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ARFID Avoidant Restrictive Food Intake Disorder: A Guide for Parents and Carers is an accessible summary of a relatively recent diagnostic term. People with ARFID may show little interest in eating, eat only a very limited range of foods or may be terrified something might happen to them if they eat, such as choking or being sick. Because it has been poorly recognised and poorly understood it can be difficult to access appropriate help and difficult to know how best to manage at home.

This book covers common questions encountered by parents or carers whose child has been given a diagnosis of ARFID or who have concerns about their child. Written in simple, accessible language and illustrated with examples throughout, this book answers common questions using the most up-to-date clinical knowledge and research.

Primarily written for parents and carers of young people, ARFID Avoidant Restrictive Food Intake Disorder includes a wealth of practical tips and suggested strategies to equip parents and carers with the means to take positive steps towards dealing with the problems ARFID presents. It will also be relevant for family members, partners or carers of older individuals, as well as professionals seeking a useful text, which captures the full range of ARFID presentations and sets out positive management advice.

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ARFID Avoidant Restrictive Food Intake Disorder: A Guide for Parents and Carers

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ARFID Avoidant Restrictive Food Intake Disorder: A Guide for Parents and Carers is an accessible summary of a relatively recent diagnostic term. People with ARFID may show little interest in eating, eat only a very limited range of foods or may be terrified something might happen to them if they eat, such as choking or being sick.

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Avoidant Restrictive Food Intake Disorder, more commonly known as ARFID, is a relatively newly introduced diagnostic category. Research in the field, although growing, remains limited, with clinical knowledge and expertise varying across clinicians. There may be uncertainty how to correctly identify and diagnose the disorder as well as how best to direct treatment.

This clinical guide sets out to be a trailblazer in the field, providing up-to-date information and comprehensive clinical guidance on ARFID in childhood and adolescence. Chapters in the book are divided into five sections, the first focussing on the importance of attending to the perspectives of those directly affected by ARFID. Three subsequent sections cover diagnosis and presentation, including chapters on aetiology, epidemiology, assessment, and outcome measures; clinical assessment, including psychological, family, nutritional, medical, and sensory components; and management, discussing nutritional, medical, psychological, and wider system approaches. The final section discusses prognosis and outcomes, and considers future research directions.

This clinically focussed book, with contributions from a multi-disciplinary authorship, is intended to function as an accessible, practical guide, and reference resource. It includes summaries of available evidence, with related recommendations for clinical practice. The advice and suggestions included will assist clinicians in targeting their attention appropriately, to ensure that children, adolescents, and their families receive the best possible care.

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Avoidant Restrictive Food Intake Disorder in Childhood and Adolescence: A Clinical Guide

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Avoidant Restrictive Food Intake Disorder, more commonly known as ARFID, is a relatively newly introduced diagnostic category. Research in the field, although growing, remains limited, with clinical knowledge and expertise varying across clinicians. There may be uncertainty how to correctly identify and diagnose the disorder as well as how best to direct treatment.

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This section includes a wealth of useful resources for individuals, parents, carers & professionals alike.

Please use the buttons below to explore the range of resources available. The different categories and tags buttons filter resources by relevant topics and the entire collection can be accessed and searched with the 'search resources' button.

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Resources This section includes a wealth of useful resources for individuals, parents, carers & professionals alike. Please use the buttons below to explore the range of resources available.

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It might not be the best time for a young person to try to change their diet if they are not motivated to do so and are getting enough nutrition.

As a teen gets older, their motivation can change, especially when they realise that eating with friends can help them make new friends.

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If the food eating isn't giving the young person enough nutrients, it's time to make a change. But we might also need to think about whether supplements are a good way to help with this. This is something you can talk about with a doctor, chemist, or dietitian.

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I Can Cook Full Episode Compilation #15 | Messy Hands - Kids Craft

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The Eatwell Guide shows the overall balance of the different types of foods and drinks we should consume to have a healthy, balanced diet. You don't need to achieve this balance with every meal but try to get the balance right over a day or even a week.

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Welcome to our Padlet on promoting dietary variety!

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Welcome to our Padlet on promoting dietary variety!

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Are you or someone you know a picky eater? Don't worry, you're not alone.

This Padlet is designed to provide support and strategies for young people who have a limited variety in their diet.

When we talk about picky eaters, we're referring to those who may have a small range of foods they're comfortable eating.

It could be because they have preferences for specific flavours', textures, or even colours of food. Trying new foods might be challenging for them, and they may feel upset or frustrated when presented with unfamiliar options.

While it's normal for young people to go through stages where their food preferences change, some may find it harder to move past this stage.

That's where our Padlet comes in handy. We'll explore strategies to help expand your food choices and make mealtimes more enjoyable.

But before we dive in, let's answer some important questions about children's eating habits.

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Your Feedback – comments, concerns and complaints

University hospital Plymouths NHS Trust is committed to improving the service it provides to patients and their families. If you would like to tell us about this please visit our feedback page.

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Tell us what you think

We aspire to be an outstanding Trust where we create the conditions for patients and families to have positive experiences of care, where we identify and strive for continuous improvements, and involve patients, families and our community in co-creating experiences that are in line with the Trust values.

We recognise there is no better or more important way of improving our services than by listening to what individuals think, feel and experience throughout their care journey and beyond.

We aim to involve patients, carers and the public in everything from what services we provide to how they are delivered and how we can improve them in the future. We provide opportunities for patients, carers and families to share their experiences and tell their stories; feedback is anonymous, valuable and acted upon.

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Tell us what you think We aspire to be an outstanding Trust where we create the conditions for patients and families to have positive experiences of care, where we identify and strive for continuous improvements, and involve patients, families and our community in co-creating experiences that are in line with the Trust values.

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This Padlet was made by the Children's Therapy Team  - Plymouth NHS Trust.

To contact the department please call 01752 439 400

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Some toddlers have an innate, or inborn, resistance to eating a wide range of foods. They may have extreme anxiety about trying new foods (strongly neophobic) or have an extreme reaction to the different senses, touch, taste and smell (sensory-sensitive).

Guidance & Tips for Parents

Things to avoid

Do not refuse to give high-energy foods, like ice cream, cakes, biscuits and chocolate, in the hope that your child will eat 'proper' meals and 'healthy' foods.
Reason: This is not a good way to get your child to eat new foods, and your child might lose weight if you withhold their 'safe' foods.

Do not try to force your child to eat food.
Reason: This will make your child even more anxious at mealtimes, and may cause your child to vomit the food back up.

Leave long gaps between meals to try to make your child more hungry or hide new foods inside foods that your child already likes.
Reason: This will make your child less hungry over time, and may lead to weight loss. Some children can very easily detect new tastes and smells, even when hidden in other foods. Your toddler may just stop eating the liked foods.

Things that help

Encourage your child to experience different textures through 'messy' play every day. Your toddler may find some textures (like Play-Doh) very difficult, so start with textures that they are happy to touch. This may need to be drier consistencies initially, such as rice or lentils. Gradually progress to more messy/wet substances, allowing your toddler to gain confidence. Have plenty of fun and get messy. If you don't like touching certain textures yourself, or don't feel comfortable allowing your toddler to make a mess, then why not take them to a playgroup in your area?
Reason: Many children who are extreme food refusers are very sensitive to touch on the hands and mouth, and so will not even pick up new foods. Messy play helps them to get used to new textures.

Give small frequent meals of foods that your child accepts.
Reason: Some children become very anxious at mealtimes and are sometimes very slow eaters. Small frequent meals will help them to take in the calories that they need.

Remember, even children who are extremely faddy eaters usually grow and develop normally, if they are given the foods that they will accept.
Reason: It is important to keep your child growing well, and these extreme food refusers do grow as we would expect them to if they have enough of the food that they will eat.

If the problem persists see your GP or health visitor who may refer you to:

a specialist feeding team if one is available in your area

a clinical psychologist

Downloads

How to Cope When Your Child Shows Extreme Food Refusal

Factsheets for Health & Childcare Professionals
Download >

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How to Cope When Your Child Shows Extreme Food Refusal - Infant & Toddler Forum

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Some toddlers have an innate, or inborn, resistance to eating a wide range of foods. They may have extreme anxiety about trying new foods (strongly neophobic) or have an extreme reaction to the different senses, touch, taste and smell (sensory-sensitive).

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There is often an expectation that your child will taste any foods; however, we could instead suggest that we want them to learn one thing about the food such as how it smells or how it feels.

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Ideally your child will eat at a table and at the same time as their family. This ensures there is positive modelling of appropriate eating behaviour.

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The Eatwell Guide shows how much of what we eat overall should come from each food group to achieve a healthy, balanced diet.
You do not need to achieve this balance with every meal, but try to get the balance right over a day or even a week.

Most of us still are not eating enough fruit and vegetables. They should make up just over a third of the food we eat each day.

Aim to eat at least 5 portions of a variety of fruit and veg each day. Choose from fresh, frozen, tinned, dried or juiced.

Remember that fruit juice and smoothies should be limited to no more than a combined total of 150ml a day.

Fruit and vegetables are a good source of vitamins, minerals and fibre.
Find out more about how to get your 5 A Day

Starchy food should make up just over a third of the food we eat. Choose higher fibre or wholegrain varieties, such as wholewheat pasta and brown rice, or simply leave the skins on potatoes.

There are also higher fibre versions of white bread and pasta.

Starchy foods are a good source of energy and the main source of a range of nutrients in our diet.
Find out more about starchy foods

These foods are good sources of protein, vitamins and minerals. Pulses, such as beans, peas and lentils, are good alternatives to meat because they're low in fat and they're a good source of fibre and protein, too.

Choose lean cuts of meat and mince, and eat less red and processed meat like bacon, ham and sausages.

Aim for at least 2 portions (2 x 140g) of fish every week, 1 of which should be oily, such as salmon, sardines or mackerel.

Find out about fish and meat.

Milk, cheese, yoghurt and fromage frais are good sources of protein and some vitamins, and they're also an important source of calcium, which helps keep our bones healthy.

Try to go for lower-fat and lower-sugar products where possible, like semi-skimmed, skimmed or 1% fat milk, reduced-fat cheese or plain low-fat yoghurt.
Find out more about milk and dairy foods

Unsaturated fats are healthier fats and include vegetable, rapeseed, olive and sunflower oils.

Remember all types of fat are high in energy and should be eaten in small amounts.
Find out more about the different types of fat in our diet

These foods include chocolate, cakes, biscuits, sugary soft drinks, butter, ghee and ice cream.

They're not needed in our diet, so should be eaten less often and in smaller amounts.
Get tips on cutting down on sugar

Water, lower-fat milks, lower-sugar or sugar-free drinks and tea and coffee all count.

Fruit juice and smoothies also count towards your fluid consumption, but they contain free sugars that can damage teeth, so limit these drinks to a combined total of 150ml a day.
Find out more about water, drinks and your health

How does the Eatwell Guide work?

The Eatwell Guide divides the foods and drinks we consume into 5 main food groups.

Try to choose a variety of different foods from each of the groups to help you get the wide range of nutrients your body needs to stay healthy.

It's important to get some fat in your diet, but foods that are high in fat, salt and sugar have been placed outside of the main Eatwell Guide as they're not necessary as part of a healthy, balanced diet and most of us need to cut down on these.

Unsaturated fats from plant sources (for example, vegetable oil or olive oil) are healthier types of fat.

But all types of fat are high in energy (calories), so they should only be eaten in small amounts.

On average, women should have around 2,000 calories a day (8,400 kilojoules) and men should have around 2,500 calories a day (10,500 kilojoules). We all need different amounts of energy (or calories) from food to be a healthy weight. How much you need depends on lots of things, including how active you are.

Find out how food labels can help you choose between foods and pick those lower in fat, saturated fat, sugar and salt.

Combination foods

Many foods, such as pizzas, casseroles, pasta dishes and sandwiches, are combinations of the food groups in the Eatwell Guide.

With these meals, check the ingredients and think about how these fit with the sections on the guide to help you achieve a balanced diet.

Does the Eatwell Guide apply to everyone?

The Eatwell Guide applies to most of us, whether we're a healthy weight or overweight, whether we eat meat or are vegetarian, and no matter what our ethnic origin.

Anyone with special dietary requirements or medical needs might want to check with a registered dietitian on how to adapt the Eatwell Guide to meet their individual needs.

Children under the age of 2

The Eatwell Guide does not apply to children under the age of 2 because they have different nutritional needs.

Between the ages of 2 and 5, children should gradually move to eating the same foods as the rest of the family in the proportions shown in the Eatwell Guide.

Read more about babies, toddlers and young children's nutritional needs in Your baby's first solid foods.

Download the Eatwell Guide booklet

For more information, including details of which foods are included in the food groups, download GOV.UK's The Eatwell Guide.

Healthy eating support

Food and diet advice on the NHS website includes:

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Read about the interactive Eatwell Guide, which shows how much of what we eat overall should come from each food group to achieve a healthy, balanced diet.

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Children consume half the daily recommended sugar intake before the morning school bell rings, according to Public Health England ( PHE).

Children in England consume more than 11g of sugar at breakfast time alone, almost 3 sugar cubes. The recommended daily maximum is no more than 5 cubes of sugar for 4 to 6 year olds and no more than 6 cubes for 7 to 10 year olds per day. By the end of the day children have consumed more than 3 times these recommendations.

A survey conducted for PHE 's Change4Life campaign found that parents are unsure what makes up a healthy breakfast for their children. It found that of those parents whose child was consuming the equivalent of 3 or more sugar cubes in their breakfast, over 8 in 10 parents (84%) considered their child's breakfast as healthy.

Some of the main sources of sugar at breakfast time include sugary cereals, drinks and spreads. Away from the breakfast table children are also consuming too much sugar, saturated fat and salt in items such as confectionery, biscuits, muffins, pastries and soft drinks These all contribute to an unhealthy diet.

PHE 's new Change4Life campaign urges parents to Be Food Smart and take more control of their children's diets. A new Be Food Smart app has been developed to highlight just how much sugar, saturated fat and salt can be found in everyday food and drink that their children consume.

The free app helps and encourages families to choose healthier options and works by scanning the barcode of products allowing parents to compare brands, and features food detective activities for children and mini missions the whole family can enjoy.

Dr Alison Tedstone, chief nutritionist, Public Health England, said:

Children have far too much sugar, and a lot of it is before their first lesson of the day. It's crucial for children to have a healthy breakfast, but we know the mornings in a busy household can be fraught.

That's why we've developed our Be Food Smart App, taking some of the pressure off parents and helping them to choose healthier food and drink options for their children.

The campaign also helps parents identify the health harms of children eating and drinking too much sugar, saturated fat and salt, including becoming overweight or obese and developing tooth decay.

Recent reports show that childhood obesity in England has reached alarming rates. More than 1 in 5 children start primary school overweight or obese, rising to more than a third by the time they leave.

Commenting on the latest research findings, Sara Stanner, Science Director at the British Nutrition Foundation said:

When analysing a number of breakfasts from families across England, we were concerned to see the high amount of free sugars and low amount of fibre in many of these.

We know a healthy breakfast can make an important contribution to children's vitamin and mineral intakes and its consumption has been linked to many positive health outcomes. There are plenty of healthier options available so we need campaigns like Change4Life to help busy parents make the right choices for their families.

Tackling obesity is everyone's responsibility, not just parents. PHE is currently working with retailers, food manufacturers and other organisations in the food industry to reduce the amount of sugar by 20% contained in products children consume. Eight in 10 parents (81%) surveyed support this action and believe food manufacturers have a responsibility to reduce sugar in their products.

Download the new free Be Food Smart app from the iTunes Store or Google Play to get hints and tips to cut down the amount of total sugar, saturated fat and salt in your family's diet.

Background

1. Find out more about Change4Life

2. PHE commissioned research which consisted of an online survey using Bilendi's panel and took place in November 2016. The survey was completed by 200 parents of children aged between 4 and 10 years about their child's breakfast. Approximately half of the respondents answered questions about a weekday breakfast and half about a weekend breakfast. Fieldwork was conducted in England only. The British Nutrition Foundation also analysed the breakfasts of those who took part in the survey.

3. Find out more about the Childhood Obesity Plan.

4. Public Health England exists to protect and improve the nation's health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health. Follow us on Twitter: @PHE_uk and Facebook: www.facebook.com/PublicHealthEngland.

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New Change4Life campaign encourages parents to 'Be Food Smart'

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PHE's new Change4Life campaign shows that children are consuming half the daily recommended sugar intake before the morning school bell.

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Make a change today! Discover healthy recipes, food swaps, nutritional advice, and top tips and activities to help the whole family stay healthy.

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If you care for a person with a learning disability, they may need help and support to stay a healthy weight.
People with a learning disability are more likely to have problems with their weight.

Some people may be underweight because their disability means they have difficulties with eating or swallowing, for example.

Others may be overweight because they have a condition that increases their risk of obesity, such as Down's syndrome and Prader-Willi syndrome.

How to check someone's weight

Body mass index (BMI) is a useful measure of whether someone is a healthy weight for their height.

You can check the BMI of someone you care for by using our BMI healthy weight calculator.

If you're concerned about someone's weight

If you're concerned about the weight of the person you care for, try to help them understand the health risks of being either underweight or overweight.

A conversation that includes the person with learning disabilities, carers and support workers is a good way to begin making lifestyle changes.

A GP can also check for any medical issues that may be causing weight changes. Some medicines can affect your weight, for example.

Healthy eating for weight management

Shopping for food: support the person you care for to plan their meals a week in advance. Help them to make healthy choices using the Eatwell guide and write a shopping list together. Using pictures is helpful if they are shopping on their own and have trouble reading. Visit A Picture of Health or the Easyhealth website for pictures of healthy foods.

Between meals: encourage the person you care for to make healthier choices when buying snacks, for example, by swapping biscuits for fruit, or sugary drinks for sugar-free squash or water.

Out and about: if the person you care for eats out regularly in a canteen or at a day centre, encourage them to make healthy choices from the menu and ask staff to support them with this.

Portion size: if the person you support eats large portions at mealtimes, encourage them to reduce these slightly. Fill up to half their plate with vegetables or salad at mealtimes

Keep records: if you feel the person you care for is not eating properly, keep records of the food they eat and the foods they do not, to build up a picture of their eating habits.

If you need more support in helping the person you care for to manage their weight, go with them to see a GP. The GP can advise on physical activity and healthy eating.

There may also be community weight management programmes available that are suitable for people with learning disabilities - ask a GP for more information.

Annual Health Checks

If the person you look after is on the GP's learning disability register, they will be offered an Annual Health Check. This is a good opportunity to talk about any issues with weight.

Tips for gaining weight

If the person you look after needs to gain weight, increasing their portion sizes may help. Or try offering smaller meals and snacks throughout the day.

If they still cannot eat much, or their weight is low, you may need to offer special calorie-enriched foods or drinks, as well as their usual diet. These often contain extra vitamins and minerals, too.

A GP can advise you on calorie-enriched foods and supplements, and prescribe them if necessary. They can also refer the person you look after to a dietitian if they need more support.

Get more advice for underweight children and underweight adults.

Physical activity and learning disabilities

Exercise is key to managing weight. It helps burn calories for people who need to lose weight. It can also stimulate appetite for people who need to gain weight.

Ask the person you look after what activities they're interested in. Try to think of ones that will fit into their routine and that they enjoy.

If you can, organise some regular physical activity and support the person you care for to make sure it happens.

Mobile adults aged 19 to 64 are recommended to be active every day and do at least 30 minutes of moderate-intensity aerobic activity, such as cycling or fast walking, on at least 5 days a week.

This can be broken down into smaller amounts, for example, 3 short 10-minute walks.

Special Olympics Great Britain helps people with learning disabilities get involved in sports - see their Facebook page.

More information

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Managing weight with a learning disability

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If you care for a person with a learning disability, they may need help and support to stay a healthy weight. People with a learning disability are more likely to have problems with their weight. Some people may be underweight because their disability means they have difficulties with eating or swallowing, for example.

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We are the UK's only charity dedicated to raising awareness and furthering information about ARFID. A not-for-profit, we work to provide individuals, parents, carers and medical professionals with up-to-date relevant information, research and support.

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Write down everything you do that has to do with food, and use photos or videos if you can. To keep track of what you've done, this is helpful.

It also lets a young person look back at their accomplishments and share their progress with others.

This can be very helpful when you're trying to figure out how progress is similar or different between sets.

If a child has taken a step towards eating at home, they might show their teacher the picture to help them do the same thing at school.

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The place where young people eat should be taken into account. If there are a lot of other things going on, it might be harder for them to concentrate on eating.

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It is important to ensure your child is able to sit in their chair with their feet flat on a stable base with their knees at a right angle. This helps them to feel positionally secure, allowing them to focus on eating. The table level should be between belly button and chest level.

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Getting more variety in your diet is not a quick fix. It is a process that needs time and attention to small steps. A young person might become more tolerant of different foods, which might not seem like progress since they haven't eaten any new foods yet, but it is a big step forward in the eating hierarchy.

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There needs to be a difference between meal times and times when we learn about food.

People should make sure that children can eat the foods that they are used to at meal times.

While we want to make sure they eat enough, we don't want mealtimes to be a bad experience for them.

During meals, we should know what to do, like sitting down at the table and eating what's on our plates.

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The eating hierarchy can be looked at in two different ways:

• The first one has to do with a certain food that we want a young person to work on eating. We can work our way up the hierarchy by first making a young person more tolerant of being near a food, then letting them touch it, smell it, and so on.

• The second way is as a general way to get used to the feeling of eating. We would spend time on each level of the hierarchy to make sure that the young person feels good about all of their senses.

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We know that eating is a complex experience with various different senses being used – for example, we register what a food looks like, what it feels like, what it smells like and how it sounds when we squash it. The sensory experiences around us, such as how busy or noisy an environment is, are also important. There is a hierarchy with eating, and we need to consider each sense in turn when supporting a young person to expand their dietary repertoire –

 

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What young people see adults do can teach them a lot. To help them, having adults and friends around who eat and enjoy different foods will be helpful. Each of us will have our own food tastes. That being said, it's important that your child's likes and dislikes come first. They should be able to try something you don't like if they want to.

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Am I happy that my child is able to eat safely? 

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Am I happy that my child is able to eat safely? 

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Before you start any work, it's helpful to have a goal in mind. A common big goal is for a kid to be able to eat the same meal as the family. While this is a good long-term goal, we might need to think about taking smaller steps along the way to help us reach it.

It's also important to think about why we want to change—who wants this change to happen? What kind of food should a young person eat right now?

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We are thinking about how to help young people who have a limited diet and don't eat a lot of different foods. This is sometimes called picky or fussy eating. Often these are young people who eat a reasonable amount of food but have a limited repertoire of accepted foods. This could mean having a strong preference for certain food brands, tastes, shapes, textures, or colours.

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This document contains various links to online blogs and other websites. Their inclusion does not indicate an endorsement by University Hospitals Plymouth NHS Trust, and no responsibility is taken for the use of any strategies or resources. Young people should be directly supervised when engaging in any messy play activities.

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For a young person, it's okay to bite, chew, and swallow new foods. It's likely to start with a single item that tastes like something they already eat. We will work on getting them to try more new foods, though, over time.

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This last step can only be taken by a young person who has completed all the steps before it. It adds to what they already know about how food looks, smells, feels, and tastes.

As a next step, we would tell a young person to swallow a small amount of food after they have learned how to chew it. It might help to make sure they have something to drink while you do this.

This last step might seem like the shortest because there aren't many ways to support it. It is, however, the last step in a young person's journey through the eating hierarchy. Even though they have only tried one food so far, they will gain the confidence to do the same thing with new foods over time.

We can talk to older children about how they might need to try a food more than ten times before they can really tell if they like it or not. This doesn't mean ten times in a row or ten large portions; it just means at least ten chances to try it and decide.

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A young person will be able to put more and more foods in their mouth to try them out and see how they taste and feel. As with the previous steps, they will probably start with foods that taste and feel like foods they are already used to. We can, however, make these foods more varied over time.

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2. Putting something in your mouth and taking one bite will be the next step. After that, you can take it out or spit it out. This gives them another chance to try the taste and think about how it feels in their mouth.

We can keep going like this, each time taking more bites and then spitting out the food.

Another option is to spread a little on a spoon that the child can then put in their mouth. This works especially well for softer foods. Again, the point would be for them to enjoy the taste, not to eat the food off of the spoon.

We can think about how to change our tastes too. For example, we can allow a young person to add seasoning to an item of food to see what impact it has on the taste.

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1. The first step is to put food in our mouths and then take it out again. I hope this is a chance to try the food, even if it's only for a short time. Many times, this works better with foods that are harder and drier than with foods that are soft and wet. This makes sure that a child can easily take the food out again. A child could touch the food with their tongue if they are not ready to eat it.

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Step 5 - tasting foods by placing it in our mouth 

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Step 5 - tasting foods by placing it in our mouth 

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This step can be split up into several steps. You will see that we haven’t jumped straight to eating a food (which involves biting, chewing and swallowing).  we'll take a look at each of these in turn, and we won't swallow until step six.

Some parts of this step will require the young person to spit out food. This is an important skill for a young person to have, particularly in their early years. So that we don't choke or gag, we need to be able to spit food out of our mouths. This is one of the reasons we don't have meal times during learning time is that spitting out food is a normal part of learning during learning time. When it comes to meals, we would expect a young person to do different things.

A younger child might need help with these steps. They might need to see you do a stage more than once, maybe over the course of a few days, before they are ready to try. You could tell them, "My turn, your turn," giving them time to take a turn but not forcing them to.

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A young person will become more accepting of how different foods feel in their hands. In the same way children get used to new smells, they should also get used to foods that are similar to the ones they already eat. It's likely that these foods will be dryer at first, but we can add foods with softer or wetter textures over time.

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Some activities we could do are

• Making pictures out of food—there are many ways to do this, such as:
o Painting with sauces and brushes made of food like broccoli or cauliflower
o Making potato prints with sauces as the paint again
o Painting your fingers with different foods
o Drawing pictures of pasta and sticking it or other food on a page

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After the first steps, this is a very natural next step. With some of the same techniques we used with food, we can start to use our hands instead of a toy or utensil. As we touch foods, we can also learn more about smells.

As with the previous steps, play is an important way to get used to different kinds of touch. We can play with food, but we can also do a lot of messy activities with things that aren't food. The will slowly make you less sensitive to the physical sensations that come with eating.

Don't forget that these things should happen at different times (and maybe in different places) than meals. For kids, this helps them figure out when it's okay to play with their food.

When we use food items for messy play, we should start with things that are dryer and less likely to stick to us. This makes it easier for kids to wash their hands after playing.

• Experiments can help us learn about how different foods make us feel in many kinds of ways. We could do this by comparing how two different foods make us feel, making sure to use scientific language when we talk about it. Not only that, but we could also cut foods in half to see what's inside, roll them along a table to see which goes faster, or weigh and measure them.

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Even though we know that foods with strong or unique smells may still be hard for some young people, we want them to be able to handle the smells of more foods.

As a first step, young people are likely to stick with foods that smell familiar. The first change might be getting used to foods that are similar to the ones they already eat, which can help a teen understand that they smell the same. Over time, we can add foods that smell more and more different.

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Putting names on smells in the kitchen or other places, like "that smell is from the onion I'm cooking."

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If a young person is more sensitive to smells in general, it's often the smell of food that makes them feel bad.

So, we want to help a young person slowly become more tolerant of things that smell different and also understand how food smells can be different. This could be done by:

• Adding things to the play that smell different. These can be food items or other things that don't smell like food. A lot of things that aren't food have their own smell, but you can also use things that smell like food, like

Toiletries that smell like food, like scented soap (even crazy soap) or bath foams

Air fresheners or other products that smell like food

scented paper goods, like scented pens and rubbers

• Putting together a matching game where different-smelling things are hidden in cups and the kid has to match them with pictures. Taking a single smell and labelling it with a name and picture is another thing you can do regularly.

• We could make a scale of smells that kids could use to rate smells from one to five. A one smell, for instance, might be mild and not bothersome, while a five smell would be much stronger and more unpleasant.

• Showing a young person two foods that are similar and asking them to think about how their smells are different. Getting a young person to understand that food smells can be very similar even if it looks different is the point.

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We want young people to enjoy touching and talking about food, knowing that they don't have to eat it.

At first, we would think that a young person would be able to handle foods that are firmer or drier better than foods that are wetter or softer.

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Part of learning about food is putting it on your body

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Part of learning about food is putting it on your body

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As a "food scientist," we can start to play around with food. Some ways to do this are to compare items by looking at their packaging, judging foods by how they look, or asking other people what foods they like.

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The next thing we do is start getting children to interact with food more once they are more used to having it around them. At this point, we don't need to touch anything, so we can use toys or objects.

This is a chance for a child to start learning about how different foods sound, smell, and feel. We can also start to learn about the different ways we can change foods, like by squishing or cutting them up.

You might want to try–

• Adding new foods to toys that are already used for play, so the child can move or interact with the food.

Don't forget that children should play with food all the time. This helps them learn about all the different ways that food can make you feel.

• Helping to make food, knowing that they don't have to eat what they're making. We can look at the different ways we can change the way food looks, like by cutting it into different shapes, either as part of this or as a separate activity.

• Helping other people cook or serve food

• When we talk about a food item, we think about the best words to use to describe it. We want to use scientific words instead of negative ones, like "green and like a leaf" instead of "yuck" or "horrible."

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We want young people to be calmer around new or different foods,. They should know that they don't have to eat anything just because they are around it.

There should be a conversation about food between teens and young adults. We might be able to figure out why they want to eat more different kinds of foods.

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Freymann, Saxton & Elffers, Joost

New York: Arthur A. Levine Books / Scholastic Press, 1999.
Illustrated by Saxton Freymann & Joost Elffers. First Edition. Hardcover. Square quarto, 9-7/8 x 10-7/8", glossy pictorial paper over boards, pictorial endpapers, fully illustrated in vivid and moving color As new / As new. Item #900070
ISBN: 0439104319

Signed by both artists on the title page. First Edition. A wide array of foods sculptures express a wide array of emotions on these artful pages. The sculptures were carved using a simple Exacto knife and enhanced with other natural materials, such as black-eyed peas (for eyes) and beet-juice coloring (for mouths). The sculptures were then photographed against plain and colored backgrounds to achieve the desired effect and mood. As new in dust wrapper and protective mylar

Price: $65.00

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How Are You Peeling? Foods with Moods by Saxton Freymann, Joost Elffers on J. Michaels Books

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New York: Arthur A. Levine Books / Scholastic Press, 1999. Illustrated by Saxton Freymann & Joost Elffers. First Edition. Hardcover. Square quarto, 9-7/8 x 10-7/8 , glossy pictorial paper over boards, pictorial endpapers, fully illustrated in vivid and moving color As new / As new. Item #900070 ISBN: 0439104319

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Young people need to be okay with different kinds of food being around them. This is a good first step. It's not possible to move on to the next steps if they are not ready to do this.

We can do this in a lot of different ways –

making sure they can see other people eating different foods without expecting them to do the same is important. For this to work, it's important for kids to eat different foods at school and at home. Also, especially in primary school, there are chances for kids to see what kinds of food are served at lunch.

• Going to shops that have food on display.

• For younger kids, using toys as food while playing.

• Brings attention to foods in TV shows, movies, and books. Some people find it helpful to watch cooking shows that show how to turn a raw ingredient into a more familiar food.

• Watching someone cook or prepare food—this helps kids understand how we cook and change foods and how we make a familiar meal.

• Talking with a teen about the foods they like. This can be done with the whole family, siblings, friends, or even the whole class. This keeps them from thinking that everyone is looking at them. Instead of just asking questions, we can use photos and pictures to help us talk. We can put pictures into three groups: "like," "learn about," and "dislike." You can also put them in order from most to least favourite.

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You can find more information about activities you can do at each level of the eating hierarchy below...

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You can find more information about activities you can do at each level of the eating hierarchy below...

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If a young person has to cook at school, it might be hard for them.

A lot of the time, students are told they have to try all kinds of foods. But we could tell them we want them to learn one thing about each food, like how it smells or feels.

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Try to get the young person to wash their hands and face after eating.

Get away from the table first if you need to help them.

They may not like it when we wipe their hands or face, so we don't want to do it where they are eating.

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To help siblings or other adults eat better, we also need to praise them. This makes sure that a young person's good eating habits are noticed. It can be awkward to compliment other adults on how they eat, but it can really help a teen do what we want them to do.

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Try not to say things like

"I told you you'd like it."

This makes things harder for a young person.

We should praise a child for taking steps towards eating, even if those steps don't include tasting the food.

This could include giving the young person a reward when they reach certain goals, making sure that these goals are attainable for them.

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Try not to ask too many questions during meals. They might be working hard to make sense of all the things that happen when they eat. They might not pay attention to this process if we ask them questions.

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If you do the same things every time before a meal, like doing the same sensory activities, your body will know it's almost time to eat.

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At least one adult should eat with a child whenever possible. This makes sure that they see good eating habits in others. If you know that a young person has sensory needs, it might help to do some sensory-calming activities with them before a meal.

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For children who are older, we could have them work through the hierarchy as a "food scientist." This is helpful when a young person wants to change, and it lets us learn more about food by going on "experiments." We can get them to think more scientifically by telling them to use more scientific or descriptive language.

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It's important to think of ways to help young people move through each level of the eating hierarchy. You might think that the child is ready for a certain step, but it's often good to go over some of the strategies with them again.

You might need to go back to the last step if a young person is having trouble with strategies. We want young people to have good experiences with food, but making them keep eating when they don't want to will make them think negatively about food and eating. If a young person is having trouble eating, try to get them to move the food away from them instead of getting up from the table.

We should always act in a way that fits the age and level of development of the young person.

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During meals, we can use a learning plate. Here's an extra plate where we can put one food item that we want a young person to learn about to start. Usually, this would be a specific part of someone else's meal, like a pea or a carrot. The teen can be asked to describe the food by saying what it smells, tastes, or looks like. They might feel more at ease using a tool or cutlery to interact with it.

We can add new foods to a young person's plate over time.

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We need to come up with different ways for children to learn about food. We can help them work through the above hierarchy during this time, which will not happen during meals (and probably not in the place where you normally eat these meals). We will keep this in mind as you read through this padlet.

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Our main goal for a young person is to improve how they eat, not what foods they eat. The repertoire will grow over time as skills improve. That being said, it's important to be aware of this focus before we start any work. Without skill, a young person can't eat a wider range of foods.

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It is helpful to remind ourselves what a varied diet should contain. Information can be found in the NHS eat well guide –

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The Eatwell Guide shows how much of what we eat overall should come from each food group to achieve a healthy, balanced diet.
You do not need to achieve this balance with every meal, but try to get the balance right over a day or even a week.

Most of us still are not eating enough fruit and vegetables. They should make up just over a third of the food we eat each day.

Aim to eat at least 5 portions of a variety of fruit and veg each day. Choose from fresh, frozen, tinned, dried or juiced.

Remember that fruit juice and smoothies should be limited to no more than a combined total of 150ml a day.

Fruit and vegetables are a good source of vitamins, minerals and fibre.
Find out more about how to get your 5 A Day

Starchy food should make up just over a third of the food we eat. Choose higher fibre or wholegrain varieties, such as wholewheat pasta and brown rice, or simply leave the skins on potatoes.

There are also higher fibre versions of white bread and pasta.

Starchy foods are a good source of energy and the main source of a range of nutrients in our diet.
Find out more about starchy foods

These foods are good sources of protein, vitamins and minerals. Pulses, such as beans, peas and lentils, are good alternatives to meat because they're low in fat and they're a good source of fibre and protein, too.

Choose lean cuts of meat and mince, and eat less red and processed meat like bacon, ham and sausages.

Aim for at least 2 portions (2 x 140g) of fish every week, 1 of which should be oily, such as salmon, sardines or mackerel.

Find out about fish and meat.

Milk, cheese, yoghurt and fromage frais are good sources of protein and some vitamins, and they're also an important source of calcium, which helps keep our bones healthy.

Try to go for lower-fat and lower-sugar products where possible, like semi-skimmed, skimmed or 1% fat milk, reduced-fat cheese or plain low-fat yoghurt.
Find out more about milk and dairy foods

Unsaturated fats are healthier fats and include vegetable, rapeseed, olive and sunflower oils.

Remember all types of fat are high in energy and should be eaten in small amounts.
Find out more about the different types of fat in our diet

These foods include chocolate, cakes, biscuits, sugary soft drinks, butter, ghee and ice cream.

They're not needed in our diet, so should be eaten less often and in smaller amounts.
Get tips on cutting down on sugar

Water, lower-fat milks, lower-sugar or sugar-free drinks and tea and coffee all count.

Fruit juice and smoothies also count towards your fluid consumption, but they contain free sugars that can damage teeth, so limit these drinks to a combined total of 150ml a day.
Find out more about water, drinks and your health

How does the Eatwell Guide work?

The Eatwell Guide divides the foods and drinks we consume into 5 main food groups.

Try to choose a variety of different foods from each of the groups to help you get the wide range of nutrients your body needs to stay healthy.

It's important to get some fat in your diet, but foods that are high in fat, salt and sugar have been placed outside of the main Eatwell Guide as they're not necessary as part of a healthy, balanced diet and most of us need to cut down on these.

Unsaturated fats from plant sources (for example, vegetable oil or olive oil) are healthier types of fat.

But all types of fat are high in energy (calories), so they should only be eaten in small amounts.

On average, women should have around 2,000 calories a day (8,400 kilojoules) and men should have around 2,500 calories a day (10,500 kilojoules). We all need different amounts of energy (or calories) from food to be a healthy weight. How much you need depends on lots of things, including how active you are.

Find out how food labels can help you choose between foods and pick those lower in fat, saturated fat, sugar and salt.

Combination foods

Many foods, such as pizzas, casseroles, pasta dishes and sandwiches, are combinations of the food groups in the Eatwell Guide.

With these meals, check the ingredients and think about how these fit with the sections on the guide to help you achieve a balanced diet.

Does the Eatwell Guide apply to everyone?

The Eatwell Guide applies to most of us, whether we're a healthy weight or overweight, whether we eat meat or are vegetarian, and no matter what our ethnic origin.

Anyone with special dietary requirements or medical needs might want to check with a registered dietitian on how to adapt the Eatwell Guide to meet their individual needs.

Children under the age of 2

The Eatwell Guide does not apply to children under the age of 2 because they have different nutritional needs.

Between the ages of 2 and 5, children should gradually move to eating the same foods as the rest of the family in the proportions shown in the Eatwell Guide.

Read more about babies, toddlers and young children's nutritional needs in Your baby's first solid foods.

Download the Eatwell Guide booklet

For more information, including details of which foods are included in the food groups, download GOV.UK's The Eatwell Guide.

Healthy eating support

Food and diet advice on the NHS website includes:

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Read about the interactive Eatwell Guide, which shows how much of what we eat overall should come from each food group to achieve a healthy, balanced diet.

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Unfortunately there is no specific NHS service for picky eating. However, if there are concerns around swallowing or growth then this may need to be reviewed by a medical professional.

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Unfortunately there is no specific NHS service for picky eating. However, if there are concerns around swallowing or growth then this may need to be reviewed by a medical professional.

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It is important to liaise with a medical professional if you have any concerns around your child’s safety while eating. 

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It is important to liaise with a medical professional if you have any concerns around your child’s safety while eating. 

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This advice is intended for children who are able to safely eat, but where there is limited variety within the diet. If children gag, choke, cough or appear in discomfort while eating then you should seek further guidance.