Toddler fussy eating is part of normal development, and some children will be fussy about food all their lives without any significant impact on their nutrition and health. However, some children may find it more difficult to try unfamiliar foods or to eat foods that have a texture, smell, or taste that offends their senses.
Even the colour and shape of the food may affect their ability to tolerate it. Some children will only eat crunchy foods, or mushy foods. Aversion to a certain texture might be a tactile issue, but it could also be due to low tone in the mouth or a motor planning problem. Some children will gag while eating, and avoid foods they fear will make them gag, because their oral-motor coordination is not what it should be.
Children who eat a poor variety of foods – for example, because they are very selective or because they have eating difficulties – may be at greater risk of nutritional problems, and care should be taken that sources of important nutrients such as vitamin A, vitamin C, iron, zinc and calcium are included in their diet regularly, or a daily multi-vitamin and mineral supplement is provided.
What to look out for
There is no need to be too concerned if the child is eating foods from each of the main food groups, and if a child, is growing well. Get advice if the child is:
- accepting fewer than 20 foods
- refusing all foods from one or more food groups
- constipated, as having constipation can have a significant impact on appetite and may require medication.
- suffering from tooth decay because of their diet
- losing weight or not growing well
- gaining weight excessively
- displaying behaviour, e.g., tiredness or pica (eating non-edible items) that might indicate a vitamin or mineral deficiency (e.g., iron deficiency anaemia)
- missing school due to eating problems.
- coughing and choking while eating, or has recurrent chest infections, especially if they have developmental delay or physical disabilities.
- missing social opportunities, e.g., if they and their family can rarely go out due to the eating problems.
Finding the cause
Start to take note of what is eaten and when. Sometimes, a food diary can be reassuring, you may in fact see that the person eats a wider range of foods than you originally thought.
Here are some examples of what to include:
- What time of the day did they eat? e.g., 11.05
- What did they eat? e.g., Salt and vinegar crisps
- Where did they eat? e.g. In the living room
- How much did they eat? e.g. Two bags
- Who was there? e.g., Mum, brother
- How did people around respond to the person eating the food? e.g., Mum praised, brother had no reaction
- Were there any environmental factors? e.g., Radio was on in the background.
This could reveal some causes of the eating difficulties, whether over-eating or restricted eating. Try to work out whether it is the amount, type or range of food being eaten which is the core issue, and then what underlying problems, or sensory issues, may be involved.
Example of a food diary: https://elht.nhs.uk/application/files/1115/9239/5661/Food_diary_form.pdf
Strategies for a restricted diet/under eating
Ideas to encourage your child to try new foods and vary their diet. It is important to stress that all the following ideas are just suggestions and what works for one child may not work for another. With all these strategies, make sure that any instructions you give your child are clear, consistent, and delivered in a calm manner. If your child refuses a food, try not to give too much attention to this.
Look at the environment(s) where your child eats and see if you can make any changes if your child is experiencing sensory discomfort. The person might find it too distracting to eat in a noisy canteen, find out if they could eat in a quiet room instead. The chair they sit on may be too hard, add a cushion. Reduce background noise if it is distracting – turn off the radio or the washing machine. Some parents have found that by having a child’s favourite music or story tape playing in the background, the pressure of eating is removed. Their child is slightly distracted, feels more relaxed and may not find eating such a task.
It is well documented that neurodivergent people have significantly different sensory experiences than neuro-typical individuals which include both hyper and hypo sensitivities. In the context of eating, this means being sensitive to how foods look, smell, taste & feel. Interoception (awareness of internal states) is another key factor to consider as it enables the recognition of hunger and the sense of feeling full.
This can affect a person’s experience of meals and relationship with food, and cause anxiety around food. Look at the sensory area of this hub for more information but here are some useful tips:
- Thinks of ways to relax your child e.g., music can be helpful.
- Do something active before mealtimes can help your child settle to sit and eat, for example animal walks, marching, bouncing including some oral sensory stimulation activities prior to an eating activity, such as blowing and sucking games / chewing / face massage (deep touch around the mouth area)
- Placing a weighted lap pad on their lap, may help them to feel more grounded.
- Improve seating, you could use an air-filled cushion to sit on if your child seeks movement and struggles to sit in one place.
- Once they know the routine, having the clear ending helps to keep them in their chair (e.g. we stay in our chairs until ”clean up time”): Blowing or kissing ‘good bye’ or throwing or pushing 1 piece of each food offered at that meal which hasn’t been eaten into the bin or a scraps bowl (this gives one final sensory exposure to foods as it is often the first time a child touches or tastes a food).
Some children eat better in the company of adults or peers – your child may be more willing to try new foods if they see other people trying the same food and enjoying it. It can also be helpful to model the behaviour you are trying to encourage. This might mean that the whole family takes part in exercise, avoids snacking between meals, or follows a rule about eating something each day from each food group.
Some children remain picky eaters beyond the toddler years because they take comfort in the predictability of foods, they know they like. You will need patience, understanding and sensory ideas to introduce new foods.
You can start with some of the basic ”picky eating” tips that follow:
- Do not give up on introducing new foods. Continue to serve foods even if they are rejected. You may have to serve a food dozens of times before your child will try it. Try introducing one new food at a time to increase your child’s familiarity with it.
- Allow your child to take just one bite and let them spit it out into a paper towel if they decide they cannot tolerate it. You may have to start with praising and even rewarding them for simply licking a food or touching it to their lips.
- You can start the familiarisation process by showing the child photographs of the offending food, then working your way up to having them eat at the table with the food in plain sight (and close enough to smell), then tolerating it on their plate (do not let the food touch other food on the plate if mixing the textures is a challenge to them), touching it, then touching it to their lips, then their tongue etc.
- Consider allowing your child to choose a few specific ‘disliked foods’ to be on their ‘no list’ and promise that you will not force them to eat these. Stick to your promise!
- If your child avoids mixed textures, separate the food using a partitioned plate or several small plates, even allowing them to use separate forks for separate foods. You can also gradually add texture, they may initially only tolerate a small coating of tomato sauce on their pasta but over time become more accepting of the sauce, eventually sauce with chunks of tomato and bits of meat mixed in.
- Give your child an incentive by awarding them points, redeemable for a small toy or extra TV time, for trying a new food or eating a small portion of food that is not a favourite.
- Vary the temperature of foods. Extra cold food might provide sensory input that wakes up your child’s mouth and makes them more willing to eat it. If they prefer their food lukewarm, let them eat it that way.
- Use your creativity and presentation skills to coax younger children to ear. Use cookie cutters to cut foods into fun shapes or arrange foods on a plate to create animals and faces. Children’s cookbooks often have suggestions for creative presentations.
- Avoid serving your child food in the container it came in. Manufacturers frequently change packaging, and your child might be convinced that the new package contains a different product and refuse to eat that food again.
Social stories are short stories, often with pictures, which explain different situations to give them an idea of what to expect. A social story might help your child to understand why we eat and the function of food. Here is a short example. ‘We all need to eat food. This is because food is like fuel – it gives us energy/power. If we have energy, we will be able to do the activities we enjoy. Missing out food groups can make us tired.’
Discomfort and illness
Physical pain and discomfort can affect how a person eats. Gut pain could cause a person to over-eat for comfort. Constipation can dampen appetite. Heartburn can stop someone wanting to continue to eat. Toothache and mouth ulcers can make someone reluctant to put things in their mouth. Some medication can affect appetite (e.g., Ritalin) or cause stomach upsets (e.g., antibiotics). A bloated intestine could cause a person to feel full when in fact they are not. Support the person to communicate physical pain or discomfort, e.g., by using a visual stress scale, PECS (Picture Exchange Communication System), pictures of body parts, symbols for symptoms, or pain scales, pain charts or apps.
Encourage activities which involve movement and exercise. This can help with weight loss (if that is needed) and reducing stress, which may have contributed to over-eating or under-eating. If the person is reluctant, think about whether there could be any underlying reasons, e.g., difficulty with balance, or socialising.
People who are sensitive to smells and taste may prefer to eat quite bland food and may find strong food smells overpowering. Under-sensitivity to taste or smell may mean the person prefers stronger flavours. Particular smells and flavours may be a source of intense pleasure. Some people might find the feeling of hard food, or sloppy food, unbearable. Try modifying food to improve the sensory experience, for example by puréeing or using food colouring, and introduce a new food or textures in small steps, for a gradual desensitisation.
Some people eat better in the company of their family or peers. They may be more willing to try new foods if they see other people trying the same food and enjoying it. For others, the social nature of mealtimes can be stressful. They might be more relaxed, and eat more volume or variety, if they ate alone in another room. If a meal is not going to be at home, prepare the person in advance by telling them who will be there, who will they be sitting with or next to, what people might talk about, and what they could say to start a conversation.
Obsessions, special interests, and routines
Many children have obsessions. If certain foods, or calorie counting, are an obsession, this could lead to over-eating, under-eating, or a rigid diet. But obsessions, or special interests, can also prove helpful. You could try to channel an obsession with eating, or with weight loss, into something positive such as cooking and writing recipes. You could use a special interest to encourage them to eat more volume or variety, e.g. by eating from a Thomas the Tank Engine plate, cutting food into rocket shapes, or exploring foods from the country or region of their favourite singer or sports team or you could use stickers of their favourite character and place on the food packaging to make it more desirable to them.
Many children rely on routine and sameness. To eat well, they may need to have meals at the same time every day, be seated in the same position at the table, or always use the same plate or cutlery. This need for sameness could also explain a person’s preference for processed foods. Processed foods are predictable, designed to look and taste the same each time. In contrast, there will always be natural variation in fresh food e.g., tinned fruits like pineapple and peaches. Introduce new foods or textures in small steps.
Presenting information visually
- produce clear daily and/or weekly menus of foods, display the time of next meal in a prominent position.
- provide visual tools to help the person express and recognise their needs, feelings, and preferences, such as stress scales, hunger and fullness scales, or happy/unhappy face pictures.
- use visual supports to give your child information about the food they are eating could help to reduce any anxiety. Your child can refer to a visual support, such as a food chart, so that they can see what they will be eating and when they might have a chance to try something new. For example, you could list the menu for the day or week ahead and have a section at the bottom stating, ‘This week or today I will try [name of food]’. You can have a list of new foods and let your child pick one from the list.
- create a timetable as it may be important for your child to have regular, set mealtimes. If this is an issue, then try to allow yourself a little flexibility while still giving your child the structure they need. For example: say that lunch will be between 12.15-12.30, say that you will do another activity first (e.g., some colouring) then have dinner.
Try to: be specific when talking about food or using pictures of food. For example, apples look and taste different, but we call them all apples. It is possible that the person likes golden delicious apples, and dislikes Braeburns, but is confused by you showing them a picture of a green apple, and then bringing them a red one.
Try not to: categorise foods into healthy and unhealthy, or good and bad. This can sometimes be taken too literally and can cause further problems.
Encourage your child to handle and prepare food.
If a child is very selective in their diet, getting them involved with the preparation process can help. Asking them to choose what goes into their lunchbox and then letting them help to prepare it can help build tolerance to new foods. Increasing your child’s contact with food could encourage positive associations with it. Try making simple things such as sandwiches, fruit kebabs, little cakes, or pizzas.
Food presentation/adapting food
Attention to detail, and difficulty with change, is characteristic of some children. The way the food is presented or positioned on the plate, or the food’s packaging, may dictate whether it is eaten or not.
- Has the positioning of the food on the plate been altered?
- Is the food over- or undercooked?
- Are there ‘bits’ on the food?
- Has the packaging changed?
- Is the logo a different colour?
- Is the box damaged?
- Have you bought a different brand?
If your child is over- or under-sensitive to certain food textures, smells, tastes, or colours, think about how you can use this to introduce new foods. For example:
- Puree foods (including new foods) if your child is sensitive to textures and try to progress slowly from there.
- Use food colouring if there is a certain colour your child likes or is averse to.
Small steps – gradual exposure
By breaking down the introduction of foods into manageable steps it can reassure your child and make them feel in control. Try to introduce new foods separately from mealtimes so that mealtimes remain a relaxed and pleasurable experience. First let the person just look at it, then touch it, then invite them to put the food on their plate, then smell it, lick it, put it into their mouth, bite it, chew it, and swallow it. Try not to react negatively to food being spat out. This is helping them to become comfortable with different foods being in and around their mouth. These steps could take months to complete. Try to see the goal as learning about and being comfortable around different foods, rather than getting them to eat all the different foods presented.
Using reward systems can be effective. However, avoid using a preferred food as a reward for trying a new or non-preferred food. It could make the preferred food even more attractive, and the new food appear like a chore. Also, ensure the emphasis of the reward is not just on eating a certain amount of a non-preferred food, but on tolerating new food being around, or tasting a new food. Rewarding them for any progress, however small, also help to encourage them to be more adventurous. For example: Place a new food on a plate alongside the child’s prefer food and if they tolerate it being there give them a sticker to add to their chart. If they can put the food in the bin, give them two stickers. If they can touch the new food, three stickers etc.
Food books are sometimes used by professionals as diaries of achievement. Pictures or drawings of foods that your child likes and dislikes are placed in the book – usually the food they like is at the front and the food they do not like at the back. As your child tries new foods and expands their diet, the ‘don’t like’ pictures are gradually moved forward in the book. This provides a nice record of progress that your child may like to look at and take encouragement from.
Sometimes mealtimes can be stressful, pressurised occasions, but by introducing new foods during an enjoyable and hopefully relaxing activity your child may be more willing to try them. Games based around food – use written instructions and visual clues, e.g., if you land on a particular square ‘touch/smell/pick up/lick a food of your choice to move forward three squares.’
Sometimes, what appears as an obsession is in fact a coping strategy. Some children say the world feels overwhelming and this can cause them considerable anxiety. Some children may over-eat, or avoid food, because of low self-esteem or anxiety. Try to minimise any stressful things the food diary has revealed, or encourage a different coping strategy, such as spending time on their special interest, or using a supportive app.
When to seek medical advice
It’s natural to worry and assume something must be wrong when your child seems to lose interest in food. In fact, this is a stage that many toddlers go through. Up to a third of children around the age of two could be described as fussy eaters.
When to see the doctor? Great Ormond Street says:
Try not to worry even if your child’s diet does seem very limited. Research shows that toddlers almost always manage to eat the right balance of nutrients needed for healthy growth and development. But if your child is losing weight, seems lethargic, weak and/or irritable, or is suffering from fever, see your doctor. Tests might be needed to rule out any underlying problem such as anaemia, caused by lack of dietary iron.