Eating Challenges
Understanding and supporting picky eating, sensory-based food avoidance, and mealtime difficulties in neurodivergent children.
Textures, tastes, smells, temperatures, and appearances can be overwhelming or intolerable.
Preference for familiar foods provides predictability and safety.
Difficulty recognising hunger and fullness signals.
Fear of new foods, fear of vomiting, anxiety about eating situations.
Planning meals, sitting still, using cutlery, sequencing eating - all require executive function.
Some children have oral motor difficulties or fine motor challenges with utensils.
Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder characterised by highly selective eating that leads to nutritional deficiencies, weight loss, or significant impairment.
Signs of ARFID
- •Very limited range of foods (often fewer than 20)
- •Food avoidance based on sensory characteristics
- •Fear of choking, vomiting, or other aversive consequences
- •Lack of interest in eating
- •Nutritional deficiencies
- •Weight loss or failure to gain expected weight
- •Reliance on supplements
Picky eating, not ARFID
- •Typical childhood picky eating (usually improves)
- •Cultural or religious food restrictions
- •Food restrictions due to food allergies
- •Body image-related restriction (that's anorexia)
When to seek help: If eating is affecting growth, health, or wellbeing, seek assessment from a paediatrician or eating disorder service.
Sensory considerations
- •Offer preferred textures
- •Process foods to preferred texture
- •Separate mixed foods
- •Serve at preferred temperature
- •Allow food to cool/warm
- •Use thermometer if helpful
- •Start mild, add flavour gradually
- •Respect genuine sensitivities
- •Don't force strong flavours
- •Reduce cooking smells
- •Allow distance from foods
- •Cold foods may smell less
- •Consistent presentation
- •Divided plates
- •Respect visual preferences
Strategies that help
Remove pressure
Pressure to eat typically backfires. Division of responsibility: you provide, they decide if/how much to eat.
Ellyn Satter's Division of Responsibility is evidence-based for feeding difficulties.
Consistent mealtimes
Regular meals and snacks at predictable times. Structure supports eating.
Routine reduces anxiety and helps children anticipate and prepare for eating.
Family meals
Eating together models eating behaviour without pressure.
Children learn from watching others eat without being the focus.
Include safe foods
Always include at least one food you know they'll eat at each meal.
Reduces mealtime anxiety. They don't need to eat everything to have a meal.
Tiny exposures
New food on the side of plate, no requirement to eat. Just exposure.
Repeated exposure without pressure increases acceptance over time.
Food play
Explore foods without eating pressure - touch, smell, play, without expectation.
Reduces fear and builds familiarity before eating is expected.
What doesn't help
Force or bribe eating
Creates negative associations. "Clean your plate" causes problems. Bribing with dessert devalues the meal.
Punish food refusal
Increases anxiety around food. The problem gets worse, not better.
Make separate meals constantly
While some accommodation is needed, completely separate meals for every meal isn't sustainable or helpful.
Hide foods in other foods
When discovered, damages trust. They may refuse previously safe foods.
Compare to siblings
"Your sister eats it" increases shame without changing eating ability.
Expect rapid change
This takes time - months to years. Small steps forward are progress.
Practical mealtime tips
Reduce distractions
Turn off screens during meals for better attention to eating (unless screens help them eat - use judgement).
Comfortable seating
Feet flat on floor or footrest. Stable seating supports eating.
Appropriate portions
Small portions are less overwhelming. They can always have more.
Time limits
Meals don't need to last forever. 20-30 minutes is reasonable. Don't drag it out.
Consistent routine
Same place, same time, same sequence. Routine reduces anxiety.
End meals neutrally
No comments on what was/wasn't eaten. Just "Meal is finished" and move on.
Example chain
Principles
- Start from where they are, not where you want them to be
- Change one thing at a time (flavour OR texture OR brand, not all)
- Go at their pace
- Any new food is progress, even if small
Common nutrition concerns
Focus on what they DO eat. Can those foods be optimised? Supplements may help bridge gaps.
Regular monitoring by GP. If growth is on track, variety matters less than you think.
Many children eat mainly carbohydrates. Add protein where accepted. Consider fortified foods.
Processed foods are still food. Focus on what you can add, not what to remove.
Important to know:
- •Weight loss or failure to gain weight appropriately
- •Signs of nutritional deficiency
- •Eating affects health, growth, or development
- •Mealtime distress significantly impacts family life
- •Food range is extremely limited (fewer than 10-15 foods)
- •Child is distressed about eating
- •Suspected ARFID
Start with your GP or paediatrician. They can refer to dietitians, feeding clinics, or eating disorder services as appropriate.
Eating difficulties are not a choice or a behaviour problem. For many neurodivergent children, sensory experiences around food are genuinely distressing. Pressure makes it worse. Patience and gradual exposure work better.
- Picky eating in neurodivergent children is often sensory-based, not behavioural
- Pressure makes eating problems worse, not better
- Progress is slow - measured in months, not days
- Some children need professional support - this isn't a parenting failure
- Nutrition can be achieved many ways - there's no one "right" diet