Most children go through a stage of ‘fussy’ eating at some point in their lives. For some, this may last for a day or two, and for others it can go on for much longer. Up to a third of children aged two could be described as fussy eaters – food refusal is a common way for toddlers to assert their independence at this age. Children with autism spectrum disorders are also five times more likely to have mealtime challenges such as extremely narrow food selections, ritualistic eating behaviours (e.g. no foods can touch) and meal-related tantrums. Whatever the reason, we’ve put together our top tips to help you cope with even the fussiest of eaters:
Step 1: Establish any underlying issues
With any cases of fussy eating it’s important to establish whether there are any underlying issues that need to be addressed first.
• Rule out any medical problems
If you’re having problems at mealtimes it’s important to first establish whether gastrointestinal distress could be at the root cause. If eating leads to tummy ache, your child will quickly form a connection between the two and start rejecting food at mealtimes. Gastrointestinal imbalances are particularly common among children with autism and many will struggle to articulate this clearly. If you are concerned that GI problems may be part of the problem, or if any other symptoms such as weight loss, lethargy, weakness, irritability or fever are also present, see your GP as first port of call.
• Rule out nutrient deficiency
Loss of appetite can often result when your child is running low in essential vitamins and minerals. Iron and zinc are closely linked to appetite so it’s worth getting these checked if you’re concerned about your child’s lack of interest in food.
• Rule out worry, stress & anxiety
When the body is under stress it diverts energy away from the digestive system and towards the muscles instead, ready to fight or take flight. Typical symptoms of low appetite and feeling nauseous commonly result. A sudden loss of interest in food or feeling sick can be an early sign that your child is feeling worried, stressed or anxious so it’s important to check whether this is the case. Encourage your child to nibble on something small that’s fairly plain such as a piece of toast, which will provide energy and help them to better cope with the stress.
Step 2: Simple strategies to improve your child’s eating habits:
When you’ve established that no other issues are present, there are some simple strategies that you can use to encourage your child to eat a more varied diet.
• Keep calm & don’t worry – It’s normal to worry that your child isn’t getting all the nutrients they need when their diet becomes very restrictive. However, children are more resilient than you think when it comes to getting what they need from food. Consider what your child eats over a whole week rather than just in one meal. Even if the diet seems very limited, most children still manage to eat the right balance of nutrients needed for healthy growth and development when you look at their intake over a longer period. If you are anxious and tense, your child will quickly pick up on this and it could make the situation worse. Keep your cool even if a meal hasn’t been eaten; just take the plate away without any fuss.
• Eat together – Food represents so much more than a collection of nutrients on a plate. Mealtimes are an opportunity for families to enjoy some quality time together and this is an important part of building a healthy relationship with food from an early age. Eat together whenever you can; even if this is not possible every day because of work schedules, it’s worth doing when you can find the time. It’s important that young children see you eating the same type of food as them - small children especially like to imitate what older siblings or parents are doing, so make sure you provide plenty of opportunities for them to do this.
• Shop & cook together – The more opportunities you can provide for your child to get involved - from sourcing food at the supermarket, to preparing and cooking at home - the more likely they are to taste the results. Encourage your child to pick out some fruits and vegetables at the supermarket and then use these as a base for your next meal. Spend a morning baking together. Help your child to make their own blend of granola and store in a glass jar with their own personalised label. Chop up a variety of fresh fruits and place on the table with wooden skewer sticks so they can make their own fresh fruit kebabs. Get creative and encourage your child to be a part of the whole process of sourcing, preparing, cooking and eating food.
• Grow your own – If your child enjoys getting more involved in food preparation then they will love the process of nurturing their own homegrown fruits and vegetables. Few children can resist tasting the end results of their efforts with tasty homegrown strawberries, carrots and tomatoes.
• Take advantage of ‘hungry’ spots – Children usually work up a good appetite after a strenuous activity or straight after school or nursery. Many wake up ravenous and ready for breakfast. Identify your child’s ‘hungry’ spots and make sure you offer something nutritious at this point – it’s also a great time to offer something new.
• Don’t ask children what they want to eat; present simple healthy food and always offer new foods alongside tried and tested alternatives so their plate looks familiar.
• ‘Buffet-style’ meals – I have used and recommended this tip time and time again and it never fails to work with fussy eaters. Try serving meals ‘buffet style’ in a series of big dishes on the table, so children can help themselves. As well as being fun, sociable and interactive, you will most probably find that your child adds more to their plate and is more willing to try new foods too. Another idea along the same theme is a ‘pirate dinner’ where plates, knives and forks are not allowed! Food is served in the middle of the table on a large platter or piece of foil and everyone just helps themselves - it’s messy, fun and kids love it! Kids appetite often increases outside so you could try picnic-style eating every once in a while too.
• If at first you don’t succeed, try and try again - Studies have shown that some children need to be shown a food 10 times before they will accept it. Don’t lose heart if your child isn’t interested the first few times you offer something new – just keep trying and your persistence will pay off in the long run.
• Optimise nutrient intake – Fussy eaters can become trapped in a vicious cycle, where a restricted diet can lead to low nutrient intake, which may exacerbate a poor appetite and so the cycle continues. In particular, children with low iron and zinc often suffer from a reduced appetite. It’s important therefore to supplement your child’s diet with a high quality multivitamin & mineral formula containing optimal iron, B vitamins, vitamin D & zinc and an additional fish oil supplement to boost their intake and kick-start a more positive cycle.
• Have a standby – It’s always useful to have an easy standby for those times when you’re really struggling. A powdered meal replacement supplement that combines dairy-free low allergy rice protein with carbohydrate, fat and added essential vitamins and minerals is no substitute for a healthy balanced meal but is a good second best when your best efforts have failed. This can be used as an occasional meal replacement for those times when your child won’t eat a thing, or as a nutritious snack to boost nutrient intake. Having a standby like this gives you reassurance that your child is at least getting some goodness into their system to support growth and development and to help them to function at their best.
Useful recipes for fussy eaters
Quick and easy pasta sauce with hidden veg
You can adapt this recipe to include whatever types of veg you like. I like to add some chopped red pepper, a handful of spinach, a couple of cloves of garlic and a dash of red wine vinegar too. Let your children dish it up themselves and serve with grated cheese. For extra variety you can try with different types of pasta too.
2 medium onions, peeled and chopped
2 tablespoons extra virgin olive oil
Handful mushrooms, wiped and chopped
Large carrot, peeled and chopped into small pieces
1 medium courgette, chopped
1 x 400g can chopped tomatoes
1 x 425g can flageolet beans
1 tablespoon chopped fresh parsley
Fry the onions in the oil until transparent. Add the mushrooms and cook for 2-3 minutes. Add the carrot and courgette and coat with oil. Pour in the chopped tomatoes and beans and simmer until the vegetables are soft. Toss in the parsley and whizz up in a food processor until smooth.
Vegetable crudités & dips
1 stick celery
1 red pepper
½ small cucumber
Chop the raw vegetables into manageable sticks. Serve on a large plate with a dollop of houmous and cream cheese for a tasty, nutritious snack.
Smoothies are a great way to get kids involved in fun food preparation and to increase their nutrient intake too. This recipe is one of my kids’ favourites and can be easily adapted to include different fruits and vegetables.
1 x small ripe banana or ½ avocado
1 x tablespoon frozen berries (any of strawberries, raspberries, blackberries, blueberries etc.)
Small handful fresh spinach
1/2 cup apple juice (add more for a runnier consistency)
Dollop of live yoghurt (you can use dairy or non-dairy alternatives)
1 tablespoon ground mixed sunflower, pumpkin and linseeds
1 tablespoon flaxseed oil
1/2 level tablespoon lecithin granules (you’ll find these in any good health food shop)
Liquidise all the ingredients to a smooth consistency and drink straight away. If left, the shake will continue to thicken because of the lecithin granules. You can adjust the quantities of the juice / yoghurt / frozen fruit to make it runnier / thicker / more fruity etc.
Roasted red pepper and squash soup
Soups are a great way to add extra nutrition into your child’s diet. Roasted red peppers add natural sweetness that kids usually love.
1 red pepper halved, deseeded and destalked
2 tablespoons extra-virgin olive oil
1 large onion, peeled and chopped
1 carrot, peeled and chopped
1 small squash, peeled and chopped
600ml low salt Swiss vegetable bouillon (you may need to add more depending on the size of your vegetables)
Preheat the oven to 180C. Brush the two pieces of red pepper with 1 tablespoon of the olive oil and place in the oven on a baking sheet to roast for 20-30 minutes. Meanwhile, chop the onion and sauté in 1 tablespoon of the olive oil until transparent. Add the carrot, squash and stock and simmer for 25 minutes until all the vegetables are soft. Add more stock if necessary. When the pepper halves are cooked, take their skins off, chop the flesh, and add it to the soup. Liquidise the soup in a food processor until smooth and serve with some fresh parsley sprinkled over the top.
Graf-Myles J, Farmer C, Thurm A et al. Dietary adequacy of children with autism compared with controls and the impact of restricted diet. J Dev Behav Pediatr2013 Sep; 34(7):449-59. doi: 10.1097/DBP.0b013e3182a00d17