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Date issued: April 2020

Review date: April 2022

Ref: C-376/JC/Child Health/Promoting dietary variety in children

PDF:  Promoting dietary variety in children and young people final April 2020.pdf [pdf] 391KB

Promoting dietary variety in children and young people

Please note: it is important to liaise with a medical professional if you have any concerns around your child’s safety while eating. This advice is intended for children who are able to safely eat, but where there is limited variety within the diet. If children gag, choke, cough or appear in discomfort while eating then you should seek further guidance.

You should also gain advice if you feel your child is not gaining weight or growing as you would expect. It is important to be aware of other issues which can impact on eating such as pain, dental issues or previous adverse events around food such as choking.

In this factsheet we are considering how to support young people who have a limited variety in their diet, sometimes referred to as picky or fussy eating. Often these are young people who eat a reasonable amount of food but have a limited range of accepted foods. This could include a preference for specific flavours, shapes, textures, colours or brands of food.

Young people who are pickier with their eating often struggle to try new foods. They may become upset or frustrated when new foods are presented to them. We know that young people naturally go through stages where their food preferences change, but we would expect them to progress out of this over time. While the strategies within this factsheet may still be helpful during these stages, it is particularly aimed at young people who have more persistent difficulties.

There are some important questions to ask before we begin any work around dietary variety.

        1. Am I happy that my child is able to eat safely?

          Please make note of the information at the top of this page. Unfortunately there is no specific NHS service for picky eating. However, if there are concerns around              swallowing or growth then this may need to be reviewed by a medical professional.

         2. What are we trying to change and why?

         It is helpful to have a goal in mind before setting out on any work. Often we have a broad goal in mind, such as for a young person to be able to sit with the family               and eat the same meal as everyone else. Whilst this is a very appropriate long-term goal, we may need to consider smaller steps which will help us to work towards           it.

         We also need to consider why we are trying to change, who is it that wants this change to take place? How appropriate is a young person’s diet at the moment?

         If diet is not providing sufficient nutrition then there is a clear reason to change. However, we may also need to consider whether supplements are appropriate to                 support this. You can discuss this with a medical professional such as your GP, Pharmacist or Dietitian. If a young person is not motivated to change their diet but               are gaining sufficient nutrition, then it might not be the right time to try and change. We sometimes see that motivation changes as a young person gets older,                     particularly as they see the social opportunities which come with eating.

       3. What is my own diet like?

        Young people gain a lot by what they see modelled to them. It will help for them to see adults and peers around them eating and enjoying a range of foods. We will              all  have our own food preferences. However, it is important that your own likes and dislikes do not overtake those of your child. You need to be able to support them          if they want to try a food which you don’t like.

      4. Is anxiety a broader concern?

       Our aim is to address eating in a way which feels safe to a young person. However, at times it may evoke some anxiety. If you feel anxiety is a broader concern then           it may be helpful to discuss this with your child’s school or another professional. It is also important to acknowledge your own anxieties around your child’s eating,               consider what impact this has on mealtimes, and the pressure it puts a young person under.

      5. What should we be eating?

        It is helpful to remind ourselves what a varied diet should contain. Information can be found in the NHS eat well guide, www.nhs.uk/live-well/eat-well/the-eatwell-guide

We know that eating is a complex experience with various different senses being used, for example, we register what a food looks like, what it feels like, what it smells like and how it sounds when we squash it. The sensory experiences around us, such as how busy or noisy an environment is, are also important. There is a hierarchy with eating, and we need to consider each sense in turn when supporting a young person to expand their dietary range.

Our overall aim for a young person is to develop their eating skill not their dietary range. Over time, as skills develop, the range will expand to. However, it is important for us to be aware of this focus before setting out with any work, without skill, and young person cannot expand the variety in their diet.

We need to separate meal times from ‘learning about food’ times. At meal times we should focus on a young person being able to eat the foods they are comfortable with. We want to ensure they are eating a sufficient amount, but do not want meal times to become a negative experience. We should have some clear expectations at meal times, such as sitting at the table or eating what is put on your plate.

We need to think about separate opportunities for a young person to learn about food. This is our opportunity to support them in working through the above hierarchy, and will take place away from mealtimes (and probably away from the environment in which you usually eat). This is what we will focus on as you progress through this factsheet.

There are two ways in which we can consider the eating hierarchy:

• The first is in relation to a specific item of food which we would like a young person to work towards eating. We can work through the steps of the hierarchy in turn, increasing a young person’s tolerance to being around a food, then interacting with the food, smelling the food and so on.

• The second is as a broader way of desensitising to the experience of eating. We would spend time focusing on each step of the hierarchy, ensuring a young person is confident with each sense.

Both of these are valid approaches, and tend to occur in combination, for example, we may be doing some broader work around tolerance to smells and textures, but keep revisiting one or two specific food items which we are working towards eating.

There is no quick solution to improve dietary variety; it is an approach which takes time, with a focus on small steps. For example, a young person may become more tolerant to being around different food items, whilst this may not feel like progress because they have not eaten any new foods; it is a significant step in working through the eating hierarchy. 

It is important to consider the environment in which young people eat. If there are lots of distractions then they may find it more difficult to focus on eating. Ideally a young person will eat at a table and at the same time as their family. This ensures there is positive modelling of appropriate eating behaviour.

It is important to ensure a young person is able to sit in their chair with their feet flat on a stable base with their knees at a right angle. This helps them to feel positionally secure, allowing them to focus on eating. The table level should be between belly button and breast level.

We need to consider strategies that help young people to progress through each step of the eating hierarchy. You may feel that a young person is already confident at a particular step, but it is often helpful to revisit some of the strategies with them.

If a young person is struggling with strategies, you may need to return to the previous step. We want young people to have a positive experience around food, and forcing them to continue when they feel uncomfortable will reinforce negative thoughts about food and eating. If a young person is struggling with an eating experience, try to encourage them to move the food away from them rather than needing to leave the table.

We should always take an approach which is appropriate for a young person’s age and developmental level.

For older children, we can consider working through the hierarchy as a ‘food scientist’. This is helpful where a young person has some desire to change, and allows us to develop our understanding of food by completing ‘experiments’. We can encourage them to think more scientifically, for example, using more descriptive or scientific terminology.

Keep a record of any work you do around food, ideally using of photos or videos. This helps you to keep track of what you have done, as well as allowing a young person to revisit their achievements and share their progress with other people. This can be particularly helpful in trying to generalise progress between settings. For example, if a young person has made a step towards eating at home, they could share the photo with their teacher to help make the same step at school.

Wherever possible, at least one adult should eat at the same time as a young person. This ensures they have modelling of good eating behaviour. If a young person is known to have sensory needs, it may be helpful to engage them in some calming sensory activities prior to a meal.

If you have the same routine before each meal, which can include consistent sensory activities, it will act as a prompt that it is almost time to eat.

Try not to ask too many questions during a meal, particularly with a younger child. They may be working hard to process all the experiences associated with eating. If we ask them questions, we can distract them from this process.

Where we do ask questions (which might be later in the meal), try to avoid ‘did you like it?’. This places a lot of pressure on a young person. Instead try questions like ‘what did you think?’

It is also important to try and avoid comments such as ‘I told you that you’d like it’. This places additional pressure on a young person. We need to celebrate the steps a child takes towards eating (which may not involve tasting it). This could involve a reward when particular steps are made (ensuring these steps are achievable for the young person).

We also need to offer reinforcement to siblings or other adults about their eating. This ensures that positive eating behaviour is identified for a young person. It can feel uncomfortable to praise other adults for their eating behaviour, but it can be really helpful for reinforcing what we would like a young person to do.

At meal times we can introduce a learning plate. This is an additional plate on which we can initially place a single food item that we would like a young person to learn about. This would typically be a specific element from a meal that someone else is eating (for example, a single pea or piece of carrot). We can ask the young person to describe the food, perhaps what it looks like, what it feels like or what it smells like. They may be more comfortable interacting with it using a utensil or cutlery.

Over time, we can place new food items on a young person’s plate (you will need to work through the steps in this factsheet before you can do this). If the young person isn’t ready to try the food, they can move it to their learning plate whilst also learning about it.

After a meal, try to encourage a young person to clean their own hands and face (if necessary). If you do need to help them, try to move away from the table first. It may be uncomfortable for the young person when we wipe their hands or face, and we want to take this experience away from the eating environment.

A young person may struggle if they have to do any cooking at school. It can be helpful to introduce clear goals or expectations before this work is completed.

There is often an expectation that a young person will taste any foods; however, we could instead suggest that we want them to learn one thing about the food such as how it smells or how it feels. 

On the following pages you will find more information about activities which you could use at the different steps on the eating hierarchy.

Step 1: tolerating food around you

This is an important first step; young people need to be happy for different food items to be around them. If they are not ready to do this, then we cannot progress through the later steps.

There are lots of ways we can achieve this.

• Ensuring a young person is able to see different people eating different foods, although with no expectation that they should do the same. This can be achieved at home as well as school, where other young people will be eating different foods. There are also opportunities, particularly in primary school, for a young person to see the foods which are available at lunchtime.

• Visits to shops where foods are on display.

• Using toys foods in play, particularly for younger children.

• Drawing attention to foods in TV programmes, movies and books. In particular, it may be helpful to watch cooking shows where they show a raw product being prepared in to a more familiar food.

The book How Are You Peeling? Food with Moods by Saxton Freymann and Joost Elffers (available in print and as an ebook) can be a helpful tool for both exploring foods and feelings.

• Observing any cooking or food preparation, this helps young people to see how we prepare and change foods, as well as understanding what we do to create a familiar meal.

• Talking with a young person about their food preferences, it can be helpful to do this together with the whole family, siblings, friends or as a class. This ensures they don’t feel the entire focus is on them. Rather than just asking questions, we can use pictures and photos to aid the conversation. We can sort pictures in to ‘like’, ‘to learn about’ and ‘dislike’. Alternatively, you can rank them from most to least favourite.

What will change look like?

We want young people to be calmer around new or different foods, and understand that they can be around foods without being asked to eat them.

As young people get older, we want them to be able to have a conversation about food. It may be that we can consider their motivation to increase the range of foods they eat.

Step 2: interacting with food

Our next step, once a young person is more accepting of foods being around them, is to begin encouraging more interaction with food items. At this stage this doesn’t need to involve touch, so we can make use of toys or utensils.

This is our opportunities for a young person to start learning about what different foods feel, smell and sound like. We can also start exploring the different ways in which we can change foods; for example, by cutting them up or squashing them.

You could try:

• Introducing different food items in to familiar play activities, where a toy can be used to move or interact with the food

Remember, it is good for children to play with food in general. This helps them to learn about all the sensory experiences associated with food and eating. In particular, wearing your food is part of the process of learning about it.

• Being involved in food preparation, with an understanding that they do not have to eat the foods being prepared. As part of this, or as a separate activity, we can explore the ways in which we can change the appearance of food, for example, by cutting them in to different shapes.

• Helping cook or serve foods for other people.

• Talking about a food item, considering the best words we can use to describe it. We want to use scientific words rather than judgemental words, for example, ‘green and like a leaf’ rather than ‘yuck’ or ‘horrible’.

• We can begin to do experiments with food as a ‘food scientist’. This could include looking at packaging in order to compare items, considering the appearance of different foods or asking questions to other people about their food preferences.

What will change look like?

We want young people to be happy to interact with and talk about food items, acknowledging again that they can do so without being expected to eat them.

We would initially expect a young person to be more tolerant to food items which are a firmer or dryer texture, rather than foods which are wetter or softer.

Step 3: smelling food

It is often the smell of foods which young people can struggle with, particularly if they are more sensitive to smells in general.

As such, we want to gradually increase tolerance to items with different smells, as well as help a young person to understand how the smells of foods may vary. We could achieve this by:

• Introducing items with different smells in to play, this may be food, but can also include non-food items. Many non-food items have their own distinctive smell, but you can also use items which have a food-like smell, for example:

• Toiletries which food-like smells such as scented soap (including crazy soap) or bath foams

• Air fresheners or similar which have food-like smells

• Scented stationary such as scented pens and rubbers

• Creating a matching game, where items with different smells are hidden in cups which a young person needs to match with a selection of images. This is also something you can do on a regular basis, taking a single smell and labelling it using the name and picture.

• Labelling smells in the kitchen or other environments, for example, ‘that smell is from the onion I am cooking’.

• We could create a scale of smells, where a young person rates smells from one to five. For example, one smell could be one which is mild and doesn’t cause a problem, whereas a five smell would be much stronger and less tolerable.

• Identifying two similar food items and asking a young person to consider the differences in their smells. The intention here is to help a young person understand that, even though a food may look different, the smells may be quite similar.

What will change look like?

We want young people to be able to tolerate the smells of a wider range of foods, acknowledging that foods with particularly strong or distinctive smells may continue to be a challenge.

Young people are likely to stick with foods which smell familiar before branching out further. Initial change may be about increasing tolerance to foods similar to those they already eat, helping a young person realise they smell the same. Over time, we can introduce foods which increasingly different smells.

Step 4: touching food

This is very much a natural progression from the previous two steps. We can utilise some of the same strategies we used to interact with food, beginning to utilise our hands rather than a toy or utensil. We can also explore smells more as we begin to touch foods.

As in previous steps, play is a key way of increasing tolerance to different tactile experiences. As well as utilising food in play, we can also consider a range of messy play activities using non-food items. They will gradually increase tolerance to the tactile experiences associated with eating.

Remember, these activities should take place at a separate time (and perhaps in a separate place) to meal times. This helps a young person understand at which times it is appropriate to play with their food.

Activities we can consider include:

• Using food items to create images, there are lots of ways to do this, such as:

  • Using sauces as paints and food items (such as broccoli or cauliflower) as a brush

  • Creating potato prints, again using sauces as the paint

  • Finger painting with different food items

  • Creating pasta pictures, sticking pasta or other food items to a page

• Utilising food items in messy play, in doing so, we need to start with items which are dryer and less likely to stick to us. This means they are easier for