I have been a registered dietitian for 19 years, and fussy eating is one of the things parents ask me about most. I spent a long time in the NHS across community and hospital settings before starting my own practice, and I have been with V&Me right from the start. In that time I have seen the same worry come up again and again: my child used to eat everything, and now they will not touch it.

So I want to set out what is genuinely normal, where the line sits between fussy eating and a feeding difficulty that needs support, and what your actual role is at the dinner table.

Most fussiness is a normal stage, not a problem

Most children will experience some degree of fussiness. It is extremely common. Most toddlers go through a phase called food neophobia, which normally starts around the age of 18 months to 2 years. That means it lands right in the middle of the nursery and preschool years.

What you see is that food which was previously accepted starts to be refused. You might have a child who ate really well in the early days, who weaned brilliantly and accepted all those different vegetables and fruits, and then suddenly they become reluctant to have those previously liked foods, or they start to reject anything new. They might say things are disgusting. They might refuse something because it has touched something else on the plate.

A lot of this comes down to the way their brain is developing and food not meeting their expectation. The banana has some bruising on it instead of being yellow all over, so it is rejected. The biscuit is broken, so they do not want it that day. It is a very normal phase, and with the right support most children will naturally outgrow it.

Appetite varies, and that is fine

All children grow at different rates, and their nutritional needs depend on their age, gender, weight, height and overall activity levels. Children are very individual, and it is important to bear that in mind when you are thinking about your own child.

Appetite varies from day to day, and it is governed by many different factors. It depends on how tired your child is, the growth stage they are going through, and whether they are about to come down with something. Children starting nursery in particular go through lots of periods of being unwell. Separation anxiety, worry, sensory issues or any kind of pressure to eat can all affect appetite too.

Most children are quite good at regulating this over the course of a week or so. Off days, and days when they eat much more or much less than usual, are very common.

Eating is a sensory task, not just a taste one

Eating is a very complex sensory task, and children with sensory sensitivities often find food challenging because they are over or under responsive to it. It involves all of the senses we have, so not just smell and taste but touch and sound, as well as the vestibular sense, which is balance and coordination, proprioception, which is body awareness, and interoception, which is your internal cues.

That is why a child can gag at the sight of a food, or dislike the feel of it on their hands. Adults subconsciously know what to expect from foods. Children are still learning what to expect.

A lot of children also dislike bitter tasting foods, and that is an evolutionary dislike, because bitter foods were potentially poisonous. Foods with stringy bits or slimy textures tend to be disliked as well.

How I tell fussy eating from a feeding difficulty

The Feeding Trust, a UK based charity, has some resources that highlight this nicely. When I assess a child's diet or look at a food diary, I am counting how many different foods they eat across a week. Different types of bread and different types of cereal all count as separate foods.

A typical eater

A typical eater would eat around 30 different foods or more when you add them all up.

A fussy or picky eater

A fussy eater would typically accept around 20 to 30 foods. They may avoid new foods, have a strong preference for certain tastes and textures, and have a limited variety overall. They may exclude a whole food group or a whole texture group.

A problem eater

A problem eater would have a very restricted range, maybe only 10 to 15 foods. They might have very strong likes and dislikes, refuse or omit whole food groups, and would likely have growth problems or nutrient deficiencies as a result.

It is worth saying that some children with very restricted diets grow perfectly well, because they are getting enough calories and protein from the same foods they eat repeatedly. That can still mean an underlying nutrient deficiency, because they are not getting the full spectrum of what they need. That is why assessment is worth doing if a child is eating very few foods.

The red flags I would want to know about

• A child eating fewer than 20 foods in total.
• A child omitting whole food groups. If they are not eating any protein rich foods, I would want to know where their iron is coming from. It is often the vegetable group that is omitted, and a child will tend to eat a couple of fruits, but not always.
• Continually refusing nursery or school food, where it cannot be explained by a normal settling in period.
• Gagging and vomiting that goes on and on and is not resolving after a number of weeks. Gagging is very normal in the early stages of weaning, but ongoing gagging is different.
• Being unable to self feed, so you are still having to feed them.
• Not coping around food with others, so visible disgust or very strong reactions to other children eating.

It is very individual, so always reach out for help if you are unsure. I am available through V&Me and do quick catch up calls with parents if you just want to run something past me.

Your role, and your child's role

This is the part that takes the most pressure off parents. Your role is to provide a regular mealtime routine, offer a balanced and varied diet, role model eating, and provide supportive language in a no pressure environment. That is your role, and it does not really go beyond that.

Your child's role is to decide what they eat from what you provide, how much, and whether they eat anything at all that day. That is known as the division of responsibility. You cannot force your child to eat. More coercion and more pressure honestly just makes children go the other way.

What actually helps

• Keep mealtimes regular and predictable, and put a limit on how long they run.
• Ignore food if it is refused, and keep calm.
• Offer sweet and savoury together sometimes, so sweet food is not put on a pedestal.
• Do not force food, and generally do not hide foods.
• Keep offering. Some children need 15 or 20 exposures, and some need a lot more than that.
• Encourage self feeding, and try not to show that you are stressed about the mess.
• Rotate the foods they do like, so they do not get stuck on a few and leave you short if they drop them.
• See your GP if you have concerns about constipation or iron, because both will affect appetite and make the whole situation worse.

Most children need a vitamin and mineral supplement up to the age of 5, and a fussy eater might need something more depending on what is missing from their diet. It is worth getting advice on that, because they come in different formats and doses.

When to get in touch

There is never a bad time to get support with your child's eating. If you are struggling, or you are worried, a conversation is usually worth having sooner rather than later. Keeping a food diary really helps to highlight what is actually going on.