Support with eating and feeding

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Understanding feeding and eating in early childhood

Feeding is a social and developmental journey

Every family has its own approach to mealtimes, shaped by culture, routines and expectations. Just like learning to walk or talk, children learn to eat over time, with support and space to explore. Some children face early challenges, such as difficulties with breastfeeding or moving to solid foods, which may signal broader developmental needs.

While many feeding issues are temporary, others can be more complex, especially for children with sensory differences or communication needs. As mealtimes become more stressful, it is common for parents and carers to feel overwhelmed. With calm routines, positive support and the right help when needed, families can make progress one small step at a time.

This page is here to support you. It includes information, guidance and practical strategies to help your family navigate feeding challenges with confidence and care.

Feeding as a developmental milestone

Feeding is an important part of a child’s development, just like learning to crawl, walk or talk. In the early months, babies rely on reflexes to feed, such as suckling and latching onto the breast or bottle. Around 6 months, many families begin introducing solid foods while continuing breastfeeding or formula. Some choose smooth purées, while others offer lumpier textures or soft finger foods.

During this stage, children begin to explore food in new ways. They learn to accept different tastes and textures, use their fingers to feed themselves and show curiosity about what others are eating. Families naturally start sharing their food habits, introducing children to the meals they enjoy. Over time, we expect children to progress steadily so that by around 1 year of age, they are eating a range of family foods alongside everyone else.

Feeding challenges in children with social communication and sensory differences

Children with social communication differences, including autistic children and those with sensory processing differences, can face unique challenges during feeding transitions. They may find some foods and mealtime routines difficult to tolerate.

Common feeding difficulties

  • Resistance to new foods (food neophobia)
  • Strong preference for sameness (for example only eating foods of a certain brand, shape, colour or texture)
  • Limited food variety (a very restricted diet with few accepted foods)
  • Aversion to specific textures (for example mushy, crunchy or mixed textures)
  • Difficulty with transitions (for example moving from purées to solids or changes to mealtime routines)
  • Strong reactions to smells, tastes or visual appearance
  • Avoidance of messy or sticky foods (reluctance to touch food or self-feed)
  • Gagging or vomiting in response to certain foods
  • Extreme distress at mealtimes (crying, tantrums, refusing to sit at the table)
  • Reduced awareness of hunger cues or difficulty recognising fullness
  • Delayed self-feeding skills (for example finger feeding, using utensils)
  • Disrupted family mealtimes due to prolonged or stressful routines
  • Strain on parent and child relationships due to ongoing feeding stress

Recognising these patterns early can help families access the right support. With thoughtful strategies and professional guidance, feeding can become a more positive and manageable experience for everyone involved.

Identify underlying causes

  • Medical issues (for example reflux, allergies, constipation)
  • Oral motor differences
  • Sensory sensitivities
  • Anxiety or temperament
  • Past negative food experiences

Every family approaches feeding in their own way, shaped by culture, values and personal experiences. When parents and carers feel desperate for their child to eat, it is common to try approaches that unintentionally increase stress and make mealtimes harder. This can lead to power struggles, anxiety and further food refusal. The good news is that evidence-based strategies can support both children and parents and carers, helping to create a more positive, relaxed and successful feeding environment.

Ellyn Satter’s Division of Responsibility in feeding (sDOR)

Ellyn Satter’s Division of Responsibility (sDOR) outlines clear roles for parents and carers and children to support healthy eating habits and reduce mealtime stress.

The Division of Responsibility in feeding, developed by dietitian and family therapist Ellyn Satter, is a widely used framework that helps families create positive mealtime experiences. It emphasises a balance of structure and autonomy, allowing children to develop trust in their own hunger and fullness cues while parents and carers provide consistent guidance.

Parents’ and carers’ responsibilities

  • What food is offered
  • When meals and snacks are served
  • Where the child eats

Parents and carers are encouraged to offer regular, structured meals and snacks, provide a variety of nutritious foods and create a pleasant eating environment without pressure or coercion.

Children’s responsibilities

  • Whether to eat
  • How much to eat

Children are trusted to decide if they want to eat and how much, based on their internal cues. This supports self-regulation and a healthier relationship with food.

Benefits of sDOR

  • Reduces mealtime stress and conflict
  • Encourages intuitive eating and food acceptance
  • Supports growth and development
  • Strengthens parent and child relationships around food

This approach can be helpful across all stages of development, including for children with feeding difficulties or selective eating patterns.

Focus on four nutrient groups

Try to make sure your child eats something from each group. Even one item counts.

  • Carbohydrates: eg Bread, rice, pasta, potatoes
  • Protein: eg Meat, fish, eggs, beans, lentils
  • Fats: eg Cheese, yoghurt, avocado, olive oil
  • Vitamins and minerals: eg Fruit, vegetables, fortified cereals

What you can do

  • Make a simple list of what your child eats over a week
  • Check if there is at least one item from each group
  • Do not worry too much about variety at first. Coverage is more important

For children with extreme picky eating, progress takes time. Be kind to yourself and your family and focus on building trust around food. The goal is not only to expand your child’s diet, but also to reduce stress and create more positive mealtime experiences. Speak to a healthcare professional if you have concerns about growth, nutrition or issues such as constipation.

STEPS framework

  • Support your child with love and structure
  • Trust your child to eat
  • Establish regular meals and snacks
  • Pressure-free feeding
  • Step-by-step exposure to new foods

Feeding steps

  1. Lower stress at mealtimes
    • Keep meals calm and relaxed
    • Try not to pressure your child to eat
  2. Create a daily eating routine
    • Have regular times for meals and snacks
    • Avoid grazing throughout the day
  3. Eat together as a family
    • Sit down and eat together without screens or distractions
    • Show your child that eating can be enjoyable
  4. Offer a mix of foods
    • Offer familiar (safe) foods alongside new foods
    • Keep offering variety over time, without pressure
  5. Help your child build eating skills
    • Let them touch, play with and explore food at their own pace
    • Support chewing and tasting skills gradually

How should I interpret my child’s growth chart?

Growth charts are tools to track a child’s growth over time, not to compare them with other children. Any centile between the 3rd and 97th is considered within the normal range. What matters most is the trend: is your child growing steadily along their own curve? Some children are naturally smaller or larger and that can be normal. If you notice a sudden drop, plateau, or you are concerned, speak to your GP or healthcare professional for advice.

Feeding and our senses

When we eat, all eight senses work together to shape our experience of food. These include:

  1. Sight – We often judge food by its appearance. Colour, shape and presentation can influence willingness to try it.
  2. Smell – Smell plays a major role in appetite and flavour perception. Some children reject foods based on smell alone.
  3. Taste – The tongue detects sweet, salty, sour, bitter and umami. Some children are more sensitive to certain tastes.
  4. Touch – This includes how food feels in the mouth (texture, temperature) and how it feels in the hands.
  5. Hearing – The sound of crunching or chewing can be either enjoyable or overwhelming.
  6. Proprioception – Awareness of body position helps with chewing and swallowing.
  7. Vestibular – Balance and coordination support safe sitting posture during meals.
  8. Interoception – This helps us notice hunger, fullness and discomfort, guiding when and how much we eat.

Feeding challenges can occur when one or more of these senses are over- or under-responsive, particularly for children with sensory processing differences or autism. Understanding sensory needs can help you create positive, low-pressure mealtime experiences.

Food chaining

Food chaining is a gentle, step-by-step strategy to help children expand their diet by building on foods they already accept. It works by introducing new foods that are similar in taste, texture, shape or colour to their “safe” foods, gradually increasing variety without triggering anxiety or refusal.

  • Start with a safe food your child already eats (for example plain crackers)
  • Make small changes such as a similar brand, shape or flavour (for example round crackers to square ones)
  • Introduce a new food that shares features with the safe food (for example toast fingers if they like crunchy textures)
  • Repeat exposure in a low-pressure way. Avoid forcing or bargaining
  • Celebrate progress, even if it is touching, smelling or licking the new food

Patience matters when supporting extreme picky eating. Change rarely happens overnight and it can take months or longer to build trust. By making small, gradual changes and removing pressure, mealtimes can become less stressful. The goal is not only to get your child to taste something, but to help them feel safe, curious and in control.

Why pressure does not work

Trying to control what or how much your child eats often increases stress and can reduce willingness to eat. For example:

  • Urging a child to eat more can lead to eating less
  • Limiting food too tightly can increase preoccupation with food
  • Pushing specific foods can lead to refusal
  • Expecting neatness can increase stress and mess
  • Allowing poor behaviour to encourage eating can worsen behaviour and appetite

Clinical presentation

Feeding challenges can look different from one child to another. The table below describes different presentations, from mild picky eating to more complex feeding disorders. This can help you decide when to seek support and what type of help may be needed.

Feeding differences table

Term What it means Signs When to get help
Picky eater A child who refuses some foods but still eats enough variety to grow well. Eats fewer vegetables or new foods, but still eats from most food groups. Usually improves with time and gentle exposure.
Extreme picky eater A child who eats very few foods and may struggle with texture, smell or taste. Eats fewer than 20 foods, may gag or cry at new foods, strong reactions at mealtimes. If eating causes stress or limits growth, speak to a healthcare professional.
Paediatric feeding difficulty Any feeding problem that affects growth, nutrition or development. May include medical, sensory or behavioural factors. Can affect babies, toddlers or older children. If feeding is difficult most days or affects health, seek support from a feeding specialist.
ARFID (Avoidant/Restrictive Food Intake Disorder) A psychological condition where food avoidance leads to health or social difficulties. Very limited diet, fear of choking or vomiting, avoids eating with others. Can cause weight loss or poor growth. Needs assessment by a healthcare professional or feeding team.

Sometimes the terms ARFID (Avoidant/Restrictive Food Intake Disorder) and PFD (Paediatric Feeding Disorder) are used to describe similar feeding challenges. This can be confusing because they often share features and can occur together. Whether a child is diagnosed with ARFID or PFD can depend on the setting, the clinical team, or the country. ARFID is a psychological condition, while PFD is a medical and developmental diagnosis. In practice, assessment and support may be similar, focusing on nutrition, feeding skills and emotional wellbeing.

Frequently asked questions

Is my child getting enough nutrition?

Many parents and carers worry their child’s limited diet does not include enough nutrients. It can help to track intake over time rather than focusing on a single day. Speak to a healthcare professional if growth, energy levels, or health are affected.

  • Appetite varies. Some days children eat more, some less
  • If your child is growing as expected, this is reassuring
  • If you are worried about nutrition, speak to your GP

Should I force or bribe my child to eat?

No. Forcing, bribing, or tricking a child into eating can increase stress and damage their relationship with food. Instead, focus on exposure without expectation, for example having food nearby, letting them explore it, or including it on the plate without pressure to eat it.

Why won’t my child eat certain foods, even if they used to?

Children can develop aversions due to sensory sensitivities, negative experiences or developmental changes. Preferences can also shift over time.

How long does it take to see progress?

Progress is often slow and not always linear. It can take months or longer to build trust and expand a child’s diet, particularly when sensory needs or developmental differences are involved.

What if my child only eats beige or crunchy foods?

This is common in sensory-based feeding differences. Gradual exposure to new textures and colours, without pressure, can help over time.

What if my child never eats fruit or vegetables?

Start with food play and exposure, letting them explore the look, smell and feel of fruit and vegetables without pressure to eat. Use food chaining to move slowly from preferred foods to new foods with similar features. Some families also discuss multivitamins with a healthcare professional.

Is it okay if my child eats the same foods every day?

Yes. Many children who are extremely selective rely on a small set of familiar foods. Focus on building a calm, structured environment around when and where they eat. If their preferred foods include at least one item from each of the four key food groups (protein, carbohydrates, fruit and vegetables, dairy or alternatives), that is a helpful starting point. Over time, small, low-pressure exposures can widen their range.

Can picky eating be linked to autism or sensory processing differences?

Yes. Many autistic children and children with sensory processing differences experience feeding challenges. Understanding their sensory needs can help you choose strategies that feel safer and more manageable for them.

Can I still go out to eat or attend social events?

Yes. Planning ahead can help. Bring safe foods, communicate with hosts and set realistic expectations. The goal is for your child to feel safe and included, even if they do not eat the same foods as others.

Should I see a professional?

If eating is affecting growth, nutrition, health, or family life, it is a good idea to speak to a healthcare professional.

Cheyne feeding support service

Cheyne Child Development Service is developing support for parents and carers of autistic children.

This is a monthly online session for parents and carers. If your child finds mealtimes challenging, whether that is limited food variety, difficulty accepting new foods, or concerns about their overall diet, we are here to help.

When: 4th Monday of the month, 10am to 11.30am

Each session will explore practical strategies to help make mealtimes easier. Topics may include sensory sensitivities around food, nutrition, feeding as a skill to be learned and supporting fears or anxiety related to eating. You are welcome to attend every month.

How: Email your interest to chelwest.ccds.feedingservice@nhs.net

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