Introduction

Many children experience stages of refusing meals or avoiding certain foods. This can leave parents and/or carers feeling frustrated and concerned. Food selectivity can be a normal part of child development, but it can also be worrying when it appears to be impacting on a child’s health and growth.

When a child appears to lose interest in food, it is natural to presume something must be wrong, but often children grow out of this stage and learn to accept a wider range of foods. Focussing on your child’s overall weekly intake rather than daily intake may help reassure you. Studies have shown that young children tend to eat the right balance of nutrients across the week to support healthy growth. 

Sometimes, however, an underlying issue may be causing a child to eat selectively and further investigations are required. Current and past medical history can impact a person’s relationship with food and their willingness to try new foods, for example, if they have had experience of reflux, constipation, or food allergies.

Assessment

Ask parents to complete the checklist in the ‘Selective Eating in Children’ sheet (see supporting information) to see if the child or young person is managing to have something from each of the food groups.

Check weight, height and BMI (if over 2 years of age) and plot on the relevant growth charts. BMI can also be calculated online at BMI calculator | Check your BMI – NHS | Please fill in your details (www.nhs.uk). Also assess linear growth to check if the child has been tracking centiles or any evidence of growth faltering.

If concerns that the child’s height centile is low, it may also be helpful to calculate the mid-parental height centile for comparison.

Investigations

Nutritional bloods may be indicated if there are clinical concerns regarding specific nutritional deficiencies such as iron-deficiency anaemia or vitamin D deficiency.

Management

If the child or young person has something from all the food groups and is growing well, provide reassurance and also give parents/carers the ‘Selective Eating in Children’ sheet (see supporting information) for additional ideas and support.

If the child is not having something from all food groups, advise parents/carers to encourage foods and drinks that are fortified with additional vitamins and minerals (e.g. cereals, bread, milkshakes) and/or try to give a daily multivitamin/mineral supplement.

Optimise management of any concurrent symptoms such as constipation and reflux that could be impacting on appetite.

If there are concerns around growth (underweight or severely overweight) or specific nutritional deficiencies or serious medical concerns, then please refer to the Paediatric Dietitians: Paediatric Dietitians – Referral Criteria – Kingston Hospital

Referral information

Please refer the following children to a Paediatric Dietitian for further assessment and support:

  • Selective eating with growth faltering or obesity
  • Selective eating with nutritional deficiencies
  • Selective eating with serious medical or safeguarding concerns
  • Selective eating with dependence on nutritional supplements
  • Selective eating causing on-going significant impact on day-to-day function

Paediatric Dietitians – Referral Criteria – Kingston Hospital

Supporting Information

‘Selective Eating in Children’ information sheet: A0213-Selective-eating-in-children.pdf (kingstonhospital.nhs.uk)

Infant & Toddler Forum:

Fussy and Faddy Eating in Toddlers Archives – Infant & Toddler Forum (infantandtoddlerforum.org)