When is it time to start worrying about a child’s fussy eating?

From toddlers throwing fruit back in your face to teens refusing anything but pizza – most parents have experienced mealtime frustrations at some point. And back in the day our own parents no doubt ordered us to “clear our plates” and “eat our greens”. 

But the child nutritionist Charlotte Stirling-Reed says these age-old phrases aren’t helpful. “We know much more about child psychology and feeding now,” says the author of How to Feed Your Family: Your one-stop guide to creating healthy meals everyone will enjoy. “Pressuring children to eat can have the very absolute opposite effect.”

So how should we deal with our little fusspots? And when does it become less of a fad and more of an eating disorder? We asked the experts.

How to encourage fussy eaters

Show don’t tell

The first thing to do is consider your own approach, says Stirling-Reed. “You’re already on the wrong track if you go in with the attitude ‘How do I get my child to eat vegetables?’ You shouldn’t get them to eat anything, nor force them to eat certain amounts of food that you assume are ‘right’ because it’s sat on their plates.

“Children learn better from observing us, not being told what to do,” she adds. “Set the example by sitting at the table with them, using cutlery and enjoying your own veg, so they understand it’s important. Mealtimes are about more than just the food, and eating together – whether just you and your child or with other family members – makes it enjoyable. Get them involved with cooking and meal planning so they feel they have some control, make it fun.”

We’ve all been tempted to stick the television on, hoping kids will eat up more happily watching a favourite cartoon, but it’s not advised. Mother of two Stirling-Reed’s own house rules are that children eat at the table and ask before they leave. “If they do ask to leave, that’s fine, but don’t allow taking food away from the table. Distractions from the television don’t help develop an appreciation or even an acceptance of food.”

Their appetite is out of your control

Let’s be frank, when you’ve lovingly made something your children refuse, it’s annoying. But, says Stirling-Reed (who’s also advised the fitness trainer Joe Wicks), try and relax. “All you’re responsible for is serving up food. You’re not in charge of what goes in their mouth. Mealtime tensions can be diffused when you accept, ‘I can’t control this so I’ll keep calm.’ 

“Most kids will go through phases, but if you play it down it might remain a phase – not a life habit. Be patient, often we need exposure to new foods up to 15 times before accepting it, so keep going. There’s no set rules about how frequently this should be, it’s more about offering foods as and when you would as a family and avoid putting pressure on them.”

Children’s appetites are variable, she says, so consider their intake over the whole day or even the week.  

Eating can be a way of exerting authority and independence in a world where they don’t have much of either, says Stirling-Reed. “The trick is often to give them autonomy in other areas of their lives, where appropriate. For example choices between a and b meals, asking them to help serve up the food and choices with what they wear.

How to encourage eating vegetables

Sneaking “hidden” veg into food isn’t something that is recommended. “Familiarity with foods, including seeing them regularly in a variety of forms, is what helps kids accept them,” she says. “Some children can become wary if they’re unsure of what’s in their foods and stop trusting what’s offered.”

Adding extra nutrients wherever possible, such as more vegetables into sauces, smoothies and muffins can work well – but remain honest with ingredients and keep offering veggies in their whole forms regularly. “Even if they don’t get eaten it helps familiarise kids to accept them more readily.”

Have a child that only eats bread? Try nutritious toppings like nut or seed butters, avocado, scrambled eggs, mashed fish with yoghurt, cream cheese or hummus. Offering them as a dip initially can be less daunting than a topping.

“Pasta is generally well accepted and easy to add spinach to, or peppers and tomatoes if they like red things. Most kids love pizza, and making pitta bread wraps when they choose their fillings. If it’s fruit you’re encouraging, porridge topped with berries can be appealing.”

Using vitamin supplements for children

Bahee Van de Bor is a registered paediatric dietitian who runs a programme called Fussy Eating Solutions. She says: “If you just have a child who turns their nose up at broccoli, but eats most other veg and fruit you probably don’t need supplements.

“But if you realise a child, for example, isn’t eating any protein-rich foods – such as red meat, chicken, lentils or chickpeas – then it’s sensible to think about what they’re missing, nutrient wise. So for children who just like to eat bread or carbohydrates I might suggest they take iron and zinc supplements. 

“There are protein supplements with fortified vitamins and minerals you can buy over the counter or can be prescribed by a GP or a dietician,” says Van de Bor.

Stirling-Reed’s suggests making smoothies which include yoghurt, nut butter, banana, milled seeds and oats and maybe some milk. 

She also says a multivitamin “can be a good back-up” if you’re concerned about your child’s nutritional intake. 

The Department of Health recommends supplements for vitamins A, C and D (which is particularly hard to get enough of through food alone). Babies under one need 8.5-10 ug (microgram) of vitamin D and those over one need 10ug daily. 

With vitamin A, babies under one need 350 ug and children aged one to six require 400ug. With vitamin C, babies under one need 25 mg and children aged one to six require 30mg.

When picky eating leads to constipation 

“It’s not unusual for children with reduced intake of fruit, veg and wholegrains to struggle with tricky poos, but this is easily fixed as they learn to eat a wider range of foods,” says Van de Bor.

Sometimes laxatives are needed but for a quick hack for those children who usually eat white bread or white pasta, she suggests gradually introducing the wholemeal-based varieties instead.

“A white slice of bread provides roughly 0.5g of fibre, but a wholemeal one has 1.9g of fibre. That’s a big difference in fibre for children.”

She recommends concerned carers keep track of children’s loo patterns with a symptom diary. “Their poo pattern and stool grading tells a lot about their digestive health.” 

When you need to seek professional advice

“I would only start to worry if your child is losing weight or if they’re not growing in the expected way,” says Van de Bor. “If you’re concerned, you can start measuring and weighing them to check against the official charts. If you believe their growth is faltering – ideally before they fall to less than two centiles under where they should be – then it might be time to seek advice from GP. There are many private registered dieticians who specialise in children if you don’t want to wait.”

She also recommends seeking guidance if your child becomes anxious around food, or it’s affecting their sleep, or they’re beyond the toddler years and still refusing to eat anything but a limited diet.  

When does fussy eating become an eating disorder?

The number of young people aged 17-19 with eating disorders has soared from 0.8 per cent in 2017 to 12.5 per cent in 2023. Last month the charity Beat reported a seven-fold increase in calls about a lesser-known eating disorder called avoidant/restrictive food intake disorder (Arfid) which is characterised by extreme picky eating. So why have we apparently become fussier than ever before? 

“Having Arfid is not just being a picky eater, it’s a complex condition that needs to be taken seriously,” insists Umairah Malik, a clinical advice coordinator at Beat. She believes numbers have risen post-Covid because “the pandemic had a huge impact on people with eating disorders and neurodivergent people, particularly those with autism, and there’s now an increased awareness and diagnosis of both”.

Unlike anorexia or bulimia, which are driven by issues surrounding body weight, or the need for control, with Arfid these are not contributing factors. 

“From the research available, we know that the main drivers of Arfid are lack of interest in eating, sensory elements – smells, textures and appearances – or fear of consequences such as choking,” explains Malik. 

When does regular fussy eating tip into something more concerning? Warning signs might be having very little interest in food, always wanting the same meal (which isn’t varied enough for them to remain healthy so they may require supplements) or only eating food of a similar colour (like beige). Or if a child seems generally anxious about mealtimes to the extent that it’s affecting school life or social occasions where there is food offered.

“These things can significantly impact a young life and make it very stressful for their carers,” says Malik.

Beat has a free online support group for parents of children aged five to 15 with Arfid, though Malik says they meet youngsters under five with eating disorders, too. The charity can also assist with finding help available in your local area. “There’s no single best treatment for Arfrid, it really depends on the individual because there are so many ways it presents,” she says. “But it can include talking therapy, exposure therapy, speech and language therapy and support from a paediatric team.”

‘My daughter takes her own pesto to friends’ houses’

Olivia Coghlan, 50, is mother to two older boys and a fussy-eating daughter, Aoife, 11. The family are from London but moved to France 10 years ago

Mealtimes at our house can feel like a battle ground. After having my sons who ate everything, having a third child like Aoife was a surprise. As a breastfed baby she was fine but started refusing foods during weaning, even sweet things, like pureed pears, which babies are supposed to love. 

The toddler years were worse. Even simple ingredients like ham and cheese – staples in France especially – became off limits. I felt other parents roll their eyes at the fussy English girl (and her indulgent mother). It went in phases although funnily enough fast food was always acceptable to her. And yes, I would cave in and allow chips or chicken nuggets more often than I’d care to admit because frankly, I was glad she was eating at all. 

Other fads included only eating very plain sushi rolls of cucumber and rice. That wasn’t cheap. At one point we had a list on the kitchen wall called “Things Aoife says she doesn’t like – but actually does”. Entries even included sandwiches and biscuits at times. 

Since moving to France for my husband’s IT job, I’ve noticed a very different attitude towards food. Here, the schoolkids are given a whole 90 minutes minimum to eat lunch. They’re served three courses, generally of seasonal produce, in the school canteen. The options are more varied than in the UK, so the children are exposed to new foods constantly and there’s rarely anything fried. It’s certainly healthier, but means Aoife can go all day on just bread and yoghurt. I’ve never worried that her weight has dropped too low, though I’ve been fuming in restaurants paying 12 euros for a bowl of plain pasta.

It’s improved with age, but she still takes her own pesto to friends’ houses in case she doesn’t like their brand.