Picky Eating/ Feeding difficulties in Children

When is it normal, and when does a child need more help?

Picky eating is very common in toddlers and young children. Appetite naturally changes as growth slows after infancy, and children often develop strong preferences for certain foods, tastes and textures.

But not every “picky eater” is simply going through a phase. Some children have difficulties with eating because of medical problems, nutritional deficiencies, difficulty chewing or swallowing, sensory sensitivities, developmental differences or anxiety around food.

The most important questions are:

Is my child growing well? Is my child getting enough nutrition? Can my child eat safely and comfortably?

Different Types of Feeding Difficulties

Picky eating can range from a normal developmental phase to a Paediatric Feeding Disorder (PFD).

PFD is broader than simply being a “picky eater”. International consensus classifies feeding difficulties across four interconnected areas: medical, nutritional, feeding-skill and psychosocial factors.

1. Medical factors

Eating may be affected by:

• Reflux or abdominal discomfort
• Constipation
• Food allergy or other gastrointestinal problems
• Pain in the mouth or teeth
• Enlarged tonsils or breathing problems
• Difficulty swallowing

2. Nutritional factors

A child may eat too little or have a very restricted diet, leading to:

• Poor weight gain or faltering growth
• Iron or other nutrient deficiencies
• Very limited food variety
• Dependence on nutritional supplements

3. Feeding-skill difficulties

Some children have difficulty learning or managing different foods and textures, for example:

• Difficulty chewing
• Difficulty progressing from soft to more textured foods
• Gagging frequently with certain textures
• Coughing or choking during meals
• Taking an unusually long time to eat

4. Psychosocial or behavioural factors

Eating can also become difficult because of:

• Strong food avoidance
• Sensory sensitivity to taste, smell, texture or appearance
• Fear after a previous choking or vomiting episode
• Anxiety around meals
• Significant mealtime conflict
• Avoidance that interferes with family or social activities

These areas can overlap. One problem can lead to another, which is why feeding difficulties sometimes need more than one type of treatment.

What Should Parents Observe?

Instead of looking only at the number of foods your child eats, look at the whole picture:

• How many foods does your child accept?
• Are entire food groups being avoided?
• Can your child manage different textures?
• Does your child gag, cough or choke while eating?
• How long do meals take?
• Does your child become extremely distressed around food?
• How much milk, juice or snacking occurs between meals?
• Is your child growing and gaining weight appropriately?

Growth is an Important Clue

Growth monitoring is one of the most important parts of assessing a picky eater.

A child who eats a limited variety but has good growth, good energy and adequate nutrition may simply have typical picky eating.

On the other hand, falling weight, poor height gain, or crossing growth percentiles downward should prompt a closer assessment.

What Can Parents Do?

• Offer regular meals and planned snacks rather than allowing continuous grazing.
• Offer a variety of foods and include at least one familiar food at meals.
• Keep portions small so new foods are not overwhelming.
• Allow repeated, pressure-free exposure to unfamiliar foods.
• Eat together and model eating a varied diet.
• Keep mealtimes calm and avoid screens where possible.
• Avoid forcing, bribing or threatening your child to eat.
• Avoid repeatedly preparing completely different meals when a child refuses.
• Avoid unnecessary elimination diets or supplements without professional advice.

The goal is to create a positive relationship with food, not to win a battle at every meal.

When Should You See a Paediatrician?

What Happens During a Consultation?

The paediatrician will assess your child's growth, dietary intake, food preferences and mealtime behaviour, together with feeding skills, development and possible medical causes.

Depending on the findings, we may recommend dietary advice, feeding strategies, nutritional assessment or referral to the appropriate feeding specialists.

Our goal is not simply to make your child eat more. It is to understand why your child is struggling with food and help them develop healthy, safe and sustainable eating habits.

Who May Be Involved?

Feeding difficulties can have multiple causes, so treatment is sometimes multidisciplinary.

Depending on the child's needs, the team may include:

• Paediatrician – assesses growth, development and possible medical causes
• Dietitian – assesses nutritional intake and deficiencies
• Speech and language therapist – assesses chewing, swallowing and feeding skills
• Occupational therapist – helps with sensory and feeding-related difficulties
• Psychologist/behavioural professional – when anxiety, avoidance or behavioural difficulties are significant
• Other specialists such as ENT, gastroenterology or allergy when indicated

This multidisciplinary approach reflects the four-domain model of Paediatric Feeding Disorder.