Parents often ask me whether their child is just fussy or whether something more is going on. It is a fair question, and there is a reasonably clear way of thinking about it that I use in practice.
The Feeding Trust, a UK based charity, has resources that set this out well, and I find they highlight quite nicely when you would be concerned.
It comes down to how many foods, counted properly
When I am assessing a child's diet, or looking at a food diary, I am looking over a week or so at how many different foods they are consuming.
The counting matters here. These are not just categories. Different types of bread count as separate foods. Different types of cereal count as separate foods. So when you sit down and add it up honestly, the number is often different from what you assumed.
A typical eater
A typical eater would eat around 30 different foods or more. If your child is over 30 when you add everything up across a week, that sits in the typical range.
A fussy or picky eater
A fussy eater would typically accept around 20 to 30 foods. Alongside the number, you would usually see:
- Avoiding new foods.
- A strong preference for certain tastes and textures.
- A limited variety of different foods overall.
- Excluding a whole food group, or a whole texture group.
There is a straightforward tick box tool on the Feeding Trust website if you want to check whether your child falls into this range.
A problem eater
A problem eater is a child with a very restricted food range, maybe only 10 to 15 foods when you add everything up. Typically they will have very strong likes or dislikes, refuse or omit new food groups completely, and would likely have growth problems, nutrient deficiencies, or both.
The thing that catches parents out
Sometimes you cannot see the problem. Children can have very restricted diets but grow perfectly well, because they are getting enough calories and protein from the same foods they eat repeatedly.
That can still mean there is a nutrient deficiency underlying it, because they may not be getting the full spectrum of everything they need. Normal growth is reassuring, but it is not a complete answer on its own.
That is why I would definitely recommend assessment for a child who is eating very few foods, even if they seem to be growing fine.
The red flags worth acting on
- Fewer than 20 foods in total. This is the clearest single marker.
- Omitting whole food groups. If a child is not eating anything from the protein rich group, I would want to know where their iron is coming from. In practice it is often the vegetable group that gets omitted, and a child will tend to eat a couple of fruits, though not always.
- Continually refusing nursery or school food, where it goes on and on and cannot be explained by a normal settling in period.
- Ongoing gagging and vomiting. Gagging is very normal in the early stages of weaning and completely to be expected. If there is lots of gagging and vomiting that is not resolving after a number of weeks, that is different.
- Being unable to self feed, so you are still having to feed them.
- Not coping around food with others, so being visibly disgusted by food or having very strong reactions to other children eating.
What to do if you recognise your child here
Keep a food diary. If you are really concerned about a child's eating, a diary genuinely helps to highlight any issues, and it gives you an accurate count rather than an impression.
Then get some advice. It is very individual, so always reach out if you are unsure. I do quick catch up calls with parents through V&Me if you just want to run something past me, or if you are not sure whether what you are seeing counts as a feeding difficulty.
It is also worth seeing your GP if there are other concerns, particularly constipation or low iron. If a child is constipated or anaemic, it will affect their appetite further and make the whole situation worse.
