Overcoming extreme faddy eating

Many children go through phases of refusing to eat certain foods or at times refusing to eat or drink anything at all.  This is particularly common in young children but can occur at any time.  It is often a child’s way of showing independence and is a normal part of growing up. 
 
This common ‘faddy eating’, although stressful for carers, rarely causes any serious nutritional, medical or growth problems, and is a phase that is grown out of.

Some children have eating patterns which seem to be much more than this ‘faddy eating’.  Their extremely rigid, eating habits may cause growth problems such as overweight or underweight, nutritional deficiencies (particularly if a whole food group is avoided), severe dental decay, dehydration and severe constipation.  Mealtimes can be extremely stressful.

Professionals may call these eating patterns "extreme faddy eating", "selective eating”, “perseverant eating”, restrictive eating” or “autism-like selective eating”, which are generally interchangeable terms.
 
Extreme faddy eating is often not grown out of as quickly as faddy eating, and sometimes can continue to adulthood. It is common in children with social communication disorders such as autism, but also occur in children with no other developmental problems.   
 
Steps to overcoming extreme faddy eating:
  1. Try our first line advice for faddy eaters

  2. Take a good look at your child’s diet - Keeping a food diary or a log of exactly what your child is eating can be a helpful first step to help you to determine how balanced their diet is and see if there is any pattern to their eating.

  3. Is your child’s diet varied enough? - See for yourself with our food group check list

  4. When to get help from a dietitian

  5. Try to understand what, where and how your child prefers to eat

  6. Strategies that may work with extremely faddy eaters, and children with ASD or social communication difficulties - visual supports; refusing demands; motivating a child to try new foods; helping your child try new foods; food play.

  7. Getting further help

  8. Download this information as a booklet


First things to try for faddy eaters:
  • Offer 3 meals a day – breakfast, lunch and dinner, and 2 or 3 nutritious snacks.  Offer 2 courses at a meal, one savoury and one sweet.  This is better than letting your child ‘pick’ throughout the day.

  • Try to eat meals and snacks at the same time each day

  • Offer small portions so that your child is not overwhelmed, they can always ask for more.

  • Drinks can fill up your child’s small stomach – avoid giving them for at least thirty minutes before a meal or snack time. Try giving a drink at the end of a meal or at snack time instead. 

  • Limit milk intake once your child is one-year-old to one pint or 20 oz or 600ml a day.

  • Try to give all drinks from a cup or beaker rather than from a bottle after their first birthday.  (Start offering drinks from a cup from 6 months.)

  • Persevere in offering new foods – a child may need to try it more than ten or even twenty times before they start to like the taste.

  • Try to eat in a calm, relaxed area, without television or toys.

  • Sit together at the table and eat at the same time as your child whenever possible, as he will learn from you.

  • Present food in fun and attractive ways. 

  • Try not to rush or drag out mealtimes.  If your child has not eaten their food after twenty to thirty minutes, take it away without comment.

  • Offer your child food without coercion (never try to force feed)

  • If your child refuses to eat food put in front of them at mealtimes, take it away without comment, and do not offer any other food until the next planned meal or snack time.  You may still offer a pudding at mealtimes if the main course is refused.

  • Do not use foods as rewards.  Better rewards are praise and star charts for good meal time behaviour.

  • Try involving children in shopping, food preparation and table laying

  • If your child is only eating small amounts, and you are worried about their weight gain, give high fat foods and snacks, offer a pudding at each meal, and add extra fats such as grated cheese or butter or cream to their food.
Food groups check list for extreme faddy eaters

Most children do manage to choose foods from different food groups and as a result grow well without suffering the effects of being deficient in any nutrients.

This food group check list can help to see which foods your child is eating from each of the main food groups. The recommendations are for the bare minimum rather than ideal intake.

If you still have concerns, get further help and advice from a dietitian.

Starchy foods: provide carbohydrates for energy, some vitamins and fibre. 

Recommended minimum intake: daily, preferably 3 times a day.

Foods to count in this group: Chips, mashed potato, boiled potatoes, processed potato shapes e.g. smiley faces, potato waffles, crisps, yam (boiled, roasted, pounded, fried), sweet potato, plantain, cassava, green banana, boiled rice, fried rice, rice pudding, rice cakes, pasta, noodles, lasagne, bread, crumpets, chapattis, naan, parathas, pizza base, bread sticks, scones, pancakes, Mexican tortillas,  biscuits, crackers, cakes, breakfast cereals, porridge, muesli, baked beans, kidney beans, other beans, lentils, chick peas, corn meal porridge, semolina, cous cous

Meat, fish and alternatives – provide protein and some minerals e.g. iron.

Recommended minimum intake – daily, including red meat 3 times a week for iron.

Dairy products are a good source of protein and can be counted in this group (see list in the next section). Some carbohydrate foods also contain some protein e.g. bread, rice, pasta, cake Foods to count in this group: Red meat (beef, pork, lamb, ham, minced meat, beef burgers, sausages, corned beef, liver, pies, pasties, sausage rolls, meat on pizza or in stews, pates), white meat (chicken, turkey, chicken burgers, chicken or turkey nuggets or processed shapes (check the meat content of some cheaper brands)), white fish (fish fingers, breaded cod, fresh cod), oily fish (tinned tuna, tuna steaks, mackerel, salmon, sardines, pilchards), sea food e.g. prawns, eggs (boiled, scrambled, fried, poached), beans and lentils (including baked beans and chick peas), hummus, Tahini, peanut butter, nuts, seeds, tofu, Quorn, soya protein

Dairy products and alternatives – provide protein and calcium

Recommended minimum intake – 200ml milk (or calcium –enriched alternative such as soya milk) or a yogurt, or a matchbox sized piece of cheese – once to three times a day.

Foods to count in this group: Cow’s goat’s and sheep milk (as a drink, on cereal or in cooking), soya milk enriched with calcium, rice milk enriched with calcium, milk shakes, milky hot chocolate, white sauces, yoghurts, dairy ice cream, fromage frais, calcium enriched soya yoghurts, custard, rice pudding, other puddings made with milk e.g. sevyiaan, Indian sweets, semolina, all cheeses, cheese strings, cheese spreads, cheese on pizza or in sauces.

Fruit and vegetables – provide fibre and vitamins

Recommended minimum intake – daily, preferably 3-5 times a day.

If your child does not eat any of these foods, try getting them to take a children’s multivitamin supplement (ask you local pharmacist to recommend one appropriate for their age.

Foods to count in this group: Raw vegetables, boiled vegetables, stir fried vegetables, oven roasted vegetables, salads, vegetable juice, vegetables in soup or stews or on pizzas, tomato sauce eg with spaghetti hoops (not ketchup), beans and pulses. Fresh fruit, stewed fruit, tinned fruit, dried fruit, fruit juice, fruit smoothies, fruit crumble, fruit in jelly


Getting help from a dietitian - when to ask for a referral

A registered dietitian can assess your child’s diet and recommend nutritional supplements if they find your child’s diet to be deficient.

Your child may particularly benefit from a dietitian’s assessment if they:

  • Are not growing well (your doctor or health visitor should be able to tell you this)

  • Do not eat any foods from the dairy products and alternatives group and are not taking any calcium supplements prescribed by your doctor

  • Do not eat any red meats or products made from red meat and are not taking any iron supplements prescribed by your doctor

  • Suffer from constipation

  • Do not eat any foods from the starchy food group (see food check list)

  • Do not eat any meat, fish or alternative foods (see food check list)

  • Do not eat any foods from the fruit and vegetable group and will not take a multivitamin supplement.

  • Eat less than 20 different foods in total

To see a dietitian, ask your GP, paediatrician or health visitor to make a referral to your NHS Dietetic Service, or if you would like private advice, request a consultation from nutritionnutrition dietitian Zoe Connor here, or www.dietitiansunlimited.co.uk holds a list of freelance dietitians in your area (in the UK).


Looking for patterns in your child's food preferences

Understanding your child’s preferences for foods and eating environments can help you to choose the best times, places and ways to offer foods and which new foods your child might be most willing to try:

What time of day and in what situations does your child eat best?

  • Some children eat better at school or at other people’s houses while some eat better at home.
  • Some children are really distracted by bright lighting, loud noises, other people eating or other people’s food smells
  • Some prefer to be distracted by music or videos whilst eating
  • Some will eat best with certain cutlery or with their hands

Does your child prefer foods of certain colours, textures, smells, tastes or shapes?

  • Some children prefer bland food
  • Some prefer foods with strong tastes 
  • Some prefer food in symmetrical shapes
  • Some prefer foods of particular colours
  • Some will only eat food from particular plates or cups
  • Some hate bits and lumps
  • Some hate sloppy foods
  • Some love dry, crunchy food
  • Some prefer sloppy foods with uniform textures
  • Some will only choose foods of certain brands or with certain types of packaging

Try making a list of your child’s preferences - i.e.

  1. Mealtime environment (seating arrangements, plates and cutlery, any distractions, any routine prefered before meals):

  2. Types of food (texture, taste, smell, appearance, arrangement of food on plate):


Strategies for extremely faddy eaters

Many carers of children with selective eating find that the standard advice for ‘faddy eaters’ is not enough to help their child.  This is not their fault; it is just that they need to develop a range of skills and techniques that other parents might not need.

The following are other hints and tips that other parents of children who are extremely faddy eaters have found useful - some of which contradict the standard advice given for toddlers with faddy eating.

It is important to remember that some of these things have worked for some children, but they may not all work for your child. 
 
A flexible approach is recommended, pick a couple to try then introduce one at a time, be patient and persevere!
  1. Create a structured daily eating routine:
    Serve 3 meals and planned snacks at similar times each day to help to establish a routine.  Make sure your child knows what this routine is and remind them after each meal or snack when the next meal or snack time is going to be.  Try to stick to this routine as rigidly as possible.

  2. Use visual supports
    Supporting spoken instructions with visual supports can be very powerful for some children – especially those with social communication difficulties. More about visual supports.

  3. Make your child’s eating environment comfortable:If you have realised that your child is distracted by their eating environment, do what you can to make them more comfortable e.g.
    - use of favourite plate, cutlery and chair
    - dimmed lights
    - providing a quiet place to eat with no distractions
    - distracting your child whilst eating – playing relaxing music or their favourite video, reading a book to them or just talking to them (please note this is the opposite to the advice usually given for faddy toddlers but some parents find this useful for children with ASD)

  4. Encourage your child to sit still at the table:
    If your child finds it hard to sit still for any activities including eating – set realistic goals e.g. sitting for 5 minutes, use a timer and praise for good sitting.  If your child sits still for other activities but not for eating, try removing their plate from them calmly if they try to leave the table, and praise them for returning to the table and sitting and eating well - don’t chase your child around the room.

  5. Try to refuse constant demands for favourite foods

  6. Ideas to motivate a child to try new foods

  7. Ideas for activities to help a child get used to new foods

  8. Ideas for food play


Using visual supports

Some children (and adults) follow instructions much better if they are visual than verbal. 
 
This is particularly true for individuals with ASD or other social communication difficulties.  Even individuals who don't seem to respond at all to verbal communications sometimes follow visual instructions to the letter.
 
Examples of visual supports:
 
  • Visual timetables that show the sequence of daily routine e.g. line symbol pictures to show: get out of bed --> breakfast --> brush teeth --> catch bus
     
  • Visual schedules that break down activities into steps e.g. line-drawing steps for handwashing put next to the bathroom sink or instructions for the steps for tasting a new food

  • The Picture Exchange Communication System (PECS) uses cards with simple line drawing pictures of objects with its name written underneath as a means to teaching children communication e.g. to request and activity or food

  • Choice boards – a board with a number of picture symbols attached e.g. by Velcro for a child to choose a food or activity

  • Social stories - stories written to specific guidelines devised by an education specialist to describe to a child how to react to an event or situation.  Books of standard stories are available covering areas such as eating at the table, eating out, cleaning teeth and many aspects of daily routine.  Trained special needs teachers may also be able to construct individual social stories for a child.  The story may be read to the child, with the child following the words and pictures, at least daily for one to two weeks. 

For more information on visual supports:

  • National Autistic Society Information Sheets (www.nas.org.uk 0845 070 4004)

  • PECS (01273 609 555 www.pecs.org.uk )

  • Widgit software – easy to use software to print off a large range of picture symbols.  Available to buy from  – www.widgit.com 01926 885303 (not cheap)

  • Do to learn – a website with ready-to-print free picture cards and tips for creating schedules www.do2learn.com

  • Official website for Social Stories, sells books of stories and describes their use www.thegraycenter.org


Refusing demands for food

Some children express a need to eat constantly or constantly demand their favourite foods such as sugary fizzy drinks, sweets or crisps.

Remember that they are unlikely to be physically in need of food if they have eaten in the last couple of hours, and if they refused their last meal or snack, giving in to their demands in between scheduled eating times is not going to help to establish a routine in the long term. 

Giving in to demands for fatty or sugary foods in between scheduled meal and snack times can also increase the risk of dental problems and excessive weight gain. 

Try some the following:

  • Stick to your set regular mealtimes and snack times, and back up with visual supports – refer to these if your child demands foods in between

  • Keep undesirable favourite foods out of sight and out of reach (or out of the house)

  • Don’t let your child help themselves to food or drinks – make sure they have to request it from you first

  • Some carers find it necessary to fit locks onto the kitchen cupboards and fridge, or on the kitchen door, or to use burglar alarm sensors to alert them to their child trying to enter the kitchen e.g. at night (http://www.nichelocks.com/ 01922 476243 are an example of discrete secure magnetic cupboard locks)

  • Instead of allowing a favourite undesirable food at a meal or snack time, try encouraging your child to choose from 2 or 3 foods you would like them to eat using a picture choice board. 


Ideas to motivate your child to try new foods

Focus on motivating your child to change one thing at a time - for example, whilst trying a new food, ignore poor table manners. 

The best motivator is consistent rewards for even the smallest steps towards the desirable change – e.g. touching the food or allowing it on or next to their plate.

Best rewards are those that are not food related – such as praise, star charts or treats such as comics, stickers, watching a favourite TV programme, or staying up later. Some carers use a small amount of their favourite food if really necessary.

Using a sticker or star chart is a popular reward – make sure you are clear as to which specific behaviours get a star or sticker, and offer a bigger reward e.g. a bigger sticker when a certain number of smaller rewards have been won. 

You could make a chart by hand, on the computer or use a template from the internet, or buy ready made charts – some examples of these are: 
Some children who don’t seem to be motivated well by rewards can sometimes respond to withholding activities they particularly enjoy - e.g. if your child likes to watch his favourite cartoon whilst eating, turn it off for a timed period such as a minute (try using a digital kitchen timer to make this visual and clear).  If they are not eating their food, increase the withholding time by a minute at a time.

Other creative ways carers have found to motivate their child include:
  • Counting mouthfuls eaten

  • Giving food new names like “Tubby Custard” or “Yummy Soup”

  • Cutting food into shapes such as dinosaurs using biscuit or pastry cutters

  • Making up songs or stories while eating

  • Using story telling or reading a favourite book where characters are eating. e.g. Hungry caterpillar book

  • Using favourite characters – e.g. feeding one for Thomas, one for James, . “……..is eating a banana, lets take a picture of/ cut out a picture of …………. for your scrap book/ copy ………………………. doing this.” or saying that “I think …………….will have just eaten a banana before going on the computer / watching TV”
Helping your child to feel happier trying new foods

It may take months of offering a new food for a child with extreme faddy eating, or selective eating to readily accept it, so be prepared to persevere. 

Introduce only one new food at a time, set small goals in stages to allow child to move step by step – e.g. first encouraging to accept a small piece of a new food on their plate or on a small plate next to theirs (e.g. one pea), then moving on to 2 or 3, etc, before even trying to put it in their mouth.  At this stage encourage them to touch it, then sniff it, then lick it, then put it in their mouth but spit it out, etc

When choosing a new food to try, use findings from your food diary – consider trying a food from already accepted food groups – e.g. a different type of bread, or a food that is similar in colour, texture and taste to your child’s preferred foods.

Give your child choice but not absolute control e.g. compare “Which of these 3 foods will you try this week” with “Will you try a new food this week”

Try creating visual supports to encourage the trying of new foods e.g.:

  • A menu sheet stuck on the wall or fridge – saying in words or pictures which foods your child will have at each meal today.  Each meal could include their preferred food plus a section to put a picture or to write “Today I’m going to try….”.

  • A “My Food” or “Eat it up” book – a scrap book in which you or your child can stick pictures of, draw or write all the foods they like at the front and foods that you would like them to try at the back.  Your child can help choose which ones will move forward to a “foods to try” section. 


Ideas for playing with food

If your child gets very upset at trying new foods, try introducing them outside meal times as a play activity.  
First make sure your child is comfortable having the food in the same room of them then try different activities to encourage them to touch the food:

Key rules for food play sessions:
  • Try to keep sessions calm and relaxed

  • Play alongside your child rather than coaxing to try things e.g. “Look I’m squeezing the jelly” rather than “You squeeze the jelly”

  • Keep sessions brief and fun

  • Remember food safety and hygiene – wash any toys and hands well before and after a session

Ideas for playing with dry foods:

  • Put some dry food in a tray with a rim, and then encourage your child to pick up and squeeze the food, to post it through food shapes, to fill and empty containers, to find hidden toys in it and to make hand prints.
    • Sweet foods to use include breakfast cereal, sultanas, raisins, sugar and biscuits. 
    • Savoury foods could be rice, rice cakes, cheese cubes, cheese biscuits or vegetables

  • Build towers to a counting song with cheese cubes, rice cakes or biscuits

  • Encourage your child to post food pieces through different shape sorter holes.  Try using cheese cubes, vegetable cubes, fruit cubes, biscuit pieces, crisps

  • Make a food picture by sticking pieces of food onto paper using toothpaste, jam or honey

  • Cut food into shapes with pastry cutters e.g. bread, cheese slices, thin meat slices

Ideas for playing with soft, wet foods:

  • Squeeze fruit into containers

  • Stir wet food with utensils, hands and fingers

  • Paint and draw with food or make hand print pictures with ketchup, mayonnaise, jam or spread

  • Post fruit and vegetables through shape sorters

  • Set a toy in jelly and encourage your child to get it out

  • Use smooth cheese or marzipan as play dough


Getting more help
  • Your health visitor can usually offer first line advice and support on eating problems.

  • Your child’s school, pre-school, portage or behaviour management workers may be able to offer support in making meal-time and eating changes, and to help decide which behavioural strategies might work best for your child.

  • Your dietitian or paediatrician may refer your child to a Speech and Language Therapist if your child has difficulty using the muscles in their mouth, or if they are extremely sensitive to things put in their mouth.  An Occupational Therapist may also be involved to help with sensory difficulties surrounding food.  They may also ask for help from a psychologist from the Child and Adolescent Mental Health Service (CAMHS) for additional behavioural support. 

Very useful books

  • How to Get Your Kids to Eat...But Not Too Much by Ellyn Satter.  Published by Kodansha Europe, 1987, ISBN: 0915950839.  Written by a registered dietitian and psychotherapist.  Includes excellent chapters on toddler food battles and on feeding children with special needs (doesn’t specifically cover ASD or social communication difficulties). Get this book from Amazon here>
  • Can’t Eat, Won’t Eat – Dietary Difficulties and Autistic Spectrum Disorder
    by Brenda Legge. Published by Jessica Kingsley Publishers, 2002. ISBN: 1853029742.  This excellent book written by a mother of a child with selective eating and ASD. The book has chapters on the approaches taken by a feeding team psychologist at Great Ormond Street, and the results of a survey the author conducted of strategies other parents found useful. Buy this book on Amazon here>


Booklets to download
 
These are for parents, dietitians or other health professionals to download and print out.  The full version is 28 pages long, and the shorter version is 20 pages long.
Technology tips: 
To read PDF documents you need free software installed on your computer such as Adobe Reader or Foxit Reader.  To download these try the following links: Adobe Reader =22.1MB - (warning - large file),  Foxit Reader (2.1MB - smaller and faster).
Booklet formats are designed to be printed on both sided of A4 paper to make A5 booklets.  To print like this on your printer, choose 'manual duplex' in the print box that pops up when you send your document to print, then follow your printer's instructions, which may involve turning the paper over half way through printing.
 
Page first published: September 17th 2006; last updated: November 5th 2007.