Feeding development and difficulties

Typical and Problematic Feeding and Mealtime Behaviours

  • Problematic feeding and mealtime behaviours usually present on a continuum between the two examples provided. Children may display more than one feeding or mealtime difficulty.

    Feeding or mealtime behaviour Example consistent with typical feeding development Example associated with more problematic feeding difficulties
      Continuum arrow
    Picky eating Not particularly interested in food. Eats slowly however mealtimes do not usually exceed 30 minutes.  Eats more quickly if given preferred foods. Parent finds mealtimes frustrating. Child may be thin but eats adequate amounts of a variety of foods to maintain appropriate growth trajectory. Not interested in or motivated by food.  Mealtimes are prolonged exceeding 30 minutes even when offered preferred foods. Intake is generally inadequate and is associated with poor growth. Mealtimes are stressful and not enjoyable for child or parent.
    Fussy eating Inconsistent with food choices at times rejects familiar foods e.g. will eat vegetables sometimes.  Has an expectation as to how food is served for example dislikes foods touching on the plate, prefers to drink from a specific cup. Inconsistent with food choices.  Fixed ideas about how food is served. Unable to cope if food doesn’t meet expectations.  May protest strongly or possibly tantrum.  May be difficult to calm.
    Food refusal Consistently refuses a range of foods. Overall intake remains adequate for growth.  However may be at risk of micro nutrient deficiencies e.g. may be at risk of iron deficiency if consistently excludes sources of iron.  Consistently refuses to eat a wide range of foods to the extent that growth is inadequate.  Whole food groups are typically excluded with increased risk of micronutrient deficiencies. 
    Food neophobia Apprehensive with trying new foods but over time is reassured by seeing others eating new foods and can be encouraged to have a taste.  May actually be fearful of new foods.  Becomes extremely upset or tantrums when new foods are offered.  
    Restricted variety of foods Variety in the diet is limited but most food groups are included. Vegetables are typically the most limited food group.  May be associated with Food neophobia.  Variety of food is severely limited.  Commonly associated with exclusion of one more food groups.  Overtime the range of foods becomes more limited.
    Food preferences may appear to be based on the sensory properties of the food.  May be considered to be a Selective eater.
    Food fads Requests the same favourite food repeatedly typically at a single meal of the day. However is able to adapt if the requested food is not available.  Favourite foods change over time and variety in the diet is maintained. Requests the same favourite food repeatedly at every meal such that variety in the diet becomes extremely limited.  Child may tantrum and is unable to cope if food requests are not met.
    Appetite concerns – includes  variable, limited, or excessive appetite Appetite varies from meal to meal and possibly from day to day.  However when averaged over a period of time intake is nutritionally adequate and growth is maintained. Poor appetite associate with picky eating resulting in poor growth.
    Increased appetite associated with obesity or overweight.
    Prolonged mealtimes Mealtimes are prolonged (longer than 20 -30 minutes) if child is distracted, tired or if given non preferred foods.   Mealtimes are consistently prolonged (longer than 30 minutes [1]) even in the absence of distractions or if offered preferred foods.  
    Parent feels need to constantly prompt child to eat reducing mealtime enjoyment for parent and child.
    May be associated with oral motor difficulties[1]
    Disruptive mealtime behaviours  e.g. refusal to sit at table with other, constantly leaving the table, spitting or throwing food   Eating may not always be the main focus at meal time.  Child may sometimes be reluctant to come or stay at the table for meals preferring to continue playing. 
    May quietly spits out foods that are tasted but not liked.
    Drops food from the high chair to see what happens or indicate the end of the meal rather than deliberate throwing of food in protest.
    Disruptive mealtime behaviours occur consistently at all mealtimes and persist for prolonged periods.
    Child will become upset or tantrum if brought to the table.
    Will spit food out or throw food to protest against eating.  

    1. Crist, W. and A. Napier-Phillips, Mealtime Behaviors of Young Children: A Comparison of Normative and Clinical Data. Journal of Developmental & Behavioral Pediatrics, 2001. 22(5): p. 279-286.