Paediatric nutrition for picky eating and weight concerns

Do you have a child who is a picky eater or are you worried about your child’s weight? We can help you with strategies you can put in place to make mealtimes more peaceful. We will listen to your concerns and devise a plan with you specific to your child/family. A responsive feeding approach will be used which means meeting a child where they are at and not pressuring them to do something they are not ready for.

Below, we explain some key topics in child nutrition.

  • What is the Division of Responsibility?
  • Picky and problem eating and
  • Weight concerns in children.

What is the Division of Responsibility?

We practise the Division of Responsibility. The Division Of Responsibility (sDOR) is an evidence-based feeding approach. It can be applied right from infancy through to adolescence. The approach allows parents to set boundaries with eating while allowing the child to learn to trust their hunger and fullness.  

At its core, parents decide what, when and where to eat. Parents provide regular meals and snacks and a pleasant eating environment free from pressure to eat. A child is then allowed to decide what and how much (if any) to eat. Children will learn to eat the food their parents eat and feel free of scrutiny when exploring new foods. You can read more about the sDOR here.

Picky eating and problem eating

About 25% of kids are reported to be fussy eaters. Kids between about 18 months and 6 years are most likely to be fussy. Some may grow out of this phase whereas more complex problem eating can be persistent if not treated. How can you figure out if your child is a picky eater or problem eater? This comparison may help.

Picky eater Problem eater
Decreased variety of foods but will generally accept 30 or more foods Restricted variety of food often less than 20 accepted foods
Can tolerate new foods on the plate and is able to touch or taste a new food Unable to cope when presented with new foods
Eats from most food texture groups Refuses entire food groups/ food texture groups

Problem eating can come about for many different reasons. For example:

  • Medical issues during infancy such as preterm delivery or reflux can create unpleasant feeding experiences for the child which can persist.
  • An oromotor problem can mean a child is unable to chew or swallow properly restricting their food variety.
  • For children with heightened sensitivity such as in the Autism Spectrum, new foods are very overwhelming and scary

How to help problem eating

It is a natural response for parents to encourage and pressure kids to try new foods or eat bigger portions when their growth is suffering. But issues can spiral when kids refuse, and anxiety levels increase for everyone. Meal times then become very stressful for the whole family.

When pressure to eat is removed, the foundation is laid for enjoyable family meals times. It can be a slow process to turn things around especially if the problem feeing has been present for years. A stepwise approach is used to first to reduce anxiety at meals times. The next steps focus on creating opportunities for a child to explore new foods an expand their variety. In general this may look like:

  1. Assess and treat (with the team) any underlying medical conditions contributing to the feeding issues (swallowing issues, allergies, GI issues)
  2. Optimize the feeding environment and establish a routine (reducing pressure and anxiety, promoting appetite)
  3. Provide opportunities for new foods to be tried in a non-threatening way. Using a child’s accepted foods and textures, variety can be expanded by bridging the gap between safe foods and the new ‘scary’ foods

Weight concerns

It can be concerning when a child is in the very bottom or top percentiles of their growth chart. Parents might wonder ‘Is my child overweight? Are they eating too much? Or the wrong foods? Or worry they aren’t eating enough. This in of itself is actually nothing to worry about. This is just diversity. Five percent of kids will naturally plot along the 5th percentile or below and the same is true for larger kids. Five percent of kids are supposed to plot at and above the 95th percentile.

What is important to note is how they are tracking. Has their weight remained stable while their height has increased? Or are they continuing to increase growth percentiles? When children plot above or below the growth charts we use a special conversion called a z score to assess whether their growth is healthy.

The Division of Responsibility is a powerful tool for weight concerns. Children are born with an innate ability to eat the exact amount their body needs. Taking away pressure or restriction can do a lot to reconnect a child with their hunger and fullness cues.

If you are concerned about your child and are wondering how we can help, please contact us here.

For information about other issues we can help with see our services