Written by Joanne Tattersall
When mealtimes become a daily battle, it can feel as if you’ve entered an endless cycle of putting so much effort into creating a nourishing meal, only for it to be left untouched. Eating is a learning process, as is walking or talking; it takes time to master textures and variety. Find out more in our blog on What Is Fussy Eating. At any age, experiencing something new or unfamiliar can be scary, and take multiple exposures to build confidence in its safety. To help children expand the variety of foods in their diet, it’s important to not be swayed by their ‘safety net’ food preferences and instead, as the parent, take the lead on what they are going to eat. However, it may be helpful to offer a small amount of ‘safe food’ alongside the foods that are being worked on.
Here are our top tips:
1. Maintain a mealtime routine – Have scheduled times for three main meals and two to three snacks. This helps to establish children’s hunger cues which they will learn to recognise and to respond to appropriately. If a food is refused outright, take it away after 30 minutes – do not offer an alternative. It may be tempting to instead give a bottle of milk, although this only reinforces a child’s experience of comfort and may keep them too full for the next scheduled eating occasion. It’s best to give just water between meals so as to not disguise feelings of hunger and fullness. If a meal is refused, continue with the original food plan for the rest of the day anyway.
2. Consider portion sizes – Too much food on a plate can be overwhelming and have the opposite effect of what you are trying to achieve causing children to actually eat less. Using children’s hands as portion guides can be really helpful: fist-sized carbohydrates, palm-sized protein and a cupped hand for vegetables. The Infant and Toddler Forum and The Caroline Walker Trust have produced handy photo guides to help with identifying appropriate portion sizes at different ages.
3. Ensure the texture is appropriate – If children have not yet developed to manage certain textures, they will not eat it. Instead, try opting for foods of similar nutritional profiles but a texture they are able to eat, for example a minced meat dish may be easier to tackle than chunks of chewier meat. Difficulties with progressing from purée may indicate a child has not yet developed appropriate tongue movement to cross the left to right and vice versa – playing at making shapes with the tongue in a mirror can be a helpful (and fun!) way to develop this.
4. Allow independence and self-feeding – It might be messy but this too can help with getting familiar with different textures of foods. Finger foods can be just as nourishing as traditional meals! To try to reduce mess, a plastic placemat can be put under the table or highchair for easy cleaning, or try the bibs with sleeves that stretch over a highchair’s tray!
5. Enjoy meals together as a family – Parents act as role models; by showing children that a variety of foods are enjoyable, they are more likely to try them too. We know life is busy at times so aiming for even one family meal a week is a good start!
6. Encourage involvement in the kitchen – Make cooking a family activity where possible; if something can even be stirred by a child, they can feel some ownership over that meal and potentially feel safer to try it. If the resources are available, growing vegetables at home can be really exciting for children and educational too!
7. Consider making a reward chart – Use a child’s interests to encourage them to try something new; a sticker could be given for each new food tried, building up to a non-food-related reward such as playing with face paints, a trip to the beach or putting on fancy dress. It is important not to use food or "treats" as the reward e.g. if you eat your greens you can get dessert
8. Keep trying! The number of exposures to new foods required before accepting them varies according to the child’s age; with research indicating for infants up to 2 years old requiring approximately 8 to 15  tries and 7 to 12 years old benefiting from trying a food up to 20 times .
What if it’s not ‘just a phase’?
The vast majority of children do outgrow their fussy eating. However, for some children, fussy eating goes beyond ‘a phase’ and may be connected to factors outside of ‘fussiness’. The Sequential – Oral – Sensory (S.O.S) approach goes deeper than the surface presentation. Assessing a child against neurotypical development may help establish reasons for their feeding difficulties.
A multidisciplinary team may be required to support children and can include an Occupational Therapist, Dietitian, Speech Therapist, Psychologist and/or Paediatrician. Each specialist is able to view a childs development and mealtime behaviour from their professional perspective and work together to not only identify difficulties, but also to formulate a plan to progress towards more straightforward family mealtimes.
The S.O.S approach focuses on increasing variety in a child’s diet rather than volume, although this often comes with time too. It can be helpful to consider a realistic time frame to resolve eating difficulties. It can take children without feeding difficulties up to 2 to 3 years  to form eating patterns incorporating a wide variety of food tastes and textures, so it may take as long or longer to resolve any difficulties, especially if there are stress responses and psychological elements to consider too.
Patience is key! It’s important to remember that with time, and sometimes input from a team of healthcare professionals, feeding difficulties can be resolved! If there are concerns around a child’s growth or nutritional intake with persistent fussy eating, it’s helpful to speak with a GP who may refer onto a Dietitian for specialist input. Joanne Tattersall, Registered Dietitian
Paediatric Specialist Dietitian
 Carruth et al. Prevalence of picky eaters among infants and toddlers and their caregivers’ decisions about offering a new food. Journal of the Academy of Nutrition and Dietetics. 2004. 104(1), 57-64. Available from: https://jandonline.org/article/S0002-8223(03)01492-5/fulltext [Accessed 30th May 2021]
 Loewen, R. & Pliner, P. Effects of prior exposure to palatable and unpalatable novel foods on children’s willingness to taste other novel foods. Appetite. 1999; 32(3), 351– 366. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0195666398902161 [Accessed 23rd May 2021]
 Toomey, K. Important Developmental Milestones Relevant to Feeding. 2016. Available from: https://sosapproachtofeeding.com/wp-content/uploads/2019/02/Developmental-Milestones-Table.pdf [Accessed 25th May 2021]
Talia Cecchele Nutrition is a team of registered dietitians specialising in eating disorders and disordered eating. We aim to bring balance back to nutrition, help you to break free from food rules and find food freedom. To enquire about private consultation please fill out a contact form.