new or previously refused foods. | These initial ‘steps to eating’ are a way in which your child can learn about exploring, engaging and eating new foods. Make sure your child is given lots of praise and positive encouragement for achieving any of these steps. Rewards can often help. |
| Offer an appropriate portion of dessert, such as fruit or yoghurt, even if your child has only tried a small amount of the savoury meal. Try to avoid using dessert as a reward or bribe for eating other foods.
|
Offering two courses at meals gives opportunities for your child to take in the calories and nutrients that they need and also helps widen the variety of foods consumed as well as making the meal more interesting. |
| Offer at least one of your child’s preferred or ‘safe’ foods at mealtimes. | Offering tried and tested foods alongside anything that is new helps to reduce anxiety by making a meal look more familiar. |
| Introduce a small amount of one new or unaccepted food at a time – this can be offered on a separate ‘taster plate’ next to their plate if necessary. | Children are more likely to be able to cope with a ‘pea-sized’ amount of a new food rather than being faced with a whole portion. As their confidence grows you can gradually increase the size of the portion. |
| Make positive comments about the food. | If you make positive comments about foods your child will be more willing to try them. |
| Give a verbal warning for mealtimes, such as five minutes until dinner, and introduce a transition activity, such as washing hands or setting the table. | Having a routine at the beginning and end of meals can help to reduce anxiety and prepare your child for mealtimes. |
| Check your child’s seating position is comfortable and they are well supported. | If your child is uncomfortable they are less likely to want to sit and engage in mealtimes. |
| Involve your child in lots of things involving foods outside of meal times. For example, ask your child to help lay the table and clear plates from the table and/or scrape plates and encourage them to help with meal preparation and shopping. | These activities all help support the ‘steps to eating’. |
Things you should avoid
| Don’t | Reason |
| Allow your child to continually graze throughout the day. | If your child is allowed to continually graze, they are unlikely to have an appetite at main mealtimes. |
| Leave long gaps between meals to try and make your child hungrier. | This can make your child less hungry over time and may lead to weight loss. |
| Withhold or restrict preferred ‘safe’ foods. | This is not a good way to get your child to eat new foods and it may lead to weight loss. |
| Mix or hide new foods within ‘safe food’. Give them alongside ‘safe food’ instead. | Your child may be able to easily detect new tastes and smells, even when hidden in other foods. Mixing or hiding foods in this way can lead to the loss of ‘safe foods’. |
| Force feed or use threats. | This will make your child even more anxious at mealtimes. It can also cause your child to vomit the food back up, which can lead to further food aversion. |
Contact us
Please contact the service though our Central Appointments Team:
0300 123 0861
kcht.centralisedappointmentteam@nhs.net
Monday to Friday, 9am to 3pm
This information should only be followed on the advice of a healthcare professional.
Do you have feedback about our health services?
0800 030 4550
Text 07899 903499
Monday to Friday, 8.30am to 4.30pm
kentchft.PALS@nhs.net
kentcht.nhs.uk/PALS
Patient Advice and Liaison Service (PALS)
Kent Community Health NHS Foundation Trust
Trinity House, 110-120 Upper Pemberton
Ashford
Kent
TN25 4AZ
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