Restricted eating: Strategies to help your child introduce new foods

Children with very restricted eating patterns can make change over time and begin to expand their repertoire of foods. However, making change requires a consistent approach with repeated exposure to the new foods and involves small, controlled steps in order to manage and reduce anxiety around the new food.

Limit new food choices

Consider up to five new foods to begin to offer your child alongside their accepted foods. Offer three to four different food items as part of their main meal but try and have one of these as a new food. You may need to start offering the new food on a separate plate with the aim of gradually bringing it closer into your child’s space. The new food is likely to need to be offered many times before your child considers even touching it. The new food choices will need to be repeated and rotated frequently for many weeks or even months. With repeated exposure in a non-pressured environment, your child is likely to become less anxious around the new food which will ultimately help develop their interest and motivation to want to try it.

When considering new foods to introduce, it can be helpful to think of the nutritional benefit as well as the wider social benefit. For example, chips can be a useful food to establish as it may enable your child to join in when you eat out in a restaurant with the family. Cheese can also be a positive option particularly if your child’s diet is low in calcium. Cheese can also be presented in different ways eg grated, cubed, sliced. Once established, both cheese and chips can be gradually expanded to other forms using the Food linking approach (see below).

Food linking

Food linking is where you take a food that your child already likes and make small changes in shape, texture or flavour to broaden their choices. By making these changes slowly and predictably, it can help your child feel more confident in trying new things. Some examples and suggestions are listed below.

Steps to eating ladder

Your child may not be ready to taste and swallow a new food to begin with. If this is the case, take the focus away from eating the new food and encourage your child to become more familiar with it by getting closer to eating it. You can use a sticker chart to encourage your child to touch the food initially, then work towards putting it in their mouth by first kissing it, licking it and finally tasting or biting it.

Tiny Tasters

When introducing a new food, your child may become easily overwhelmed and anxious if they are offered a large portion at the start. The principle of offering tiny tasters allows your child to build their confidence with the new food and gain success from tasting and hopefully swallowing a very tiny amount without triggering an extreme disgust response such as gagging or vomiting.

• Choose a new food to taste that is close to what your child already eats (eg new type of bread, biscuit, new flavour of crisp, different type of chip).
• Expect your child to eat a tiny piece or crumb (size of a grain of rice) at each meal or snack time before they are allowed to eat their normal food or drink.
• Offer the same new food repeatedly before changing to a new one (repeated exposure reduces anxiety by increasing familiarity).
• Very gradually increase the size of the new food on successive presentations once your child starts to eat it without distress.
• Develop a reward program associated with success eg sticker charts.
• The same approach can then be applied to introduce new foods outside their normal range once your child has accepted the new pattern.

Tasting times

For some children, it may be helpful to make regular tasting times away from meals to begin with. The tiny tasters approach can be incorporated as part of this.

• Establish three to four set tasting days across the week when there are no other activities going on. Choose one or two of the chosen foods to explore at each session.
• Choose a specific tasting plate to use for each session.
• You may wish to create a weekly timetable for your child so they can anticipate when the tasting times are.
• It will be important to consider the steps to the eating ladder for each item such as touching, smelling, kissing, licking, tasting.
• Anticipate that your child will need to build their tolerance up to five times at each level before going to the next stage.
• When talking about food, describe it in different terms as in what colour it is, what texture is it, what does it look like, what shape is it, what does it smell like, does it remind them of another food?
• First stage: Touching – they may start with only poking the food with their finger, gradually progressing to picking it up and holding it in their hands.
• Smelling: Encourage them to have a sniff, gradually bringing the food closer to their nose and taking deeper breaths.
• Putting on lips or kissing: this may start on the outside of the lips, moving towards the middle and aiming to hold the food between their lips.
• Licking: Progress to sticking out their tongue to touch the food, progressing towards licking.
• Tasting: To begin with, follow the tiny tasters approach. If they appear to be struggling as the food gets bigger, allow them to remove the food from their mouth and have a drink but discourage spitting. Always encourage having a drink at hand or a preferred food to help wash down the new food.
• Final stage: progressing to biting, chewing an appropriate size of the new food.
• Remain positive and calm giving lots of praise and encouraging feedback.
• Avoid watching them too closely when tasting. Consider sitting by their side rather than facing them.

Messy play

Messy food play away from meals can be particularly helpful with children who have feeding difficulties as it helps to expose them to food in a non-threatening way. The play activity can help to desensitise them to the smell, look or texture of particular foods. It will ultimately reduce any stress and anxiety around food and encourage them to gain confidence in touching and handling varied textures. These are all essential steps in order to progress towards eventually tasting and accepting new foods.

Please refer to the separate Messy Play handout for activity ideas.

Managing your child's anxiety

Being presented with new foods can be very anxiety provoking for a child who struggles with their eating and when children are anxious they may present with challenging behaviours (having a tantrum, hitting out). Remember they are not doing this to be naughty; rather it is the feeling of fear that is driving the behaviour.

Try to:

• reassure and comfort them as you would in any situation
• name the emotion they are feeling and tell them that you will not make them eat anything they do not want to, but you would like them to stay near the food if they can
• encourage them to breathe deeply and slowly
• get them to describe what they can see or smell and what it feels like (if they can touch it)

Rewards to support progress

The most effective reward for desired behaviour is positive attention and praise because they reinforce the behaviour on the spot and help a child make the connection between what you are saying and what they’ve just done. However, sometimes children need more to motivate them. Sticker and reward charts are a great way to encourage a new behaviour. The idea of a sticker/reward chart is a child will do something they find unpleasant if they know there is a reward coming after.

How do I make a reward chart?

You can buy reward charts but it is often better to develop a chart yourself based on something your child likes (princesses, dragons, trains). You could even make it with them, deciding together on the behaviour to work on and the reward they are working towards. You can cover your chart in sticky-back plastic or get it laminated so that it can be re-used.

Using the reward chart

Make it clear what you want the child to do in order to get the sticker eg touch the carrot, smell the orange. Immediately after the child has done the desired behaviour, they should get the sticker on their chart. After five to ten stickers, you should give a final goal or reward to aim for. It can be helpful for the child to decide on this reward (it does not need to be something of monetary value; it could be going out for a cycle ride). Avoid using food as a reward. Outings or spending supportive play time with a parent are the best option.

Ideas for reward charts

• Draw a reward chart in the shape of a mountain, with the final reward at the top.
• Create a colour-by-numbers chart where each child has a colour and a picture will emerge once the chart has been filled in.
• Use a reward box. This could be a cardboard box filled with rubber snakes or little balls for example, which the child can fish out with a net each time they are well-behaved. Four snakes and they qualify for a treat.
• Older children might appreciate something a little different. For example: a reward tower or jar given to the child with three marbles already inside and the chance to earn more marbles with the target behaviour followed by a treat of their choice when the jar is full.

Email the paediatric feeding team for further information.