Extreme fussy eating in children

For some children, fussy eating is a persistent struggle that can lead to health concerns for parents and carers.

Understanding the reasons behind the fussiness and when to seek professional advice are key to maintaining optimal nutrition, health and happiness for both child and family.

Extreme fussy eating is often a behavioural expression of something that is going on behind the scenes, making eating and trying new foods uncomfortable for the child.

Causes of fussy eating

While approaches for treating fussy eating are often the same, understanding the underlying cause for this behaviour is imperative for parents, carers and professionals.

This means empathising with the child and trying to understand what they’re experiencing and why. For example:

• was there a traumatic gagging experience that led the child to only eat smooth textures?
• is there too much background noise that may be creating too much sensory stimulation and quietness is needed for the child at mealtimes?
• is the child experiencing anxiety related to food when pressured to eat?

When to seek professional support

Extreme fussy eating in babies and very young children can be distressing for parents. It’s also difficult for them to know what normal fussiness is and when to seek professional support.

If parents demonstrate significant anxiety despite initial advice from their general healthcare provider, speciality services should be sought to explore the underlying cause and what the most effective treatment might be.

These services may include support from a mix of paediatric dietitians, psychologists, feeding clinics, gastroenterologists, and occupational, speech or language therapists.

A referral is especially important for children who:

• fail to meet appropriate nutritional or energy requirements
• follow a limited diet, such as in the treatment of allergies
• have a chronic disease such as cystic fibrosis or diabetes
• have parents who demonstrate high levels of distress around food
• have a sensory processing related problem (see below).

Sensory-related feeding problems

According to Thompson et al (2009), feeding-related problems due to possible sensory processing preferences may be indicated by the following:

Inadequate eating, eg:

• • repeated food refusal
  • not swallowing food
  • the tendency for regurgitation, choking, retching or coughing
  • accepting only minimal amounts of food
  • intensely limited range of food, including difficulty advancing to solids
  • limited movement of food around the mouth as the infant develops.

Difficult mealtimes, eg:

• • • excessively lengthy feeding periods (eg 30–45 minutes)
    • problem behaviour, such as screaming or throwing food
    • the expression of extreme distress at mealtimes.

Inadequate weight gain due to lack of nutrition.

In this video, Inger Neylon, a family dietitian, outlines some of the underlying causes that can manifest in extreme fussy eating and food refusal, and why – for some children – professional support is needed to address this.