Improving Nutrition for Fussy Eaters

For children with complex fussy eating or even ARFID (Avoidant Restrictive Food Intake Disorder) it can be difficult to meet their nutritional requirements.  They are often eating a very limited range of foods, and most can be from one food group e.g. carbohydrates.  Many children with complex fussy eating can be very rigid in their eating and refuse to try new foods. They may only eat specific brands or flavours of a food and food may have to be prepared and presented in very specific ways for them to accept this.

When the diet is this limited it is extremely worrying for parents and carers. Unfortunately, this tends to increase anxiety at mealtimes for both parent and child and this usually leads to them eating even less and everyone dreading mealtimes.

One of the ways of addressing extreme fussy eating is to reduce anxiety and stress at mealtimes.  If parents can feel more confident that their child is meeting their nutritional requirements this is more likely to happen.

The information here is to show ways of improving different elements of a diet.  Each child will have different ‘gaps’ in their diet depending on the foods they eat; you may not need to incorporate all these ideas. Discuss with your dietitian where your focus should be.

Improving Energy Intake

If a child is mainly eating foods that are low in energy, they can struggle to gain weight and grow. Before considering prescribed nutritional supplements (that they may not tolerate) we want to try and maximise the calories they are getting from food. 

However, we also have to be cautious because changing a safe food that they eat too much can lead to a child then refusing to eat it. Always introduce a change slowly. 

Examples of food fortification

Your dietitian can give you more food fortification ideas. 

It is also useful to give your child more opportunities to eat – offer 3 meals and 3 snacks a day.  Don’t wait for them to ask for food or tell you they are hungry; make this part of the daily routine. 

If these strategies don’t work your dietitian may suggest trying a prescribed nutritional supplement.  These come in a variety of flavours and styles. However, it can be difficult to identify one a child with complex feeding behaviours will take regularly.

Improving Protein Intake

Children need protein to help them grow and develop and protein rich foods are also an important source of other vitamins and minerals. Many children with extreme fussy eating can really struggle with meat and the texture of meat dishes. They may only eat processed meat such as chicken nuggets or fish fingers.  These foods tend to be the same each time they are cooked and are more predictable for them. 

We do have to be cautious when changing a safe food as too much adaptation can lead to a child then refusing to eat it.  Always introduce a change slowly.

Ways of increasing protein content of meals:

• Use of vegetable proteins e.g. lentils and beans.  Mix these into dishes they already eat;
• Blend protein sources into puree meals, soups and sauces e.g. beans, pulses, meat, fish 
• Offer nuts/seeds as snacks
• Use nut butters 
• Add ground/powdered nuts to dishes
• Milk and dairy products have a good protein content so encourage these.

Improving Vitamin & Mineral Intake

Many fussy eaters will eat little or no fruits and vegetables.  They are usually very resistant to trying them.  It can take a bit of lateral thinking to find ways of introducing these foods.

Different ways of getting fruit / vegetables into the diet:

• Fruit or vegetable crisps (homemade or shop bought)
• Vegetable chips
• Dried fruit
• Compressed fruit e.g. BEAR range, Kiddylicious, Fruit Bowl
• Fruit smoothies or juices.

All of the following are examples of products that could be used to introduce different fruit and vegetables in a form your child may find easier to accept. Many come in different flavours, so it’s worth trying lots of different options. It may not be how you imagined your child having fruit and vegetables, but it is a start.

• Jungle Paws (Bear)
• Claws (Bear)
• 100% Fruit Drops (Frootz)
• Peelers (Fruit Bowl)
• Flakes (Fruit Bowl)
• School Bars (Fruit Bowl)
• Apple Crisps (Kiddylicious)
• Carrot Crisps (Kiddylicious)
• Banana Bites (Kiddylicious)
• Fruit Wrigglers (Kiddylicious)
• Sweet Potato Crisps (Kiddylicious)
• Pineapple Snacks (Kiddylicious)
• Goodies Bars (Organix)
• Crispie Tiddlers (Kiddylicious)  

To specifically improve iron intake:

• Blend iron sources into puree meals and soups e.g. lentils, pulses, red meat
• Adding ground nuts to cereals

To specifically improve calcium intake:

• Offer milky puddings after meals e.g. yogurt, custard, rice pudding
• Use extra cheese on foods and in cooking
• Use milk in cooking

Using fortified foods to boost vitamin and mineral intake:

There are a range of fortified foods and drinks that you can use that might help boost the vitamin and mineral content of the diet. 

• Fortified breakfast cereals (most cereals are fortified with additional (vitamins and minerals)
• Fortified baby foods
• Fortified bread (for example, Kingsmill 50/50 Vitamin Boost, Warburtons Protein Bagel.)
• Calcium, iron, and the B vitamins thiamin and niacin, must be restored to white and brown bread flour by law in the UK to ensure they contain similar levels of these nutrients as wholegrain bread;
• Fortified drinks (e.g. fruit juices with added vitamins).

Improving Vitamin & Mineral Intake – Multivitamin & Mineral Supplements

Your child may already be on basic vitamin drops such as:

• Healthy Start (Vitamins A, C & E) 
• Abidec and Dalivit (Vitamins A, B, C & D)

However, these may not be enough to fortify their diet and meet their nutritional requirements. There are a huge number of over-the-counter multivitamin and mineral supplements and it can be really hard to know what ones to try. The following are a range of general multivitamin and mineral supplements that have a good nutrient profile:

• WellKid® Baby and Infant 
• WellKid® Smart Chewable or WellKid® Liquid – for 4years+
• HalibOrange® Kids Multivitamins, Calcium and Iron – for 3years+
• Vitamixin Sprinkles
• Animal Parade Gold.

These supplements come in different flavours and formulations e.g. liquid, chewable tablet, sprinkles. You may need to try a few to identify one your child will take.  You don’t have to tell them it’s a vitamin; it may be helpful to refer to it as a sweet or a super power gummy.  Anything that helps your child to accept it. 

Remember you don’t have to start with a full dose.  It may be easier to start with a small amount or a corner cut off and build up the amount slowly as your child adapts to the taste and texture. 

It is often easier to find a vitamin supplement your child will like.  Supplementing minerals can be trickier as they affect the taste of products much more.  

Improving Vitamin & Mineral Intake – Prescribed supplements:

There are Vitamin and Mineral supplements available on prescription. They only come in powdered or granular form and may not be as palatable as over-the-counter options. 

There is a limited flavour range as well. Although as a powder they can be mixed  with foods it is important to introduce them slowly as they will affect the foods  taste and this may put the child off eating it. 

If your dietitian thinks these are needed they will advise you. 

• With all vitamin and mineral supplements it’s important to consider the following:
• What nutrients are actually required – don’t supplement all if you only need certain ones;
• Liquid, chewable or sprinkles – what is your child likely to accept or what will be easier to mix into their food/drinks;
• Amount needed – the size of the gummy or the amount of liquid needed varies from product to product.  Also only supplement the amount you need, mega doses can be dangerous;
• Flavour – there are lots of flavour options available, you may need to try a few to find one your child likes. Would unflavoured be better?
• How to present it – are you trying to hide it in foods, giving it as a sweet, promoting its ‘super powers’.  Different approaches work for different children.

First Community provides front-line NHS community healthcare services in east Surrey and parts of West Sussex.

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