Feeding difficulties are a common challenge for many children, affecting their ability or willingness to eat in ways that support healthy growth.1 However while some feeding issues may only require minor adjustments or simply resolve with time, others can be more serious and persistent, potentially increasing the risk of malnutrition.
Understanding the causes of feeding difficulties and recognising the signs of malnutrition are crucial for parents and caregivers in supporting a child’s healthy development. We asked our in-house Dietitian about these challenges and to share practical advice on how to promote positive eating habits and prevent malnutrition. Please note that the information on the site is for educational purposes only and does not constitute medical advice or diagnosis.
What are feeding difficulties?
Feeding difficulties encompass a range of issues, from picky eating and slow growth to extreme food aversions or problems related to medical conditions.2 Some common types include:
- Picky eating which is often a phase in toddlerhood where a child may develop strong preferences or aversions.
- Medical feeding disorders that involve underlying physical conditions such as acid reflux, food allergies, or respiratory issues, making eating uncomfortable.
-Behavioural feeding issues, often related to anxiety or sensory sensitivity around eating.
- Oral-motor problems that affect chewing or swallowing, which is more common in children with certain neurological or muscular disorders.
Each of these difficulties may require a different approach, which emphasises the importance of understanding the underlying reasons behind a child’s eating challenges.
Causes of feeding difficulties
Several factors can cause feeding challenges, and these can be physiological, emotional, or developmental. Sensory sensitivities, for example, can make certain textures or tastes overwhelming, which is common in children with sensory processing issues or autism spectrum disorder.
Medical conditions like gastroesophageal reflux disease (GERD), constipation, respiratory issues, or food allergies can make eating uncomfortable or painful, leading to a reluctance to eat. Developmental delays may also impact feeding abilities, as some children struggle with the fine motor skills needed to self-feed or with the oral-motor skills required for chewing and swallowing.
In some cases, feeding difficulties may stem from the child’s emotional environment. Mealtime stress, trauma around eating, or overly controlling feeding practices can all create negative associations with food, leading to refusal or avoidance.
Additionally, parent-child feeding dynamics play a role; pressuring a child to eat or failing to establish a consistent eating routine may lead to anxiety and further resistance.
Recognising malnutrition risks
When feeding difficulties persist, they can pose health and developmental risks. Malnutrition happens when a child doesn’t receive the right amount of nutrients to support growth and development, potentially leading to a range of health issues.1
Key indicators include poor growth (underweight or slow height gain), weakened immunity, fatigue, and developmental delays. Nutritional deficiencies often manifest physically, with signs like dry skin, brittle nails, or hair loss, all of which can signal a lack of essential vitamins and minerals.2
Supporting a child with suspected feeding difficulties
Successfully managing suspected feeding difficulties involves creating a positive eating environment, ensuring nutritional needs are met, and seeking professional help when necessary. Here are several possible strategies2,3:
1. Foster a positive mealtime atmosphere
Establishing regular, structured meal and snack times can help create predictability and reduce stress around food. Keeping mealtimes calm and minimising distractions, like screens or toys, can allow the child to focus on eating.
2. Encourage hands-on involvement
Engaging children in food preparation can encourage a more positive attitude toward eating. Simple tasks like washing vegetables, stirring ingredients, or setting the table can give children a sense of ownership, making them more willing to try new foods. Creative plating and presentation can also make foods more approachable and interesting, helping to reduce fears of unfamiliar tastes or textures.
3. Gradual food introduction
For children with strong food aversions, gradual exposure to new foods is key. Introducing small amounts of new foods alongside familiar favourites can help children feel more comfortable. It’s normal for children to refuse certain foods at first, but repeated exposure, without pressure, often increases acceptance over time.
4. Encourage self-feeding skills
Allowing children to feed themselves—even if it’s messy—promotes independence and helps them build motor skills. Finger foods and a variety of textures and shapes can also encourage sensory exploration, which is beneficial for children who are sensitive to food textures. Gradually, this can lead to a more positive association with eating, as children feel a sense of independence.
5. Provide lots of praise
Praise your child even if they only eat a little. While it can be tempting to pressure a child to try new foods, avoiding force or punishment around food choices is essential, as this may make them more likely to refuse food. Try not to use food as a reward or your child will start to think of the foods they don't like are a punishment. Instead offer a trip to the park or a game as a reward.
6. Prioritise nutrient dense foods
When feeding difficulties limit a child’s diet, it’s crucial to focus on nutrient-rich options to help meet their needs. Foods high in calories and nutrients, like avocado, nut butter, and full-fat dairy, can support growth and development even if the child’s intake is small. For children who struggle with solid foods, nutrient-dense drinks, smoothies or supplements may be useful in ensuring they get essential vitamins and minerals.
7. Seek professional guidance
When feeding issues are persistent or severe, consulting a doctor or dietitian can be beneficial. These professionals can assess the child’s health, provide nutritional guidance, and recommend appropriate feeding therapies. Specialists in speech or occupational therapy can also work with children to improve oral-motor skills or address sensory processing challenges, which are often at the core of feeding difficulties.
When to consider professional help
Persistent feeding difficulties that last more than a few months, particularly when they affect growth or development, should be discussed with a healthcare provider.
Specific warning signs include:4
- Frequent gagging
- Vomiting, or choking during meals
- Taking a long time to eat or creating pockets in their mouth
- Getting stuffy during meals or getting a gurgly voice during or after meals
- Signs of significant nutritional deficiency
- Dehydration e.g. dark urine
- Weight loss
- Distressing reactions to mealtime that interfere with the child’s quality of life
Healthcare professionals can assess growth patterns, monitor nutritional intake, and suggest tailored treatment plans that address the child’s specific needs.
In conclusion
Supporting a child with feeding difficulties requires patience, understanding, and, sometimes, specialised guidance. Although challenges with eating and nutrition can be distressing for families, many effective strategies exist to help children develop healthy eating habits and reduce the risk of malnutrition. Recognising and addressing feeding issues early can make a significant difference, helping children to thrive physically, mentally, and emotionally. A calm, consistent, and compassionate approach, along with a willingness to seek help when needed, can support both the child’s well-being and the family’s overall quality of life.
References
- Taylor CM, Emmett PM. Picky eating in children: causes and consequences. Proc Nutr Soc. 2019 May;78(2):161-169.
- Yang HR. How to approach feeding difficulties in young children. Korean J Pediatr. 2017 Dec;60(12):379-384.
- NHS. 2024. Available online: https://www.nhs.uk/conditions/baby/weaning-and-feeding/fussy-eaters/#:~:text=Tips%20for%20parents%20of%20fussy%20eaters&text=Try%20to%20eat%20with%20them,food%20away%20without%20saying%20anything.
- American Speech-Language-Hearing Association. n.d. Available online: https://www.asha.org/public/speech/swallowing/feeding-and-swallowing-disorders-in-children/?srsltid=AfmBOooRq3yPYmp1hWu-YrGS0LadJvQ5L6fGTKw4r-wI7MJ0UNTaJ1LS
